How Does Lactic Acid Affect Muscles?

Lactic acid buildup is often blamed for post workout muscle fatigue and pain, but just how true are these claims, and how exactly does lactic acid affect muscles, fitness and performance?

First of all, let’s get familiar with the basics of the chemical process of energy production in muscle.

In aerobic metabolism, the oxygen that is required by cells to create energy is obtained via respiration. The “energy” that is produced is ATP, or adenosine triphosphate, which is a molecule that is created and stored in all body cells and provides chemical energy for cellular function. ATP provides the energy required for a muscle to contract, and is also necessary for the operation of the muscle’s calcium pump, which is involved in the sliding filament mechanism responsible for muscle contraction.

When the body is no longer able to obtain oxygen from aerobic metabolism, the energy is obtained by a process known as anaerobic cellular metabolism. Activities such as weight lifting, sprinting, or prolonged maximum output activities achieve oxygen deficit quite quickly, where more oxygen is required for cellular reactions than is available. Lactic acid is a metabolic by-product of anaerobic processes.

During anaerobic activities, energy is produced in one of two ways, the first of which involves a reaction between the creatine phosphate that is stored in muscle cells, and adenosine diphosphate (ADP). The creatine phosphate gives its phosphate molecule to adenosine disphosphate, making it “triphosphate”; therefore, the by-products of this reaction are creatine and ATP. The energy produced from this reaction is enough to last about 15 to 20 seconds, or a 100 metre sprint, then it needs to be replenished.

The second process by which anaerobic metabolism occurs is known as glycolysis – the breakdown of glycogen, which is stored energy in muscle. (glycol = sugar or glucose; lysis = splitting). ATP is a by-product of glycolysis, as is pyruvic acid. If there is still not enough available oxygen to produce more ATP in conjunction with pyruvic acid, then the pyruvic acid is converted to lactic acid and is released into the blood stream.

And this is how it happens…

Maximum contraction of a muscle during quick bursts of power, or maximal sustained effort, increases lactic acid production in muscle because blood vessels are compressed and oxygen can’t be delivered to the cells – the aerobic, energy producing pathway is insufficient to allow oxygen to fuel the reaction. As a result, an anaerobic energy production is used, and ATP and pyruvic acid are produced. The pyruvic acid is then converted to lactic acid – therefore, during an oxygen deficit, lactic acid will be the primary by-product of glucose metabolism within a cell.

When lactic acid is released from the muscle cells into the bloodstream, it is taken to the liver usually within 30 minutes of cessation of activity. In the liver it is reconverted to pyruvic acid and released into the bloodstream for further use by muscles, or it is converted to glycogen or carbon dioxide via aerobic metabolism. It is important to note at this point that lactic acid is not necessarily the “bad guy” it has been made out to be, as it still plays an important role in energy production when sufficient oxygen becomes available again.

When large amounts of glucose are used in sustained anaerobic activity, lactic acid accumulates and is alleged to contribute to muscle soreness. The buildup of lactic acid increases muscle cell acidity (hence the burning feeling in muscle) and makes ATP production more difficult. ATP is also required for the sodium-potassium pump which maintains cellular homeostasis. In the absence of ATP, the sodium-potassium pump is unable to correct any ionic (sodium, potassium etc) imbalances in the cell environment, and muscle becomes unresponsive to stimuli.

And don’t forget that the calcium pump, used in muscle contraction, requires ATP to operate. When a deficit of ATP occurs, the muscle fibres are unable to release the “cross bridges” which are created during contraction.

As a result, in either one of the two above case scenarios, the muscle may not be able to relax, resulting in cramping and spasm.

How Can Massage Therapy Assist with Lactic Acid removal?

Ok, so maybe you don’t really care about how this all transpires, and that’s fine. Here is what you need to know about lactic acid if you are a fitness enthusiast:

The claim that lactic acid causes muscle pain has been disproven, as mentioned in the article Lactic Acid Does More Than Cause Fatigue , though it is known to cause fatigue. If this is the case, then my (educated) guess is that muscle pain is caused by micro-tearing and inflammation of muscle fibres due to over-exertion.

There is also some debate concerning the degree of assistance that massage therapy can lend to the removal of lactic acid from muscle. However, as mentioned in my previous article, Massage Therapy, Fitness and Optimal Performance , massage therapy has both a mechanical and chemical effect on the body, and I believe for these reasons, it can have a positive influence on the removal of lactic acid from muscle tissue.

Mechanically, the stretching, manipulation and kneading of tissue will assist in “unhooking” the cross bridge created during contraction and relieve some cramping and spasm. Increasing circulation by this mechanical effect will assist in oxygen delivery and waste removal to and from muscle respectively. In addition, the chemical effects of massage, causing increased blood vessel permeability, will also assist in the process. And, also, don’t forget about the release of endorphins as a benefit of massage, which can help alleviate pain.

To learn more about the physiology behind this topic, please refer to my source noted below:

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How often should I get a massage?

