resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Dietary Supplement Research: Contradictions, Bias, Misinterpretation and Confusion
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Environmental Toxins: Cause of Modern Illness (Part I)
Environmental toxins have created burdens on the human body that put demands beyond our evolutionary development. Modern diseases that historically did not exist to any great degree have been rising sharply in the last 40 years.
How Much is Enough?
One of the primary arguments used against acupuncture care is the overuse of treatment. Some people say, "once you go, you have to go forever."
Chinese Herbs Debut at the Cleveland Clinic
Chinese herbal medicine is now being prescribed at the Cleveland Clinic thanks to a trailblazing team of people.
Alternatives to the Rainy Day Fund: Better Things to Do With Your Money
Google "rainy day fund" and you'll find the predominant and traditional advice given today is that you need to have three months of living expenses saved for an emergency. Some even recommend six months or more.
Revisiting the Neurological Exam
In spinal trauma or disease, the neurological exam chiefly aims to determine whether one (or more) of three basic neurological conditions is present: myelopathy, radiculopathy and peripheral nerve disorder.
Are You Driving Patients Toward Dependence on Big Pharma?
Over the years I have had the opportunity to talk to doctors of chiropractic about health promotion, wellness and preventive care in chiropractic practice.
Enhancing TCM with Enzymes
Herbal formulations are an integral component for most Traditional Chinese Medicine (TCM) practitioners. One of the best ways to enhance their effectiveness is the addition of plant-based enzymes.
Anti-Aging: Educating Your Patients About The Skin
We know that cosmetic acupuncture works but what then? Education is a key part to the practice of Chinese medicine and when you practice cosmetic acupuncture, facial rejuvenation, etc., it is time talk about skin with your patients.
Your Chance to Go Back to High School
As the father of a student who recently entered high-school sports (soccer), I have come to recognize an untapped opportunity for the chiropractic profession.
San Zhen Protocols Part II: Case Studies
In my last article, I presented a collection of three-point acupuncture combinations which can provide effective clinical results.
Socializing In My Slippers
When I graduated college, I had grandiose dreams of becoming an amazing acupuncturist. I wanted to build a great practice and make a good living. For four years, 13 semesters to be exact, I had a spreadsheet.
Dry Needling is Acupuncture: Anatomy of a Legal Victory in Oregon
On January 23, 2014, the Oregon Court of Appeals overturned the Oregon Board of Chiropractic Examiners "dry needling" administrative rule, which allowed chiropractic physicians to perform acupuncture after only 24 hours of training.
AAAOM: Facing An Ultimatum
On the heels of the growing discontent with leaders of the AAAOM, the Council of State Associations (CSA) recently took it upon themselves to present the organization with an ultimatum: for all board members to resign from the board and turn the organization over to the CSA or they will proceed on their own to become the primary representative of the AOM profession.
Making Sense of Chronic Inflammation
Inflammation is big business, evidenced by not only the laundry lists of medications patients bring me aimed at managing inflammation, but also the never-ending stream of advertisements for anti-inflammatory supplements that constantly find their way to my desk.
Shoulder Strategies: Reduce Pain, Improve Function With Proper Taping
Shoulder pain / dysfunction is a common problem for chiropractic patients. Clinicians who utilize elastic therapeutic taping as part of their treatment approach know it can be effective for a variety of shoulder problems.
Colorado to Have the First Acupuncture Medical Reserve Corps in the U.S.
In the summer of 2012, Colorado was on fire. Literally. Many acupuncturists from around the state, especially those who had received disaster response training through AWB, wanted to help those affected by the fires as well as the first responders and tireless state and local officials, with the healing and stress-relief of acupuncture.
Chiropractic Management of Sports-Related Tendinopathy
Tendinopathy is increasing in prevalence and accounts for a substantial percentage of sports injuries. Despite the magnitude of the disorder, research on chiropractic treatment is limited.
Evaluating Prenatal and Pediatric Automobile Injuries
Often in a family practice, one of your patients or an entire family is in an automobile accident and you are sought out to provide care for their soft-tissue injuries.
