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Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
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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