Without fail this is one of the most common questions I receive as a massage therapist. The truth is, though, how often you should get a massage treatment is very individual and doesn’t follow a set formula.

As a massage therapist, I am asked this question by every 9 clients out of 10.  There are several factors that I take into consideration, and these factors include, but aren’t limited to, the following:

1. Why are you coming for treatment?  For example, is this for a specific issue, or is it for relaxation?

-       treatments which focus on specific issues are usually more frequent, though I rarely have treated a client more than 2 times a week for more than 3 or 4 weeks.

-         for relaxation and general health purposes, more than once a month is not necessary unless you have the time and financial resources to get treated.

2. What is the tissue presentation?

-         if you have a chronic, long-standing issue, and the tissue is very “dense” or “hard”, then you may need several treatments over a few weeks to make progress. Once your tissue has loosened up a bit, you should start feeling better. After a few weeks, your therapist should see how you are progressing, and you should be given the option of reducing treatment frequency.

-         tissue that is inflamed from injury cannot be treated directly with massage therapy, however, surrounding and compensating structures can and should be addressed to prevent pain and muscle imbalance.

-         tissue that is inflamed from injury can be treated with Manual Lymph Drainage (also known as lymphatic drainage or mld). Frequent treatments of this nature are recommended as this therapy facilitates the removal of metabolic waste from the injury and relieves pain and congestion.

3. Keeping in mind that everyone is individual and responds differently to treatment, you may notice that the effects of the treatment last only a day or so after the first treatment, with longer periods of feeling better as you progress – this is when your therapist should reduce treatment frequency.  After all, how are you going to know that you’re feeling better if you are still getting treatments twice a week? Exactly …

4. After 3 treatments, how are you feeling?

-         Personally, even with chronic issues such as upper back pain and tension, I feel that a client should notice an improvement by the end of the 3^rd treatment. This is my guideline which tells me I am on the right track, and it keeps me focused on what the client needs. I’m not saying there should be a huge or remarkable improvement, but some progress should have been made.

-         And just a side note for clients – if you aren’t seeing some improvement such as decreased pain, increased mobility etc by the end of the 3^rd treatment, then your issues aren’t being addressed. At this point your therapist should go over the treatment plan again (sometimes we miss things), and perhaps revamp it a bit.

-         If no progress has been made by treatment #5, ask to be referred to another therapist.  Beware the therapist who insists that you continue to book, and don’t be shy to say that you’re not feeling any different, after all, massage therapy is your investment in health.

If you are unable to come for the recommended frequency due to financial concerns, talk to your therapist. If he or she is aware of your financial limitations, she might be able to adjust the treatment plan so that you can maximum benefit for your restricted budget, or recommend things you can try at home to enhance and prolong the effect of the treatment.

For more information on Massage Therapy Treatment Frequency Guideline …

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What Does Muscle Strain Mean?

Muscle strain is a very common injury treated effectively with massage therapy. What does muscle strain mean, and how does this type of injury happen?

Strain is a term used to describe an injury to the musculotendinous unit, or the muscle and the tendon which attaches it to bone.

Muscle and tendon is known as contractile tissue due to its ability to contract (shorten) and extend (lengthen). This contraction and extension of muscle causes movement, and because of this, muscle strain will be noticed when you attempt to use the muscle, either contracting or stretching it during movement.

There are basically 2 mechanisms of injury which cause muscle strain:  overloading the muscle (too much pressure or weight), or overstretching muscle (think of trying to catch a falling object that is really heavy – weight is suddenly applied to muscle that is stretched. It could also happen, for example, due to a sudden slip or fall.

Symptoms of Muscle Strain:

The symptoms of a muscle strain will depend on the severity of the condition. Muscle strains are classified as mild (1^st degree), moderate (2^nd degree) and severe (3^rd degree).

Mild muscle strains occur when there is some tearing of the muscle or tendon fibres.  While you may still be able to carry on activities at the time of the injury, there is obvious muscle stiffness the following day.  In spite of the discomfort (with or without palpation) and stiffness, there is no loss of function.

In addition to muscle stiffness and soreness, there may be some minor weakness, a decrease in normal range of motion, some minor swelling and spasm, and minor pain with either contraction or stretching of the affected muscle.

Moderate muscle strains may have considerably more (up to 75%) muscle tissue damaged.  At the time of injury, you will be unable to continue activity, and there will be considerable pain. Inflammation will be present at the injury site, with increased muscle spasm and possible bruising.

Severe muscle strains usually result in immediate and complete loss of function due to disruption of the tissue. There may be extreme pain, however, if there is a complete rupture of the muscle or tendon, there may be no pain due to the lack of muscle contraction.  There may be visible and palpable gapping of the muscle tissue.

You’ve just hurt yourself, what do you do now?

Whether you slipped and fell, or were being a hero rescuing Granny’s kitten from a tree, it doesn’t really matter at this point. Let’s just hope it’s a mild strain and nothing more serious.  If you are in a lot of pain, or the body part in question doesn’t look like it usually does, please see a physician or medical professional ASAP who can diagnose and treat the problem.

