How Often Should I Get a Massage – Frequency Guideline

Following my initial blog post on this subject How Often Should I Get a Massage, here is my treatment frequency guideline, for massage therapists and their clients.

Remember, this is just a very generic guide, and will have to be adapted for individual situations.

Here are my general guidelines for treatment frequency:

Relaxation – once a month for an hour, unless you want to come more often.

Acute injury – more frequent treatments of shorter duration should help – for example, 2 times a week for 30 – 45 minutes. This should help relieve pain and congestion in the area, then after a few weeks, switch to deeper, muscular work for longer periods of time. At this point your injury may have moved into a subacute or chronic stage of healing, depending on the severity of the injury, 1-2 times a week for an hour, over a period of 3-4 weeks should get you on the road to recovery.

Treatment for chronic conditions (i.e. headaches or back pain) – one hour twice a week for 4 treatments, then try once a week for 3 or 4 weeks, and try to decrease to 1x in 14 days for 2 treatments. You will then go into maintenance mode. Once again, very individual, and the longer the condition has been an issue for the client, the more treatments will usually be needed to make consistent gains.

Some more general guidelines:

Follow remedial exercise and homecare advice – passive treatments such as massage therapy can only take you so far, it is YOUR responsibility to be proactive in your own health care. This means follow exercise, stress management, nutrition and lifestyle advice. Record what you do and how you feel, try to make a correlation between various factors. If you have a team of health care providers who are willing to work together, use them!

Don’t go too long between treatments! Progress made during a treatment is building on the progress made in a prior treatment. This means that if I’ve treated a client for chronic back pain for a month and we’re seeing some results, if he stretches out the length of time between appointments to 8 weeks instead of my recommended 2 – 4 weeks, it may be like starting all over again. What a waste of money for the client!

Remember, though, that if you start to feel consistently better (and consistent is key), you have the right to say “I’d like to stretch out the time between treatments a few more days, can we try that?” Your therapist can only give you advice and guidance, you have to figure things out what works for your situation.

If the treatment is not helping – find another therapist! Sometimes people feel awkward about ditching their therapist, especially if you have a good relationship with him or her. BUT, it’s your time and money, and you should see results. Sometimes massage therapy is not the be-all-end-all of treatments, I personally find a combination of therapies to be the most effective.

Knowing your rights as a client will prevent you from getting expensive, unnecessary or ineffective treatments, and will enable you to receive treatment that suits your needs.

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

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 and Informed Verbal Consent

What is Informed (Verbal) Consent, and why is it necessary for a massage therapy assessment or treatment?

Ignorance is NOT bliss in the massage therapy profession.

I remember my first few weeks of massage therapy school – making new friends, touching people I didn’t know, and the overwhelming amount of information involved, not the least of which was trying to wrap my head around informed verbal consent.(also known as informed consent) I was more “fortunate” than most of my peers, because I had actually had an awful first experience with massage therapy which, as a student and later a therapist, instilled in me the need to advise my clients of what to expect during treatment.

I swear that the massage therapist who treated me for my very first treatment could have been the poster child for what NOT to do to a new client. He didn’t tell me what to expect, he used pressure so deep I wanted to cry, and he talked about how much he hated his ex girlfriend. Wow, did I ever feel vulnerable, and had I known I could discontinue the treatment I would have. With a first experience like that it’s amazing that I ever went to another massage therapist, let alone became one.

So basically, the definition of informed (verbal) consent is: obtaining client agreement to the impending treatment based on full disclosure by the therapist as to what the client should expect before, during and after the treatment. The client consents on the treatment with full knowledge of what’s going on.

Why is Informed Verbal Consent so important?

There are a few purposes to obtaining informed verbal consent, not the least of which is that the client has a right to know what is going to happen – this is not rocket science. Would you buy a car or a house without knowing the specifications? Probably not. And certainly where a client’s health is concerned, he or she must be presented with sufficient information to make an informed decision concerning the treatment, and then give you permission to do it. Informed consent is about empowering the client through knowledge and trust. This knowledge and empowerment protects the best interests of the client. After all, it shouldn’t take too much imagination to remember how it feels to be lying in a very vulnerable position, mostly undressed, in a closed off room with just you and a complete stranger.

Informed consent helps establish trust between the therapist and the client – which is the foundation of a productive therapeutic relationship. When you say to expect XYZ and the client receives XYZ, then he or she knows you are a person of your word. If a client feels pain during treatment, and you stop whatever you’re doing when you are asked, the client understands that you are there to look out for her best interest.

