Masseuse vs. Massage Therapist

There was a piece on a morning radio show yesterday about "Men Massaging Men: Is That Weird?". The discussion was pretty superficial, but at least there were positives that were introduced such as female MTs being able to deliver significant pressure. By the end of the show, myself and my MT peers were able to at least get the hosts to stop calling us "masseuses". This led to one of my co-workers sending me the following question:

"Is there a difference between a masseuse and a massage therapist?"

Here's the reply:

Sara,

Big Time.

We don’t have different gender terms for a doctor, physical therapist, or psychologist. “Masseuse” and “masseur” are outdated terms referring to male and female massage practitioners and nowadays it is often used to refer to a less skilled or less professional massage practitioner. The preferred term these days is massage therapist (MT) – which takes the emphasis off of the gender of the practitioner so it can be placed on what really matters; their competence. The gender of the MT is not nearly as important as their ability to address the needs of their client; a good MT will make a client feel safe, respected, welcome, and cared for.

Masseuse has connotations with the shady side of massage – bath houses, parlors, and the sex trade. The massage therapy profession is working hard to differentiate massage therapy from prostitution in the eyes of the public and, unfortunately, regulatory agencies in city government. Massage therapists, including our students, have to deal every day with people who illegitimize or invalidate what we do. We have to justify our profession, educate the ignorant, and refute misconceptions on a daily basis. The terms masseuse and masseur simply serve to reinforce those outdated misconceptions about massage and the people who practice it.

An MT would be ignorant and naïve to think that human sexuality can be exorcised from a person for the duration of their massage session. Massage is holistic and addresses a person’s entire being. Massage is an intimate service and obviously involves touching and disrobing. Our society sexualizes everything (especially women) and is highly homophobic. In the US, most of the touch people experience is either violent or sexual. If a person has never experienced anything else, it is easy for a person to simply classify massage as sexual (because it’s obviously not violent and it feels good, right?). As MTs, we have to educate our clients about even the very existence of nurturing, therapeutic touch as one of the primary responsibilities of our profession. Proper draping, establishing rapport with a client, and protecting boundaries are some of the foundational skills of a massage therapist. Some people will always have preferences for males or females, but many people don’t care and we shouldn’t emphasize gender through having different terms for male and female practitioners.

Calling an MT a masseuse typically reveals ignorance and is just repeating what somebody else has said. It is often received as a degrading, condescending, dismissive, or insulting comment to the MT. Often we patiently educate the one using the word or harboring the misconceptions, but inside an MT will feel the frustration of having to fight the battle one more time. It can truly be exhausting. All MTs dream of the day when stating you are an MT is a badge of honor, a profession that is understood and esteemed instead of joked about. We work towards it one conversation at a time and hope that we can get through to people such as yourself who are curious and desire to know. I hope that the next time you hear someone say “masseuse” or deride our profession that you can be an advocate on our behalf and change another mind.

Thank you for asking and thank you for the opportunity! Please let me know if you have any more questions.

Teach Your Inner Circle

This made me realize how even the people who I work with; fellow teachers, admissions reps, other program directors, and students in different programs don't know about what we do. It is up to us to teach our friends, family, peers, clients, and the general public about our profession. What we stand for and what we are about. We do it every day already. Your best friends may talk you up to their circle, but if they don't know the right things to say they may be hurting you and our profession through their ignorance.

Teach them. It doesn't have to be formal, but make sure that you explain how you would like them to discuss your work, what your philosophy is. Develop a mission statement and actually show it to people. Hone your message and you will find your circle using your own language when they describe your work.

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Cause-Related Marketing in Your Massage Practice

(Sorry it's been a while. I've been a busy bee...)

The economy isn't so hot right now, as if you need me to tell you. Unfortunately, that has a lot of implications for massage therapy. As a teacher, I get asked a lot about what the job prospects for massage therapists are these days. "Is there a market?", "Will I be able to find a job when I'm done with school?" I get asked a lot. From what I have seen, my graduates have still been able to find jobs, but the current state of the economy has created a bit of turmoil in our industry. What I've seen lately is that businesses that were on shaky footing may be closing their doors, laying off workers, or cutting hours and wages. Others seem to be experiencing an increase in business. There are many experienced therapists out looking right now. I haven't seen a drop in demand for massage therapy, but I have seen some shaking up as MTs move around. What gives?