You should, however, do something about it quickly. “Quickly” is the key word here, as a muscle strain injury (or any other type of injury) that is addressed immediately often is less complicated and takes less time to heal.

For an acute injury, remember R.I.C.E:

R is for Rest – don’t aggravate an injury and cause more damage by continuing on. Stop what you’re doing. Now. Ok, if it’s a mild injury, you may be able to get back to mild activity in a day or two which is good for the body (“mild” is the key) If it’s more serious, then I probably didn’t have to tell you to stop, because you (hopefully) would have anyway.

I is for Ice – great for controlling the degree of inflammation, ice is also great for controlling pain, as we all know. And here is why:

When tissue is injured, inflammation begins immediately in response to the injury. Inflammation is not necessarily a bad thing, as it can stabilize an unstable joint, and will clean away cellular debris and dead cells, increase circulation and cellular metabolism by delivering oxygen and nutrients via blood flow.  Due to this increase in fluid build up in the area, pain is caused because tissue is stretched and the pain receptors (nociceptors) in the tissue are irritated.

I have been made aware by colleagues who are physiotherapists that the “newer” approach is to place heat on an acute injury. Why? you might ask. (I asked the same question). Apparently (in theory) to increase the blood flow will increase the rate of healing. However, I will take this opportunity to respectfully disagree;   based on my experience, my clients who have had this type of treatment have been in absolute agony, as if the injury wasn’t enough.  The use of cold and ice isn’t long term, but in the acute stage, it is a great tool to control pain.

C is for compression – once again, compression will control the degree of edema (swelling) which occurs. It is imperative that it be done correctly; bandages that are too tight will completely cut off circulation, and uneven bandage pressure can also damage tissue. My suggestion is that if you can’t find a medical professional trained in wrapping to do it, than it might be better to forgo it altogether. Remember, too, that the bandage will have to be removed and reapplied at least once a day.

E is for elevation – elevation will help the blood and lymph flow away from the injury site, reducing the edema and relieving pain.

Disclaimer: This information is provided for educational purposes only, and is not meant to replace the advice of your primary health care provider. When in doubt, please consult a qualified medical professional in your area.

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What are the Causes of Low Back Pain

Low back pain is one of the most common conditions treated by massage therapists. I have been asked by countless clients “what are the causes of low back pain?”, and I am afraid to say that there is no simple answer. The causes of low back pain are many, and it is important for clients to understand this, as appropriate treatment approaches differ as much as the causes themselves.

So common is low back pain that I decided to do a little research and try to get some statistics on it.

Here is what I found:

Back pain statistics from the Workers Compensation Board of British Columbia

From 2000 to 2004 WorkSafeBC (Workers’ Compensation Board) received over 107,000 claims for back strains

back strains account for just over 25% of all WorkSafeBC (Workers’ Compensation Board) claims.

Roughly 30% to 40% of all workplace absences in Canada are due to back pain

injuries may be caused by a single instance of overexertion or develop as a result of repeated motion over time.

Over two-thirds of back injuries are a result of overexertion

60% to 90% of the population will experience low back pain in their lifetime

More than 90% of low back pain cases have no specific cause (such as infection, osteoporosis, arthritis, etc.). In these cases the pain will usually subside without treatment in four to six weeks.

In the health care industry, injuries due to patient handling (lifting, transferring, or repositioning) account for about 35% of all accepted time loss claims and for about 40% of claim costs.

So, that’s all fine and well, but while “back strain” appears to be the most common cause of low back pain, and quite a generic term, there are other causes of low back pain. It is very important to identify the cause and contributing factors to low back pain for successful treatment, otherwise clients may just end up wasting time and money.

Falling into each of these 4 broad categories, which I am going to name as causes for low back pain, are several different conditions which I have seen in my practice.

Low back pain cause – Muscle fatigue or strain

Also referred to as a “pulled muscle”, this happens when muscles are overused or is weak. Muscles can also be torn from an injury, and of course, the more serious the damage, the longer it will take to heal …

This is also the primary participant in “soft tissue injuries” – the effects of which insurance companies have lead people to believe are minimal. The reality is that soft tissue injury, and the chronic inflammation which may accompany the more severe injuries, often take longer to heal than the ballpark figure in the insurance tables. However, I digress …

Pain can also be caused by an imbalance of muscle development, or a lack of “extensibility” or “stretch” of the muscles. This is very easy to see, for example, in athletes who may overuse and overdevelop one muscle group. This muscle imbalance is stressful for the body and may cause pain and spasm in the opposing muscle group as the body tries to maintain homeostasis. This lack of balance can lead to “mechanical dysfunction” of the joints of the back (see below). Muscle imbalance, can, however, be treated at home if you know what to do.

Low back pain cause – Joint and bone dysfunction

This type of back pain is often referred to as “mechanical back pain” or “mechanical joint dysfunction” when referring specifically to the joints. What this means is that a joint is not able to move as it is meant to, either from injury to the bone or joint, or hypertonicity of the surrounding muscles (hyper meaning ‘too much’, tone means the amount of tension in the muscle). Unfortunately, this can lead to several other issues and can be a self-perpetuating cycle if left untreated, often causing seemingly unrelated problems.

