Wednesday, January 09, 2019

To Tip or Not To Tip Your Massage Therapist?

Should you tip your massage therapist? A Caring Touch: Massage Therapy, State College
I recently had a client come in for a massage who admitted that she hasn’t really had many massages before. She asked “Is this like a haircut where there is one price listed and then I’m expected to pay a tip on top of that price?” It was an interesting way to put it, but I do get asked this question frequently by clients. Tipping is often something that many people aren’t sure what exactly the protocol is when it comes to massage because massage exists in so many different forms and is used for so many different reasons. 

According to Wikipedia, “A gratuity (also called a tip) is a sum of money customarily given by a client or customer to a service worker in addition to the basic price.  Many times when we hear the term ”service worker” or “service industry” we immediately think of restaurant servers, taxi/Uber drivers, or hairdressers. We tend to view massage therapists in mainly one of two ways: spa employees or health care professionals. This creates an odd divide for individuals who do relatively the same thing. You usually wouldn’t think twice about tipping your hairdresser (service industry) but would never dream of tipping your doctor (health care industry). But ultimately, massage therapists can fall into both categories. They provide a service to individuals, so they qualify as members of the service industry, however they are also responsible for improving your health, so they are also members of the health care industry. 
Should you tip your massage therapist? A Caring Touch: Massage Therapy, State College

Two big things also help make tipping confusion stronger; Environment and purpose. If someone is an employee in a spa, it seems like a no-brainer that, like a hairdresser, you give them a tip. However, if someone providing the same service in a doctor’s office, tipping may not seem as natural. Likewise, the purpose or reasons a person receives a massage can change the perspective as well. Some people get massage purely as a relaxing treat, while others get massage for therapeutic or medical reasons. This can change their perspectives on if a tip is warranted. This is probably the reason I get this question. I work out of a chiropractors office, but I am self employed and my rate doesn’t include gratuity built in. Plus, I may be in a health care setting, but, (at least in the state of Pennsylvania) every massage therapist, even those that work exclusively in a spa setting, has to have a license to practice just like medical professionals.

Should you tip your massage therapist? A Caring Touch: Massage Therapy, State College
So I guess this whole article is a very long-winded roundabout of a very simple question and answer: should you tip your massage therapist? The answer that I give to anyone who asks me is: A gratuity is never required, however it is always appreciated.  Bottom line, massage therapists are members of the service industry. They provide you a service - making you feel good. They also are members of the health care field - so it is their job to make your health and well-being a priority. If you choose to and you feel it is appropriate to tip your therapist (unless their employer or organization specifically forbids it), it is never required but always appreciated. There is no right or wrong answer, it is all in how you view your therapist and the care that you get from them. 

Thursday, December 27, 2018

Should You Talk or Not Talk During Your Massage?

Should You Talk or Not Talk During Your Massage? A Caring Touch: Massage Therapy, State College, PA
Massages are supposed to be a relaxing experience. But does relaxing mean the same thing to everyone? Case in point; one question that I frequently get asked: "Should you talk or be completely silent during a massage?" Well, like many areas of massage, there really isn't one answer because everyone is different, and their needs as well as reasons for coming to massage are different.

One side of the argument says that you should be relaxing during a massage, so that means be quiet, listen to calm, quiet music, and just mentally let yourself enjoy the quiet to allow yourself to relax. The other side of the argument says some friendly banter allows the person receiving the massage to ask questions and get educated about things going on with their body, and can also be a form of relaxation therapy in itself by allowing the client to expend any pent up energy, frustrations, or just basically having someone to talk to.

Sometimes the technique itself can work better if there is talking versus no talking. Cranial Sacral or Myofascial work is more effective when the therapist can quietly concentrate on the sensitive and intricate things they are working on, while something like stretching or deep tissue work might require communication between therapist and client to make sure that the modality is working and not too much, as well as some conversation about what caused the issue in the first place.

I have seen forums and routine questions throughout the massage industry about what other therapists think of this topic. I've seen answers that range from therapists who find it fine to be sociable and chatty, while others state that they prefer to work in silence and have gone as far as to gently tell chatty clients to be silent 'for their own relaxation benefits'.  There are also factors such as the environment or the rapport of the staff that can influence whether talking is discouraged or encouraged during a massage.
Should You Talk or Not Talk During Your Massage? A Caring Touch Massage Therapy, State College, PA

Personally, as a therapist, I believe that it is ultimately up to my client - the person receiving the massage. After all, they are the ones coming to me for relief, healing, relaxation, or whatever their reason. I should allow them to achieve their goals however they need to. Some people do want the silent, quiet relaxation, and it can be a calming, almost meditative session that lets them fall asleep and me to put extreme focus on what I'm doing. Other times, people will ask questions, vent frustrations, relate plans they are excited about, etc. I used to wonder how they were able to relax while being so chatty, but I realized that perhaps they don't have anyone else to talk to so they need an outlet to vent or just enjoy speaking to another adult before they can unwind. In these cases, the talking is therapeutic and relaxing in itself, so I don't discourage it. I do, however, strive to let them lead the conversation or lack of it. The only time I usually try to initiate conversation is when I'm either asking about conditions, giving instructions, or reassuring a fear or concern. I work with many Prenatal clients, and many first-time moms can get concerned with all the strange things that are happening to their bodies, so sometimes I need to reassure them and will sometimes tell them about my own experiences in the same situation to help put their minds at ease and give them a chance to relax.