Massage As a Luxury
Unfortunately, there are many people out there who still see massage therapy as a luxury service and not a necessary one. When the economy turns south, discretionary spending on luxuries is the first thing to go. Yesterday on NPR's Marketplace there was an item about shopper's guilt. It's a phenomenon in which in a down economy, people feel guilty about spending money on things that aren't seen as necessary. It kind of feels like you're rubbing it in on the less fortunate. So what can a massage therapist do to overcome shopper's guilt?

Cause-Related Marketing
This is a practice in which when a consumer makes a purchase, a part of the sale is donated to a charity. It can assuage the guilt associated with the purchase in hard times. The nice thing is that the donation is actually tied to a sale instead of just asking for money. You might even consider matching the client's contribution up to a limited dollar amount. You could support a cause that is dear to your heart or allow the client to select a charity of their choice. Both have advantages, some of which are discussed in the next section. Allowing the clients to choose their favorite charity can add value to your service and make it more personal.

Working with a Charity
Another option is to actually partner with a charity for mutual benefit. This can be practiced in a variety of forms, including the following:

• providing complimentary services to the charity for them to use in their marketing efforts, gift certificates work well because they are easily transferrable
  
• offer your services at their events with half or more of the proceeds supporting the cause
• health education - teach the organization or the groups they serve. You may just pick up some clients

In this season of giving amidst a backdrop of economic uncertainty, give your clients a way to feel better about the money they spend while helping to make the world a better place. What could be better?

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Using Movies to Teach

I love introducing films into the classroom to illustrate topics. Educational video is great, but I'm talking about Hollywood. Nothing pulls in a student like a good story and the nice thing about a movie is that it wraps it all up in a tidy, 2-hour package. It is something that a student can relate to and it will engage them in their learning.

Prepare the Student

The important thing about using movies as instructional tools is to set the stage appropriately and follow up after. Typically, I show a film after I've had a lesson or series of lessons about the themes I want the film to illustrate. That way the class has already had a discussion about the theory and the film can demonstrate a "real life" application, albeit a dramatized one. To set the stage right, you need to give the student some information to look for while watching. This will change the viewing experience from a passive role to an active one. They will be searching the material for information and they will be comparing it to what they already know.

Follow It Up

Just as important as setting the stage is the follw up. The film should be followed by an activity to integrate the learning; ideally an activity that will allow the students to come together in their understanding. A good method is to have the students write a reaction paper to the film, giving them some guidelines for their discussion and tying their own emotional reactions to the material. Then bringing the students together in a discussion will emphasis the themes. Many students will come to the same conclusions, but they will all have different takes and some students will surprise you with what they find.

The Legend of Bagger Vance

I'm going to use this movie as an example of one of the films I use in class. In one particular class, we discuss the theory behind many topics vital to a massage therapist's success - ethics, boundaries, relationships, communication, thinking vs. feeling... all of which are addressed in this film.

Other Films:

1. Contact - Beliefs, values, persistence, communication, relationships
2. Pay It Forward - Ethics, values, social responsibility

The great thing is that the film brings the "real world" into the classroom. It gives the students a break from listening to a lecture from their regular instructor (students always love guest speakers). But the main advantage of using film to illustrate a point is that it gets the students thinking situationally - outside the classroom.

What films can you think of that could be used to teach?

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Life, Outsourcing, and Massage Therapy – Part 2

In part 1, we discussed general busy-ness in our clients’ lives and the reason people outsource. I also introduced the idea that we as massage therapists are contracted as outsourced wellness providers. So what can we do with this?

Extend Our Reach (and Role)

So what is your role? As a massage therapist, most people would give the simple answer of “giving massage to my clients”. Close, but too vague. Sure, that is how we go about it, but really we provide wellness, stress-reduction, and all of the other benefits that our clients experience out of our work. When I say that we need to extend our reach, I mean that we need to fulfill our wellness contract. If our clients have put it into our hands to be responsible for a part of their wellness, then we better see that it gets done!

First off, communicate what it is that you are doing. “I provide wellness”, “I improve athletic performance”, whatever your mission is. Make sure your clients know it, and then let your clients know what it is that you do to get them there – that you will proactively help them with their well-being.

Being a proactive partner in your client’s health implies action on your part. I see far too many therapists that sit back and wait for clients to come to them, wait for clients to rebook, or wait for clients to respond to their marketing. Although marketing might seem to be a proactive approach, really you do something and then you have to wait for the client to respond. Gaining clients proactively is a whole new discussion, but what about the clients you already have? What can you do for the clients you already have a wellness contract with?