Of course, bones and joints can also be affected by fractures, breaks, arthritis and a multitude of other conditions which is well beyond the scope of massage therapy to diagnose and in some cases, treat. Massage therapy can, however, be used to alleviate symptoms and assist in recovery.

Low back pain cause – neurological

Low back pain from a neurological source can be a result of a variety of triggers, all of which are related to either the intervertebral disc, spinal cord, or the “nerve roots” as they exit the spinal cord. This type of pain can be excruciating and very debilitating, as anyone with a “slipped disc” will tell you. (this is a bit of a misnomer, and will be addressed in upcoming articles). This type of low back pain usually presents as symptoms in the area which the affected nerve root supplies, so the location of the symptoms is really dependent on the nerve root “level” where the injury or restriction happened. (and often the level of the injury is determined by the presentation of symptoms.) Pain which occurs in one area but originates from dysfunction in another area is called “referred” or “referral” pain.

Low Back Pain – Neurological from Bulging, or Herniated, Disc

Low back pain cause – visceral referral

In some cases pain can be a result of a dysfunction or infection of an internal organ. This happens because the “nociceptors” (pain receptors) of an organ are irritated and the pain is either felt in the skin or tissue which is superficial to (or just above) the organ, or in a classic “referral pattern”. Pain caused by visceral dysfunction can be quite severe.  A classic example is low back pain in the lumbar area which may wrap around a persons front, or extend down the sides of the thighs and into the groin.  This is a referral pattern of the kidneys, and should never be ignored.

Remember, most low back pain is a result of muscle weakness or imbalance. However, if you are not aware of any activity or cause of the pain, the pain is severe, or if the pain has been present for any length of time, I would urge you to see a physician immediately to rule out anything more serious than a muscular cause for the pain. You may also want to check out more information I have found on WebMD.

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Where can I find a great Massage Therapy job?

Knowing your job options BEFORE you embark on a massage therapy career can help you better decide if this is the profession for you.

Start your own practice – this is a great option for those who are entrepreneurial minded. It means you can call all of the shots, but be forewarned, if you don’t already have entrepreneurial experience, you have quite a learning curve. You’ll have to know when to take off your therapist’s hat and put on your business one, and keep it separate. It can be done, many therapists successfully own their own clinic.

Join a clinic that hosts a variety of treatment modalities. This could be anything from physiotherapy, chiropractic and massage therapy to a naturopathic or holistic clinic or doctor’s office. It’s a wonderful thing to be surrounded by people who are passionate about integrated health care. You will have the benefit of working with other professionals who are highly trained, and you will participate in the care of patients with a variety of conditions, from common injuries to extensive rehabilitation.

Start a mobile massage service – if you don’t like the idea of being stuck in a small room all day, and like to get out and about, this could be great for you. The key is to be organized – time management is really important in this business, and it is even more so when you are mobile.

Go corporate! Many large companies provide employee benefits that include massage therapy, and the coverage is usually great. Corporations provide these benefits because they realize that employees who use stress management tools such as massage therapy miss less time and are more productive. Even better if the therapist is on site, then employees miss less time going to and from appointments.

Health or Fitness facility – massage therapy is a great adjunct to fitness, so many club owners are wising up to having a massage therapist available. They realize that having qualified therapists on hand enhances their professional image by providing an additional service to clients seeking optimal fitness performance.

Sports teams or facilities – this is a little more intense than your average health club. This is where you will find budding stars with huge performance goals – as a result, you, too, will have to be at the top of your game whenever you are needed. Unless you have a sports medicine background or contacts in the business already, you probably won’t get into this right out of school, but that’s not saying it’s not a possibility. Work hard, get your sports massage certification (there are different programs available in Canada and the United States), volunteer, and it could just happen. What a great way to combine a love of sports with a passion for health.

Spa – not all spas employ licensed, certified or registered massage therapists, but many do, and the number is growing. If esthetics and hydrotherapy interest you, a spa could be a great place to start learning in that capacity. Medical spas are also growing in number, with treatments being a little more therapeutic in nature – let’s think lymphatic drainage after cosmetic procedures. Either way, a bonus is that you may get discounted or even free esthetic services, which is really great. Pedicure, anyone?

A resort or cruise ship – Depending on the location of the resort or cruise line, either one may give you the opportunity to rub elbows with a high end clientele. Your accommodation may be provided, and will definitely be part of the plan when you are on a ship. In the case of working for a cruise ship, while the hours are long and the pay is not so great, tips can be fantastic, everything is provided for you, and if you have a bit of wanderlust, working for a cruise ship could be your ticket to the world.

Hospitals or palliative care. It takes a special type of person to work in these environments, but if you have “the stuff” to do it, then it can be a very rewarding career path. Whether the service you provide is in a rehabilitative capacity with a physiotherapist or bed side with palliative care patients, you will be providing human contact to people who may be touch deprived. You may not be able to make a living per se, but you can improve the quality of life for someone, even if (in the case of palliative care) it is only for a brief period of time.