The Right Idea at the Right Time
On Feb. 28, 2014, Virginia Governor Terry McAuliffe appointed David Brown, DC, as new director of the Virginia Department of Health Professions.
News in Brief
In Remembrance: A Moment of Silence for Dr. Dick Versendaal; NYCC Named Chiropractic College of the Year by ACA; National University Partners With Indiana VA Facility.
The Recliner Test
"Hi, Bill, how are you?" "Oh, I'm OK, Doc. I've got pain down the leg again, so I thought I would stop by and get you to check it."
Through the Eyes of a Child
Once upon a time there was a girl name Lucy. Lucy had cancer, but she had a heart filled with love and compassion. Please come along to hear this story of an amazing child, her tenacity and her dream to help other children.
No Whining on the Yacht
This admonition – no whining on the yacht – may sound familiar to you. Many claim its origination.
Arch Height and Running Shoes: The Best Advice to Give Patients
Because runners with different arch heights are prone to different injuries, running shoe manufacturers have developed motion-control, stability and cushion running shoes for low-, neutral- and high-arched runners, respectively.
February, 2014, Vol. 14, Issue 02
"Selling" Gentle Massage to Clients with Cancer
By Tracy Walton, LMT, MS
Sometimes, even the most thoughtful message, delivered with the best intentions, will disappoint a client. As a massage therapist, it can be tough to weather that moment. How do we break the news, when a client's health calls for a gentle session?
In our oncology massage clinic, a new client told us she had a long massage history. She also checked "Yes," under chemotherapy on the health form, and wrote "A little walking, light housework," under a question about activity level. She was extremely fatigued. We knew the client needed a gentle session. Yet, when asked her likes and dislikes about massage, she praised deep tissue work and asked for deep pressure and focused work in our training clinic. She said she was stiff and sore and craved a deep massage.
There it is. The Moment.
Zoom in on that "crave a deep massage" moment and you can see it teetering. It could fall anywhere. So many important things are poised: ethics, client safety, conflict, agreement, client expectations and possible disappointment, client satisfaction, the health of the therapeutic relationship and even therapist liability.
The student therapist had been coached to expect this. She channeled all the role plays we did and took a deep, centering breath. She nodded at her client and said something like, "I definitely understand the request for deep work. This time, because you are in chemotherapy, I need to work gently with you. We don't know how my work will interact with your body and your current chemotherapy treatment, so it's important to go gently with our pressure."
Clearing her throat, the therapist tried again. "There are many new things at play here. I haven't worked with you before and never during chemotherapy. Chemotherapy is strong treatment, as you know, and can bring about a 'new normal,' such as the fatigue you are experiencing. Clients in cancer treatment, even those who are used to stronger pressure, tell us that the gentler, careful work is what makes them feel better. It might take a little adjustment at first, but it can still be deeply relaxing — a great session."
At this, the client narrowed her eyes and crossed her arms. "But I don't want gentle work. It's not going to do anything for my soreness that way! You don't have to treat me like I'm going to break, just because I have cancer. I'm the same person as before."
By now, in cases like these, both the client and therapist have become tense. Not the friendliest beginning to a massage session.
Conflict and Client Expectations
Most massage therapists entered this line of work hoping to bring comfort and happiness to clients; it's tough to disappoint someone before they even get on the table. It's not a good feeling for either party. And yet, we simply can't honor all client requests, especially those that put client safety at risk. Even if they believe we are being too cautious. Even if they think we are unfairly treating them differently. I believe it is Gayle MacDonald who first stated that these situations require us to take a greater leadership role.
This is counter to the expectation of "client-centered care," and to the saying, "the customer is always right," and can even run up against our employer's expectations of us. At times, the fear of angering someone we are supposed to comfort, of losing business or the simple fear of taking an unpopular view can make us shrink from the responsibility to work gently.