Be An Active Partner

Let me paint a picture for you. You enroll in a class. You show up for your first day, excited about all the great things you are going to learn. The teacher sits you down, hands you a textbook and says, “I’ll be over there if you have any questions”. How would you feel about that?

Figure out what role you can play in helping their wellness goals to become a reality. One answer is to take on some of the responsibility yourself. And I mean the responsibility for making the massage session even happen. Make sure that for every client you have, you have a plan. Make sure that that plan is well communicated and understood by both you and the client. Make sure that the plan is as much the clients as it is yours. Maybe even have them sign it (not a binding contract!) to give it a little more weight. Then help them to fulfill it. That may mean telling them straight out that if you haven’t heard from them for two weeks, you’ll call to check in with how they are doing. It may mean sitting down and planning out their session schedule so you can have a number of appointments set up and in both of your calendars. It means following up with them by phone, email, text-messaging, and smoke signals. Get the client’s agreement of course from the start. We don’t want to harass them!

This approach may seem pushy to you. However, I have found that clients appreciate the concern. I’ve called clients that I haven’t seen in a while and it’s like they’re reading from a script every time – “Oh, hi! Has it really been that long? I really need a massage! I’ve just been really busy. Thank you so much for calling! Can I come in…?”. I think it’s because they outsourced this part of theiw wellness to you in the first place and they are happy to have you do it for them.

Reminder cards can work, but it is still putting the task of remembering on them. Don’t forget, they have to remember, it has to be at a convenient time, and it has to be urgent for them to pick up the phone. Make it as easy as possible by remembering and picking up the phone for them! I know I’ve found services like Genbook (a free online scheduling service) to be great boosts, because it makes it so easy for them to get an appointment AND it sends reminder emails (or text messages too if you pay for the upgrade). Remember, it isn’t their job to keep you in business, so do the remembering for them!

Outsourcing Wellness = Opportunity

I haven’t seen many therapists take this approach to their practice. However, if you look at it this way, you could expand it to include business wellness programs, government health programs, and more. The important thing there is to demonstrate benefit, and that means a lot more than your clients walking out saying they “feel better”. You need some proof. Use research from the Massage Therapy Foundation, the Touch Research Institute, or the International Journal of Therapeutic Massage & Bodywork to back up your claims. You want to translate those studies into something meaningful to your clients. Stress-reduction may not mean much to them, but maybe helping with insomnia might.

The key is to remember that people outsource work to people who can do it better and more efficiently than they can. I would start taking a look at the different programs out there to promote wellness, pain reduction, sports performance, or whatever your specialty is and develop a program to compare and compete. Ask yourself, “how can I make this easier, more effective, and more time efficient for my clients?” and “What can I do to help my clients take advantage of massage work and stay on track?”

My money is on the fact that if you start being more proactive about your clients’ wellness it’s really a win-win for everybody.

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Life, Outsourcing, and Massage Therapy – Part 1

Just reading the title, you may be wondering what the heck I’m talking about. Well, you may have noticed that it’s been a while since I’ve posted to this blog. Life happened. Life is still happening. I teach, I have a family, car repairs, sports massage events, I’m in school taking classes, and I’m working on setting up a business. I just got busy.

The thing is, so do our clients. Often, as massage therapists, we wonder where our clients go. The truth is that many times it has nothing to do with the client not wanting to come back. Life just got in the way. Very few people I know have large blocks of time in their schedules to do with what they wish. MTs often fall prey to thinking that they are only competing against other massage therapists. Some who see a little bit more realize that they are also competing against other niche products like chiropractic, pain relief, and stress-reduction activities. But in the broader scheme of things, we are fighting tooth and claw with almost every other business (and even person) out there for one thing. Time.

Time and Our Service Economy

We are competing with sports events, TiVo, concerts, charity events, kids’ recitals, theme parks, you name it. Time is our clients’ most precious commodity. It seems that all too often, even when you want to get together with a friend, they have to check their schedule and pencil you in in three weeks. More and more, people are just so busy they can’t get away for anything.

What does that have to do with the service economy? Few would deny that massage therapy is a profession that rests firmly in the service sector. Whether you look at it as health care or a luxury, it is still a service. In one of my business classes recently, I learned that the rise of the service economy in the U.S. really began after World War II. What ended up happening is that incomes rose so that people had more to spend. At the same time, a counter-trend was occurring in that people had more demands on their time. The result was this, people began to pay others to do time-consuming services that they didn’t wish to do. Things like dry cleaning, painting the house, dining out increased. People began outsourcing more of their needs to others.