Senior’s centres – with a growing aging population, the need for extended health care grows as well. Your clients can range from a vibrant “80 years young” to a senior with a few more health concerns. Once again, a lot of times it’s about providing company and human contact to the elderly more so than the massage itself, which is a very compassionate way to enhance the quality of life for someone.

Any way you look at it, there is a ton of potential with a massage therapy career. It is Ok to change course as well, and you may find that you like to try your hands in different capacities until you find the perfect one for you.

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Is a vegan or a vegetarian diet REALLY healthy?

My response to an article “Cruising to Health” in Organic Spa Magazine.

Hello,

My name is Jodi Forsythe, and I am a Registered Massage Therapist (Canada) and the creator of www.WhyMassageTherapy.com. I wanted to first of all commend you on a fantastic magazine which combines two of my favorite things – organic living and spas.

Secondly, I would like to comment on the article in the August 2009 edition “Cruising to Health” by Judith Fein. I am always interested in hearing of new things which help people attain the highest quality of life possible, but I am concerned with the sweeping generalization in the article that a “vegan” lifestyle is the panacea for achievement of optimal health.

While I would not argue that there are numerous benefits to switching to a mostly plant based and/or raw food diet, I am concerned that in an article such as the one mentioned above, no further resources are mentioned which may help people make an informed and balanced decision. If I would have had proper information during my attempt at veganism 13 years ago, I would have done it a lot differently by consulting a health care professional who knew what she was talking about, or not at all. As it was, from the misinformation I read, all that I achieved was extreme suboptimal health which took a long time to heal.

During my healing process, I was struck by the reality that humans are omnivores, and that agriculture did not begin in earnest until about 5000 years ago, before which our species were hunter-gatherers. (notice that “hunter” comes first … ) I do not believe that a diet free of animal products is how our species has evolved over millenia, and I firmly believe that animal protein is necessary for humans to obtain optimal health.

Please note that I am not talking about the rampant over-eating and gluttony of processed and damaged food which is so pervasive in our society, including chemically processed and packaged food products. I am talking about eating food that is actually part of the food chain, which we can in theory “pick, hunt, gather, milk or fish” (Thanks to Dr. Diana Schwarzbein for that useful perspective). Our bodies recognize and assimilate the raw material as needed, and because we are receiving the nutrients that we require to thrive, we are not cursed with the chronic hunger and ill health which happens in an over-fed yet under-nourished society.

I firmly defend my decision to eat chicken, beef and fish, but I also believe in animal welfare and sustainable farming and fishing practices. Using animals for food can be done at far less of a humane and environmental cost than is currently occurring. For example, purchasing only meat, poultry and dairy products from farms and organizations which support animal welfare is the best way to start. I’m thinking grass-fed beef, which actually produces far less methane than their corn-fed counterparts, or free range chickens that are not factory farmed and stuffed with feed made from renderings of other dead animals.

On the flip side, if we are so concerned with the environmental cost of food production, we should also take a look at the prevalence of genetically modified crops such as soy, and the impact on human health and the environment. So recent is this scientific development that the gravity of our choices isn’t even beginning to be understood yet, and I am concerned for what is to come. And please, don’t even get me started by saying that switching to a plant-only diet would allow us to feed so many more starving people. It is a fact that food aid sent to impoverished countries often doesn’t make it to the intended recipients, but is rather diverted by hostile regimes for their own purposes. At this point in time famine has much less to do with a shortage of food than it does with politics, and that is the real crime.

In closing, while this piece was interesting and well written, I would like to see more articles with a balanced viewpoint on what a “healthy diet” really means; preferably from a variety of medical and naturopathic professionals who can then refer readers to accurate information and resources.

Regardless, I will continue to purchase and enjoy your magazine, and look forward to reading more interesting articles.

Sincerely,
Jodi Forsythe, BA, RMT
Registered Massage Therapist

http://www.whymassagetherapy.com

Massage Therapy – a tool for living well.

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Massage Therapy Client Obligations and Responsibilities

Massage therapy is unique in that it is a profession with one foot in health care and another in the service industry. This bridging of worlds brings a certain set of responsibilities to not only massage therapists, but also to their clients.

In keeping with my previous postings concerning the therapeutic relationship, I have decided to enlighten massage therapy clients as to what constitutes behaviours which massage therapists appreciate and those which we don’t. A little give, take and understanding of what massage professionals go through on a daily basis might help you establish a better relationship with your therapist, putting you on the top of the pile for preferred days and times, as well as getting “squeezed in” on short notice.

Here are the top things you can do to establish a great relationship with your therapist:

1) Show up on time. Massage therapists really appreciate a client who arrives on time and ready for treatment. It helps our day go smoothly, ensuring we don’t get behind. It also demonstrates to us that you respect our time and profession, which we really appreciate.

2) If you are late, expect that you will pay the full fee even if your therapist can only treat you for the remaining time. And, some therapists will not treat clients at all who are more than 15 minutes late for the appointment.