Most of us aren't fans of conflict, and yet a moment of conflict can become a learning moment. It takes good skills in clinical reasoning and communication to send that moment off in the right direction. It also takes a bit of salesmanship.
Reasons to Work Gently
While the fear of massage possibly being able to spread cancer is thankfully on its way to becoming an old wives' tale in both the massage community and the lay community, there is still a long list of massage modifications for different cancer treatment presentations. In most cases, even a standard "relaxation massage" might be too much for a body to handle while going through treatment. Multiple body systems are affected during and after treatment and massage that is too forceful or taxing to the body can cause the client to feel worse physically and possibly increase their stress.
Even a client who "looks healthy" or has "good numbers" in terms of blood counts may not respond well to strong massage. There is no certain way we can truly predict what effect a massage might have on them. Sometimes, a massage might even feel wonderful on the table at the time, only to be followed with flu-like symptoms a few hours later.
In the case of the client example above, the therapist had to "dial down" a relaxation massage even further, with lighter pressure (think of the pressure you would use to rub lotion into the skin) and slower speeds. Even rhythms, gradual transitions and other factors are softened for the person in treatment.
There are many reasons to shift into this dialed-down mode and plenty of massage literature to support it. Reasons include bone metastasis, vital organ involvement and low platelets. There are strict precautions regarding pressure and direction at certain sites in cases of lymph node biopsy, radiation and DVT risk. Some cancer treatments have late effects, spanning decades after treatment, and massage adaptations are lifelong. Moreover, in a setting where little or no client health history is known, it's critical to dial down the session because of limited information.
With so many reasons to work gently during cancer treatment (and beyond) it's important to be able to communicate them to clients. But sometimes, the trickiest part is "selling" all of these points to our client who is convinced they want a vigorous massage because they don't want to settle for something "fluffy." Or they had heard that deep work would "clear the chemotherapy toxins out of their body."
The selling we must do here does not need to drum up the sound of a sleazy pitch. This is something that comes with our job as massage therapists. We are selling safe yet still effective massage to our clients and our words don't have to be creepy or uncomfortable. We do, however, use good communication wrapped in sensitivity and we assume a leadership role to deliver the message with confidence and ease.
Explaining the reasons behind dialing down the massage approach can often help to defuse some of the tension. Here are some of the phrases we use in our training:
Indeed, letting a client know what we can safely do during their session (perhaps spending extra time and a little more pressure on the feet, or a few gentle squeezes at the shoulders or a long stretch of gentle scalp massage) can ease the feeling of a long list of can't-dos and limits. The right tone can make it feel more like a friendly compromise, with still plenty of good things coming their way. Sometimes, it can be our words even more than our touch that can help the healing process along, and with that, our clients with cancer can feel safe but still encouraged and empowered.
In the clinic client story above, the student did their best and a skeptical but willing client followed them to the table for a very gentle session.
Afterward, I found the client resting quietly on a bench in the hallway. She was slumped against the wall and a little dazed. I asked her how it went. Smiling, she told me it had been a pretty light massage. But she acknowledged, "Even that was a little much. I feel good, but a little wiped out. Thank you for convincing me I needed lighter massage. I'm sorry I pushed it, but I get it now." "Thank you," she said again.
We don't always see such strong agreement with our gentle approach, but good communication boosts the chance that we'll get there. If we are clear within ourselves about our role and reasoning, our words come more easily. We can be present to the "craving a deep massage" moment and guide it to the best outcome. Through education, patience and understanding, we can deliver not only what our clients want, but also what they need.
Tracy Walton & Associates offers a 4-Day Intensive Course, "Oncology Massage Therapy: Caring for Clients with Cancer." Spring 2014 offerings are in Boston, Miami, Siler City, NC; Hartford, CT, and Atlanta. See the complete 2014 calendar at www.tracywalton.com/trainingschedule/trainingschedule.html. To learn more about hospital-based massage, oncology massage and other conditions, view Tracy's webinars at www.tracywalton.com/webinars/index.html.
Click here for more information about Tracy Walton, LMT, MS.
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