The International Esthetics, Cosmetics & Spa Conference was held in Las Vegas, Nev., April 30-May 3, 2005, where I was invited to attend as a continuing education presenter. It was truly an amazing event, very well run and heavily attended. I got to immerse myself in the spa industry and talk to spa owners and operators, as well as spa massage therapists. There are some interesting issues bubbling in the spa industry regarding massage. The two I found most fascinating were injuries and product sales.

All health care professions have their "walking wounded" who are practicing through their injuries and "dis"-health. It is amazing to me how few health care practitioners actually practice what they preach. The spa industry is no different. The majority of the therapists I met at the show were suffering from massage related injuries and not getting proper care for themselves.

Of course, this is a problem in our entire profession because body mechanics are seldom taught and rarely learned when they are taught. The volume of work done at spas increases the incidence of injury when therapists do not receive adequate training in working postures and self-care. This will undoubtedly begin to cost spas a lot of workers' compensation dollars.

Maybe this issue will eventually force schools to teach body mechanics and self-care in a more than passing manner. If I had a spa, I would only hire therapists from schools that adequately trained students in these subjects. Isn't it time schools started conditioning their students to be able to physically do the jobs expected of them? Time will tell.

The second issue is product sales. Spas have products for sale for their customers and they want their staff, including massage therapists, to promote and sell those products. Usually the therapists receive a commission from the sales they make. Spa operators are rather perplexed because massage therapists are resistant to this concept.

For some reason, massage therapists are being taught that it is unethical to sell products or additional services to clients. This amuses me. I do not see why selling something is unethical. I do not know of a health care profession that does not sell products to their patients. MDs sell drugs, appliances, casts, braces, splints, TENS units and all sorts of stuff by the boatload. DCs sell supplements, pillows, braces, supports and lots of other useful items. I cannot think of a health care profession that does not sell "stuff." Yet, somehow, in the massage profession, selling something is this huge ethical issue. Would somebody please tell me what is wrong with selling something?

This pious, unjustifiable, false morality should be laughable, but, sadly, some take it quite seriously. It has always amazed me how indignant some massage therapists get when something is offered for sale at a massage school or continuing education event. Where is this coming from? If you don't want it, don't buy it. It is not unethical or immoral to offer something for sale. Is this some envy of success issue or poverty consciousness, or maybe some of both? What is wrong with offering (selling) a useful product that can be beneficial to a client or student?

Most likely comparable products cannot be found elsewhere, as schools, practitioners and spas tend to sell professional grade products that are not available in the public marketplace. Even if the product is available at a local health food store for instance, why not provide the convenience of availability and expert advice for use to the client? There is nothing wrong with selling stuff! A lot of struggling massage therapists could increase their incomes significantly if they added products sales to their practice. This should be taught, not discouraged.

No, I do not think a massage should be an hour-long sales pitch; however, it is very rare I have a patient who, during the course of the massage, does not tell me about some problem or another. I assume they are looking for suggestions and help or they would not bring it up. If a product I have is appropriate, I mention it (without missing a stroke), then let it go and bring it back up at the end of the appointment during checkout time. My patients are grateful for the high-quality, professional products I have available for them, not offended.

There have been some reports of spa operators imposing sales quotas. I understand that to tell a massage therapist they have to sell a minimum volume of product could be unreasonable, especially if the products are shampoos and creme rinses; however, if such quotas are made clear during the hiring process, and the therapists knows and understands the quotas prior to accepting the position, I do not see a problem. It is unreasonable and unfair if the quota comes down on their head as a surprise after they have begun working somewhere. So, if you are going to work for a spa or salon, be sure you know all the conditions of employment and have them in writing before accepting the position.

Help! Following the lead of my editor, Cliff Korn, I want to ask for your help with my column. If you have a hot therapy tip or a favorite therapy technique you think is worthy of sharing with your colleagues, send it in to me. I will share it in the "Try This" section of my column. Of course, I will give you credit for it, unless you want to remain anonymous. No more than 150 words and only one tip per person. Send to ralph@ralphstephens.com. We can help each other help more people. Thanks!

Try this: Having problems with neck complaints involving the sternocleidomastoid muscle (SCM)? Sometimes the SCM just won't respond to massage and relax like it's "supposed to." Move inferior and work the rectus abdominis, especially its upper attachments at the ribcage and sternum. Then work the sternum and the inter-costal spaces on each side of it. (Be sure to advise your female patients of what you are going to do and get their consent, as this can be a boundary issue.) Now return to the SCM, it will often respond positively. There is a fascial connection from the SCM to the pubic bone.

Have a great, safe 4th of July!