3) Please call 24 hours in advance if you have to cancel. We understand that life happens, and if you don’t give 24 hours notice and this is an isolated incident, it’s not usually too big of a deal. However, do expect the cancellation policy to be enforced, and if you fail to pay the balance owing, you may be “discharged” from your therapists care.

4) Know your insurance policy, if you have one, before the treatment. There are many different plans which may or may not cover massage therapy treatments, sometimes even within one organization, such as the government. It is your responsibility, not ours, to know how much coverage you have, if a medical referral is required, if direct billing is allowed etc. A therapist, even if he or she does permit direct billing, has the right to ask for payment up front if you are not sure of what is covered or don’t have the appropriate information. A therapist may also only direct bill for certain insurance companies. While most therapists do their best to accommodate clients (within reason), It is our prerogative to decide how to run our business.

I advise calling your insurer well before your appointment and asking them things such as 1. to what association does my therapist need to belong for me to get reimbursed, 2. do I need a medical referral to get my treatments covered, 3. how much coverage do I have and how much will I get reimbursed per treatment, 4. is direct billing permitted, or do I have to pay up front and submit my receipts? If you do need to get a medical referral, do so before your treatment, as massage therapists and doctors cannot “fudge” treatment or referral dates so your treatment is reimbursed.

5) Comply with the treatment plan and recommendations, especially if you are going in for a specific reason, such as an injury. While massage therapists are not permitted to diagnose, and are only permitted to form a “clinical impression“, we usually have great suggestions for treatment plans and exercises to ensure the best possible outcome. Remember that as great as massage therapy is, it is a passive therapy and only part of the health management equation. If you suffer from tight hamstring muscles, but don’t do the recommended stretching between your bi-weekly appointments, then there is only so much your therapist can do to help.

In the case of a client who is receiving insurance coverage for a motor vehicle accident, he or she has to realize that massage therapists are obligated to report to the insurer if the client is “non-compliant” with treatment and home care recommendations. I have seen many people discharged for “non-compliance”, and I have discharged patients myself for this reason. In a rehabilitative setting it is our job to attain certain treatment goals which may not be reached if the client doesn’t hold up his or her end of the bargain. By discharging a patient, I am preventing insurance fraud and freeing up my time so someone else can benefit from treatment.

6) This may hit a nerve with some people, but I’m going to say it anyway – client hygiene is really important. I am not talking about someone who had a shower in the morning and goes to see their therapist after work needing to worry about hygiene. I’m talking about someone for whom hygiene is generally an issue. After all, if a therapist is obligated to maintain a certain level of hygiene to treat clients, the therapist should be able to expect that clients show up presenting a certain level of hygiene. Think about it like this, would you want to be in a small room in close proximity to, and touching, someone who hadn’t had a shower for a few days? I didn’t think so.

And a side note: refrain from using cologne or perfume or tons of hair and body products. It’s really hard to work in a closed spaced with someone who smells like they tried every perfume in the local drugstore. No scent is the best scent, and this ensures that your therapist doesn’t get a migraine or has a flare up of allergies.

7) This is a business, and for most of us, our livelihood. A lot of massage therapists have a hard time reconciling the business aspect of the profession with the “caring” and healing aspect of the profession. But, make no mistake, this is how we pay our mortgages and buy our groceries, not to mention everything else that we need to live.

Someone (I can’t remember who, but I thought she was brilliant) stated in a cartoon “the caring is free, but the service is ($80.00) per hour”. We may choose to do pro-bono work, or may offer reduced fees to long-time clients if there is sufficient reason, but these cases are exceptions that are made of our own volition. I have had potential clients argue and tell me how much I should be charging – the key word being “potential”, I refused to book them. I also won’t negotiate “deals” with people or give them bargains just to get them to be my client – this is devaluing my own professional worth and undercutting my colleagues. Kind of like buying groceries, the price is what it is, and payment is due when the transaction happens.

8 ) Be prepared to pay with the massage therapists preferred method of payment. Find out when you are booking your appointment what is accepted, and don’t expect to run a tab.

Massage Therapists also have obligations to their clients – please check out Massage Therapy Client Rights if you are unsure of anything.

Following these simple steps will ensure that you establish a great relationship with your therapist, and that you get the most out of your treatments.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy Client Rights

Question: At my first massage therapy appointment, I asked the therapist some questions concerning the treatment. I found her to be evasive, and a little impatient with me. As a client, don’t I have right to know what is going to happen?

Yes, you certainly do. Here is a list of some of the rights you have as a massage therapy client.

1) Get some advice on how to find a licensed massage therapist – you have the right to know what qualifications your therapist holds. Ask where he or she went to school, to what professional association or college he or she belongs, and if they have any additional training. And remember, don’t discount a therapist just because he or she has recently graduated – there are some really fantastic new therapists who begin their careers every year.

