resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
Reader Beware: Consider the Source
The aftermath of last year's presidential elections brought a running conversation on the role played by "fake news" that was largely presented via social media.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
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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