“Oh, so you just do relaxation massage, not therapeutic.” I bristle when I hear those words. It’s only been six months since I was hired at the picturesque day spa overlooking a prairie on the outskirts of Madison, Wisconsin, and my coworkers are still trying to figure me out. In the vernacular of the spa, they, like many in the profession, dichotomize ‘relaxation’ and ‘therapeutic’ work, a common approach that undermines the very essence of massage.
I was a writer long before I became a massage therapist. In college, I had the immense joy of being a peer tutor at the campus writing center. As peer tutors, we didn’t correct papers with broad sweeps of red pens; instead, we sat with students and helped them establish their own writing process. Rather than acting as arbiters of correctness, we equipped students with confidence in their own skills, encouraging them to see themselves as writers.
I couldn’t have imagined that being a massage therapist would entail a similar relationship. When I graduated from massage school, I saw myself as the authority, eager to explain to a client what was going on with their body. Now, however, I’m thrilled to step down from the place of authority and pass authorship back to whom it belongs: the client.
Critical thinking allows me to make informed choices around pain complaints, pressure, and giving feedback. I use the information gathered during the brief intake and initial conversation concerning the client’s goals. If a client asks for deep pressure and they haven’t had regular massage, I explain what may be a better approach and why that is so. By understanding pathologies and appropriate techniques, I can safely give a massage that is customized to the individual.
Research helps me understand pain science and explain the nervous system’s role in pain. Many clients ask about trigger points, toxins, foam rolling. By staying current with research and attending conferences (e.g. San Diego Pain Summit), I can offer valid and thoughtful responses to the questions I’m asked. While many spas I’ve worked in prefer the massage therapist not to engage in conversation with the guest, I am able to listen and ask pertinent questions and continue gathering information during the session. I’ve had several guests thank me for the “information” as well as compliment my work. My experience as an A&P instructor has also helped me gain respect, and I’m now working with a client who was injured at a local spa and required a second neck surgery. ~ Jody Hutchinson, CMT, Seaside, California
The data and science are always changing, so I realize I need to update my clinical opinions and approach. I’ m aware of my biases and need to keep them in check and consider confounding evidence against them. I’m also willing to be wrong and realize that this will happen quite often, which makes me comfortable to tell patients that I don’t know what causes their problem. There are still a lot to figure out when it comes to manual therapy. The experience of touch is subjective, and I am careful to color this experience with suspect explanations. Unless they ask me what I think is happening, I try to be as science-based, rational, and honest as I can.
The evidence just isn’t clear on manual therapy’s efficacy. What we do know is touch felt as safe, calming, and affective aids in triggering our self-healing mechanisms. This is my guiding principle though – what type of touch will mediate down-regulation of symptoms for this client?
As far as incorporating research goes, while working on the table, I ask myself, ‘Why am I doing what I’m doing in this anatomical region? What do I know about the data concerning the symptom? What is best for the client? What is this person’s previous experience with manual therapy? What did they like about it?
Overall, critical thinking has taught me to be OKAY, or at least try to be, with the uncertainty of outcomes, flexibility with approach, and promote a client-led experience. ~ Minki Kim, BA, Rolfer, New York City
“So, is my back a mess?” It’s a common question after a session, and my clients look to me for answers. They’re also looking for validation, an acknowledgment of their pain. I choose my words carefully. “I can tell there are areas where your muscles might not be relaxing fully, but I also feel a lot of movement. Are there any areas that stood out to you during the session?”
I hope that our conversation inspires them to listen to their bodies in a new way and spark a new understanding of their body. Above all, I hope to empower them to take back the red pen wielded by healthcare practitioners and use it to author their own story. ~ Chloë Bradley, BA, LMT, Madison, Wisconsin
How Do You Apply the Biopsychosocial Model of Health to Your Practice?