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Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
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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