Informed verbal consent protects the therapist, too. When therapists take the time to advise a client on the various points of informed consent, he or she is ensuring that whatever happens will not alarm, scare or cause undue pain to a client. A therapist should document that he or she received permission to continue with the treatment for each treatment – a simple IVC next to the treatment date should suffice. And therapists should remember that any time any new area or body part is worked on, or different treatment modality is used, consent must be obtained from the client.

What should be included in basic Informed Verbal Consent?

1) The nature of the treatment – tell the client what body parts you’ll be working on, as well as how much pressure you’ll be using. I like to explain to my clients how the will be undraped (uncovered) and that the only part of the body that will be uncovered is the part that I am working on.

I also tell clients to undress to their comfort levels, though it is more effective if I work directly on the skin. If my new client looks unsure, I usually tell him he can leave their underwear on, and I will leave the room so he can undress and get on the table in privacy. I also make sure before I do leave the room that my client doesn’t need any assistance with either.

2) The benefits of treatment – If your client comes in for a relaxation treatment, then a benefit should be that she will be more relaxed and may sleep better. If a person comes in specifically for treatment of an injury, then the benefit of treatment should be the same as the treatment goals – i.e. decreased pain, increased mobility etc.

3) What are the risks and side effects of the treatment? A risk is generally more long term in nature, whereas a side effect is more immediate. For example, a side effect is that a client may be a little “woozy” when he or she gets off of the table, but a risk of a more vigourous treatment is that your client may be a little sore the next day.

4) Advise your client of alternatives to treatment. This is described in the context of massage therapy – for example, if a client presents with scar tissue, you can advise your client that you will be performing Frictions (aka friction massage therapy). In the event that this is too much for your client to tolerate, you should advise that an alternative is to do petrissage and deep kneading to the area.

5) What are the consequences of not having treatment? If a client doesn’t have treatment, then he or she can expect to NOT achieve the goals and aims of treatment and not improve. So, if a client presents with limited range of motion of the right shoulder, and opts out of treatment designed to increase the ROM, then a consequence of not getting the treatment would be no improvement of shoulder range of motion.

6) The client ALWAYS has the right to stop or modify the treatment. Period.

Sometimes clients look a little confused when I say this, so I tell them “if anything makes you uncomfortable in any way, please let me know and I’ll stop what I’m doing. If you feel that you have had enough of the treatment, then we can finish.”

7) Ask the client if she understands what you have told her AND if she has any questions. This presents her with the opportunity to speak up if she is unsure about anything.

8 ) Ask the client if you have her permission to proceed with the treatment as you have described it. This might seem obvious, but you don’t ever want to get caught on a technicality. This gives her the ability to “Yes” or “No” the treatment, enabling you to carry on with confidence.

This is basic informed consent that every therapist should use when treating a new client.

For those candidates preparing for the College of Massage Therapists’ of Ontario (CMTO) certification exams (i.e. the MCQ and OSCE exam), informed consent is a little more involved. (OSCE = Objectively Structured Clinical Evaluation).

Though informed verbal consent (aka informed consent) may seem tedious, once you establish your own way of doing it, it should become second nature to you. And remember, it serves both you and your clients, and builds the therapeutic relationship on a foundation of trust.

© 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.

Massage Therapy and Anatomy – C1, C2 and Arthrology

Question of May 8, 2009 – The C1 and C2 vertebrae are considered “atypical”. Why is this, and explain how the 2 vertebrae relate to each other.

C1 and C2 are considered “atypical” cervical vertebrae because their form and function differ from the other 5 cervical vertebrae.

C1, also known as the ‘atlas’, is a circular ring of bone, which consists of anterior and posterior arches and 2 lateral masses. On the superior surface of the lateral masses are the superior articular facets, on which sit the occipital condyles. This allows for a “nodding Yes” motion of the head. On the posterior surface of the anterior arch is the facet for the odontoid process of C2. (see below).

There are no intervertebral discs between C1 and C2.

C2, also known as the ‘axis’, is somewhat similar to other cervical vertebrae, except for the presence of the “dens” or odontoid process – a bony protrusion which projects upward and articulates with the anterior arch of C1. (it is held in place here by the transverse ligament which attaches on both lateral masses of C1). The axis allows for rotation of the head, as in shaking your head “no”

How is this relevant in Massage Therapy? – This is a very vulnerable part of the body, so understanding the anatomical structures in the area is necessary in the case where a therapist may have clients with a WAD injury (whiplash associated disorder). Clients who may have had a bad slip, fall or accident (car or otherwise) in which acceleration/deceleration occured may have the potential for instability in this area. It is important, ergo, for the client’s physician to give a green light for massage therapy treatment, and then for the therapist to proceed carefully.

Question for today (easier today)

What does the term arthrology mean?

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.