Outsourcing

The way I see it is that our clients have outsourced some of their care needs to us. We provide a therapeutic service and can rattle off all kinds of therapeutic benefits for massage therapy. We’ve been contracted to provide something that our clients want or need, but either can’t or don’t want to do themselves.

Think for a minute about the things that you want or need and can’t/won’t do for yourself. A person could get in shape without a personal trainer or a gym membership, but isn’t it easier to pay the membership or have somebody else guide you? Massage is kind of the same. People could reduce their own stress, there are many forms of massage that people really could do for themselves. But that isn’t really the issue. It’s time and focus.

General Busy-ness

A month ago, I wrote about my TFL and my plan for addressing it. I was going to chart the progress and write about it here. I know this stuff. I teach this stuff. I recommend it to my clients. Did I do it? Nope. It wasn’t important enough to me at any given moment to do much. Oh, I worked on it a few times. I got some massages at my school. But did I do the entire protocol that I laid out for myself? Sorry.

The point is that our clients are the same way. It’s not that they’re lazy, or uncommitted, or that they don’t want to be healthy. It’s that they have a gazillion priorities and their health is only one of them. Proper nutrition requires a lifetime commitment while McDonald’s only requires a commitment of $5, right now. When so many people demand so many things, something has to give. Unfortunately for us, for many people that seems to be massage and taking care of themselves.

And Back to Outsourcing

The answer to busy-ness for most people is one of two things. Put it on the back burner to be ignored or forgotten OR… outsource it. Our clients are outsourcing part of the wellbeing to us. We just need to know the best way to go about it for our particular group of customers. So what can we do to fulfill our contract as outsourced wellness providers? I’ll save that for part 2… (nice teaser, eh?)

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The Wolnick Trigger Point Protocol

OK, lame name, I know. I’ll come up with something better soon.

Over the years, I’ve dealt with a lot of trigger points. I just talked about a few of my own in my last post. Now some of these trigger points are just plain nasty. They exhibit the kind of pain that simply wants to make you cry – the “exquisite tenderness” described by Travell & Simons. I’ve seen what’s out there as far as techniques for addressing trigger points and have developed a protocol for deactivating them that has worked very well. Surprisingly enough, I’ve never seen any one source that puts all of these techniques together into a single protocol. If you have, let me know, and I’ll give them credit! This is what I teach my students and use myself. Works like a charm!

Here’s a simple version of my protocol:

1. MET
2. Cross-Fiber Friction
3. Static Compression

In that order!

MET, aka Muscle Energy Technique

MET has to be one of my favorite styles. It has some great advantages, not the least of which that it can address a trigger point without the same kind of excruciating pain as the other techniques. Simply described, MET is a technique that you can use to reset the communication between the brain and the muscle. Often, at least part of the irritation is that the nervous system is maintaining a negative feedback loop that reinforces the dysfunction in the muscle. In my experience, using MET nearly always reduces the irritation of the trigger point before you start using any more painful techniques. This decreases the discomfort of the client, and some trigger points may even disappear entirely without any pain! I love the look of confusion on a client’s face when you do a simple exercise and then their pain has disappeared. They always ask “Are you pressing in the same spot?”

MET involves a thorough knowledge of kinesiology and the ability to apply very slight resistance in precise planes of movement. You establish a clear signal between the brain and the muscle and take advantage of innate reflexes to obtain specific effects. Sounds complicated, and the reasoning behind it is, but in practice it’s fairly simple to actually perform. You can learn more about MET here, a few videos here (1 and 2), and a technical paper here.

Cross-Fiber Friction (CF)

The favored technique of Clair Davies, author of the Trigger Point Workbook, this technique has seen a rise in popularity over the years. While it is still painful to the client, the pain is in short bursts rather than a sustained pressure. This allows the client to tolerate more, but also allows for more of a pumping action in restoring circulation to the area. Davies recommends that only 6-12 good, firm strokes over the trigger point constitutes a treatment – a guideline I agree with. This prevents you from overworking the point and causing the trigger point to go active on you. Ouch.