2) You have the right to be informed about what to expect during and after a treatment. This is known as Informed Verbal Consent and is a set of statements designed to make the client aware of expectations concerning the treatment, as well as his or her rights as a client. Informed verbal consent goes above and beyond some typical quesitons, such as “do I have to take off all of my clothes” or “is it normal for the treatment to hurt?”. For any Canadian massage therapist who practices in compliance with the CMTO standards, informed verbal consent is mandatory before assessment or treatment begins and provides the client an opportunity to ask questions.

I have been disappointed to hear from clients who, when they’ve seen me for the first time, tell me that no
massage therapist has ever gone over informed consent with them. I cannot speak for students educated in the US, but Canadian massage therapists should really know better. We are obligated to advise clients what is going to happen. Period.

3) You have the right to receive treatment in a safe and hygienic setting. This is everything from the entryway of the clinic, to the bathroom and waiting facilities, and most certainly extends to the linens, towels etc that come into direct contact with the client. Linens should only be used with one client, and anything that comes into contact with the client’s skin needs to be washed after each use.

Equipment should also be safe, clean and in good repair, and there should be nothing on the floor on which a client could trip or lose footing. If the linen looks dirty, the equipment is wobbly or obviously broken or the
clinic is obviously unhygienic, you have every right to turn around and leave. (and I suggest you do)

4) You have the right to receive treatment from a massage therapist who is clean and hygienic herself. If there appears to be “hygiene” issues, you have the right to voice your concern and leave, you are not obligated to receive a treatment from someone who makes you uncomfortable or is unclean. I can pretty much guarantee that if a therapist doesn’t pay attention to his or her personal hygiene, that the linen and equipment will be lacking in this department as well.

5) You have the right to refuse treatment from a therapist who is ill. Your therapist should advise you in advance (preferably) or when you arrive if he or she isn’t feeling well or has a cold, and should not charge you if you decide to postpone treatment until he or she is feeling better.

6) You have the right to stop or modify the treatment at any time. If you are in a lot of pain, or for ANY reason you are uncomfortable, you do have the right to tell the therapist you want to stop. The therapist should respect your request and allow you to get off of the table and get dressed in privacy.

A massage therapists needs to receive informed verbal consent from you if he or she is going to be working in a “sensitive area” – for example, breast massage is not typically performed unless it is clinically indicated by your presentation or health history. Either way, it is always your choice whether or not to receive or refuse treatment.

If you feel that any inappropriate touching or remarks have been made, whether of a sexual nature or not, you have the right to report the therapist to his or her professional association. Please do so, as therapists who violate massage therapy professional standards and a position of trust do not deserve to call themselves massage therapists. In addition, therapists who engage in sexual misconduct commit a crime for which there should be repercussions.

7) You have the right to be advised of the massage treatment fees when you book your appointment. You also have the right to not be subjected to “upselling” or pressure sales tactics. The College of Massage Therapists of Ontario, and any provincial massage therapy association who follows their guidelines, require therapists and clinics to post their fees in a visible space for all clients to see. Anyone who doesn’t do this is in violation of the policy.

8 ) You have the right to know what products are being used on you. If you have a health issue such as an allergy, or an objection (for example) to products tested on animals, you need to ask this when you are booking your appointment. Remember, though, that a therapist also has the right to know of any issues in advance so he or she can be honest with you, whether or not he can accommodate your request.

9) You have the right to receive your treatment on time. Occasionally a therapist may run a little behind, for example, if the previous client was late; however, if this is habitual, then it shows an issue with your therapist’s time management. While the duration of the appointment will probably be reduced if YOU are late, if your therapist is late, you should receive your full treatment.

If the therapist is so late as to keep you from other commitments, you have the right to leave without incurring a charge. After all, you were ready at the agreed upon time.

The above points are some of your rights, but do realize that a therapeutic relationship between a massage therapist and client is based on mutual respect. If for any reason you don’t feel the situation is working out for you, please consider finding a therapist with whom you have a “good fit”.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

My first massage therapy treatment – is it normal to be sore?

A frequent question that I hear from new clients is “My (Aunt Betty) had a massage, and she was so sore she could hardly move the next day. Will I be sore, too?”

We have all heard horror stories about the therapist who had bone-crushing pressure and didn’t listen when asked to back off. I’ve heard another client of mine tell me that when she asked her (previous) therapist to lighten up, the response was “I’m not using a lot of pressure, and it has to hurt to work.”

I’m hear to tell you that this is NOT the case – and that massage can be very effective when applied with moderate pressure. It takes intuition, experience and time to learn just how much pressure the tissue (and a client) can take, and this amount of time varies from therapist to therapist. I’d also like to add that your massage therapist should never brush off indications of pain – as a massage therapist myself I wouldn’t go to someone else who seemed to have no regard for my pain tolerance.

Does Massage Therapy “have” to hurt?