This technique is one that you can do easily on yourself as well. This is good, since it is better to work frequently and in short bursts on a trigger point than rarely but for a long time. It is something that your clients can do at home. Often, the cross-fiber friction will take care of the trigger point aggravation. If not…

Static (Ischemic) Compression (SC)

Ahh, the good old standby of Neuromuscular Therapy (video here). This technique involves holding sustained pressure directly over the trigger point. This has the effect of increasing the pain sensation and “overloading” the neurological circuit so that it shuts down, kind of like tripping the circuit breaker. The analogy that I like to use is that of a rain bucket. The water in the bucket is the amount of irritability in the trigger point. As it fills, eventually the bucket overflows (the TrP goes active) and starts sending pain elsewhere. SC is like tossing bricks in the bucket. It causes it to overflow, but after you’ve drained some water, when you pull the bricks out there is less water in the bucket.

This is certainly the most uncomfortable of the trigger point techniques – which is precisely why I save it for last. However, there are some trigger points that don’t seem to respond to anything else. The good news is that by the time you get to static compression, the other techniques should have reduced the irritability so that this one isn’t so bad.

To perform this technique, locate the precise point of the pain, sink in to the point until you get to a pain of 7 on a scale of ten (the point where if you go past you’ll need to tense up to resist it), and hold it. If the pain is increasing, release and try something else, if it is staying the same, hold for 8-15 seconds then repeat, if it is decreasing, ride it home until it levels off.

I recommend that you only combine up to 3 treatments of either CF or SC at one time to avoid overworking the point and sending the client home in pain. It is a very common mistake to overwork a point and it is very easy to do.

Happy Trigger Point Hunting!

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Getting in Touch with Your TFL

Your Tensor Fasciae Latae (pronounced Tensor Fah-sha Lotta), or TFL, is a small, upside-down teardrop-shaped muscle in your hip. While the muscle isn’t large, it certainly has a large role in how your hips function. You can see a picture here from Gray’s Anatomy and some interactive anatomy here. The TFL helps to abduct, flex, and medially rotate your hip as well as extend your knee (or prevent it from collapsing while walking). Of course it helps to regulate the opposite of those actions too. In short, TFL is involved in every motion of the hip and the major actions of the knee! The insertion for this important little muscle is on the Iliotibial Band (ITB), that taut strip of connective tissue going down the outside of your thigh. TFL can be responsible for some considerable tenderness and tightness on the outside of the thigh.

My Connection

I think it’s funny that I teach this stuff, and I pass it along to my client’s all the time about what is good for them, and yet I have problems with my own TFLs. I had reconstructive surgery on my ACL 12 years ago and I have to say that my hips and legs haven’t been the same since. Over time, I have slowly realized that it’s not so much the surgery as how my body responded to the surgery – and the protective mechanisms I developed. Don’t ask me why it took me so long to realize this; I guess it’s easier to look objectively at somebody else’s body.

How it manifests for me is a massive trigger point in my left TFL. It’s bothered me on and off over the years – some little stress sets it off and it will make my entire leg ache. Over the past few years however, I’ve found a new pattern of periodically tweaking my hip when I carry something awkward (like a massage table) on one shoulder. Invariably it causes my left piriformis to go into spasm so that I can hardly walk – limping for several days. Only just recently have I realized a direct connection between the two pains. I have the same problems mirrored on my right side, just not as severely.

Lifting something awkwardly for a Memorial Day picnic, my piriformis went into spasm again. In working on the area myself, I probed around the rest of my hip to try to see what else was contributing. When I pressed on the latent trigger point in my TFL, my piriformis began pulsating for as long as I help the pressure. When I dug in a little further, I felt a sharp pain in the middle of my anterior shin (Tibialis Anterior) – another common site of pain for me. AHA! Paradigm shift!

Bodywork

IN my next post, I’ll go into a little more detail over the treatment protocols I intend to use to get rid of these things. I’m a massage teacher, and I can receive bodywork on a fairly regular basis. Still, I’ve been receiving bodywork regularly for years and it hasn’t done much for these trigger points. Nothing short of direct, focused efforts will do it. So here’s my plan.

First, I will make sure that I get at least one massage per week with at least some special emphasis specifically on my hips and these trigger points. Good, but that won’t be enough. Clair Davies recommends that you work on them with 6-12 good strokes multiple times per day and that you’ll see improvement in less than 2 weeks, even for the really bad ones. Well it’s proving time! I’m going to work them at least three times per day for at least two weeks and gauge the results.

I’ll keep you posted!

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