Let me put it this way – it is normal, especially if you’ve never had a therapeutic massage before, for muscles to feel a little stiff or sore after a treatment. I think of it much the same as working out, after all, muscle tissue is being manipulated and worked, so a little discomfort is not unusual. If a person has never been to the gym before, it is not a good idea to ask him or her to leg press 100lbs, any more than it is wise for a massage therapist to put all of his or her weight behind their elbow as they perform muscle stripping on the back of a new client. Either way you look at it, if you’ve never had a treatment before, you have NO idea how your body will react or how much pressure is “enough”, and the therapist really has NO idea what “deep” means to a client. Depth of pressure is very subjective, and pain is a subjective response – what hurts to client A might feel great to client B – there is just no way to tell.

It didn’t take me long to learn that the size of the client has absolutely no bearing on how much pressure he or she can take. I have been able to use deep pressure effectively and painlessly with some very small women, and much less pressure with some very muscular and burly men. My approach is now this – when I first start treating a new client, I use broad, firm pressure, and resist the urge to “go deeper” even at their request. What I tell them before they get on the table is that the first treatment I will be very moderate because I’m not sure of how they will react – they may feel great in the days following the treatment, in which case next time I will go deeper. (here’s a question to consider – does the saying “the customer is always right” apply in this scenario?) If my client feels not so great in the days following a treatment, then I know I need to do something different and will adapt subsequent treatments to suit my client.

In a nutshell, what I would tell a client is that while some discomfort is normal, your request to a therapist to lessen the pressure should never be ignored or brushed off. You are paying for a treatment, and you always have the right to stop or modify what is happening (an FYI in case your therapist doesn’t tell you this.) If you are a therapist, especially a new one, take the time to listen to your client and his or her muscle tissue – not everyone is created the same, and it does take time to learn how much is “enough”. Also, be sure to advise your client of any possible side effects or risks associated with the treatment (informed verbal consent), and let him or her decide what is right for their body.

Your first massage therapy treatment – what to expect.

Even if you’re a veteran at getting massage therapy treatments, there is always some apprehension when you go to a new massage therapist.  When you’re a newbie to the therapy, it can be really overwhelming and intimidating – maybe you’ve heard stories that make you wonder if you really want to put yourself in such a vulnerable position.

Rest easy, there’s no need to be afraid. Here are some common questions that I’ve addressed with new clients.  Also, remember that you should feel comfortable asking questions of your therapist, and a therapist’s reluctance to address concerns may be an indication that he or she isn’t right for you.

Q. Will I have to take off all of my clothes?

Not necessarily.  Your therapist should encourage you to undress to your comfort level, though massage is much more effective if performed directly on the skin.  For people who are a little more shy or reluctant, you can leave your underwear on, though (for women) the bra should come off to allow for better access to the back and shoulders. If your therapist doesn’t bring this up, please ask to clarify your concerns before the treatment begins.

Q.  What parts of my body are exposed?

The only part of your body that should be exposed, or uncovered, is the part of the body that is being worked on. At no time should your genitals be uncovered – though your therapist may undrape you just to the outer edge of the area if working on the front of your upper thigh.

If your therapist is working on the back of your thigh, it is not unusual to uncover part of the gluteal region to allow access to muscle attachments.  When your therapist is draping (or undraping, as it were)  the sheet or towel should only go the the edge of the gluteal cleft (aka the bum crack – pardon my English, I really don’t know how to say this politely, my apologies).  For a therapist to place the sheet or towel in the cleft is not only inappropriate but uncomfortable for you as a client.  If this happens, feel free to speak up and ask the therapist to move the sheet or towel more to the side – after all, you’re not paying to get a wedgie.

Q.  Why does my massage therapist insist on taking my health history?

The health history form is so important, as it gives an overview of a client’s health. Please remember that what you say to your massage therapist is confidential, and files should be stored in a secure area. Therefore, your massage therapist is not going to discuss your medical issues with anyone unless you have signed a consent form giving your therapist permission to do so. Quite often, massage therapists will discuss issues of their clients in a very general way with a goal of learning from each other – this is done with no names mentioned, so you should not have concerns about the confidentiality of your information.

Massage therapy works with the musculoskeletal system and can also affect the autonomic nervous system – this is your “fight or flight” response.  As such, a seemingly benign treatment or technique can really cause damage if your therapist is not aware of any health concerns.  When a massage therapist is informed about any concerns or limitations a client may have, he or she can modify the treatment so as to deliver the most effective and safe therapy possible.

A good example is when a person is taking medication for a headache.  An analgesic will alter pain perception, so if you usually get a deeper treatment but you fail to make your therapist aware of your medication, he or she might use deep techniques that are painful – however, you won’t know this until after your meds wear off.  At this point it is too late, and you might really feel the effects of the treament (and not in a good way) for several days.

Personally, I have refused to treat a new patient who refused to fill out a health history questionnaire.  As a massage therapist I couldn’t be expected to provide the best possible treatment if I didn’t have an overview of my clients health. From a liability point of view, I always insist that a client sign the form – this ensures that I can’t be held liable if a client fails to disclose health issues or concerns, provided that I’ve worked within my scope of practice and worked in the interest of their safety and wellbeing.

For more information on how to find a good massage therapist, or what to expect during a treatment, please visit WhyMassageTherapy.com – Information About Massage Therapy.