That being said, I do believe the answer of "to talk or not to talk" is up to the person receiving the massage, and what their goals of receiving the massage are. Sometimes quiet silence is needed and wanted, and sometimes chatting, venting, or letting off steam is just as important to their relaxation and healing. If my client wants to talk, I'll talk, but if they want to be quiet and go to sleep, I'm not going to engage them in deep conversation. I'm there to provide my clients with what they want and need, and everyone's wants and needs are different but no less right or wrong.

Wednesday, December 12, 2018

Self Care: You Have Permission To Stop.

Self Care: You Have Permission To Stop. A Caring Touch: Massage Therapy
Last week was what I call "Hell Week". Hell Week is simply the week that leads up to something big, in this case, the Special Holiday Performance at CPDW, the dance studio where I teach.  Hell Week is usually filled with a heavy mix of rushing to finish costume construction for all my students, keeping parents informed and reinforced on the weekend's schedule, coordinating who needs to be where, preparing to spend 48 hours locked in a theatre, and worry that the performance will go off without any problems. Add on top of that dealing with every day issues such as family, kids that still need to get to everything, husband's work needs, the approaching holidays, and oh yeah, my regular job. It is a week where I live off of daily lists of schedules to keep my brain straight, don't sleep well due to stress,  and drink a LOT of wine. (Yet, when it is all over, I gleefully look forward to preparing for the next one. Go figure.)

So one day last week, I did something very strange for me to do during one of the busiest weeks of the year - I went back to sleep. This week usually includes lots of late nights dealing with work and costumes that can't get done until the kids go to bed. That morning, oldest child had to be up half an hour earlier than usual, so after getting her sent off successfully, and after youngest child was securely sent off on the school bus, I went back to bed and slept for about 2 1/2 hours. After waking up, I felt amazing. My list was still there, and I was rapidly running out of time to get stuff done, but I felt so good, I didn't care. Usually when something comes up that sucks 2 1/2 hours out of the busiest week of the year, it doubles my stress, but when I woke up, I felt great - and realized that it was ok that I felt like that.

Self Care: You Have Permission To Stop. A Caring Touch: Massage Therapy
Also that week, I made a conscious decision not to ride our new exercise bike. Seems silly, but at the beginning of December, I realized that if I kept up with riding through the month, I could hit a milestone 200 rides by Christmas*. I had riding on my daily list of things to do this week, but early on, I realized that riding would stress me out too much if I either tried to squeeze it in, or if I skipped and left the unfinished checkmark on my list. So I flat out decided not to ride at all this week. And I felt good about that. Not about not exercising, but that allowed myself to remove something from my schedule without feeling guilty about it.

I haven't felt so unstressed about decisions in a long time. It has made me realize that stopping is a good thing. It is not easy. I'm the go-go-go type that always has so much going on, I never rest. Despite all the studies and research that say "take time for yourself", "calm your mind for a bit", "it's better for your overall well-being",  how often do we really do that? I know I don't. And if I do, I usually feel guilty about it because I'm not go-go-going, and that is what everyone expects of me, including what I expect of myself. So this Hell Week, I finally gave myself permission to stop.

Why has this concept escaped me for so long? Fear and guilt are the two things that spring to mind immediately. Fear that I won't get everything done, and guilt that I'm not working hard enough to to get everything done. However, looking back at the week - I did get the costumes done in plenty of time. (Enough time to actually repair a bunch when the first design failed). All the kids got where they needed to be, and the world kept turning. And I actually felt physically and mentally good about it. Maybe I really just did need the sleep. After Hell Week wraps up, I generally get sick - maybe my body saw this as an opportunity to ward off the inevitable illness that will hit me sometime in the next 2 weeks (So far, so good - knock on wood).

So from here on out - one of the reasons I'm writing this is to remind myself, come next Hell Week, or whenever, it is ok to stop and take time for myself. And for you - if you need to hear it, You have permission to stop. Whether it is a nap, a detour to a few quiet minutes at your favorite coffee shop, or a weather-permitting walk outside. No fear - it will get done. No guilt - you are not doing yourself any favors by destroying yourself. Nobody will think less of you. Take a little time for yourself because it is ok to stop.
Self Care: You Have Permission To Stop. A Caring Touch: Massage Therapy

*Update: one day later than planned, but I did it!

Thursday, May 03, 2018

Holes Are For Donuts, Not Massage Tables

Every so often, I get a new prenatal massage client who takes their first look at my massage table, then they say, “Oh, I thought you had one of those tables with a hole in it”.

Yes, such a thing exists. There are some massage tables that have a hole or some other indentation cut into them to allow extra room for a belly and/or breasts to extend beyond the flat edge of the table when lying face down. You might look at this and say “Great! Perfect for prenatal massages! Who needs their back worked on more than pregnant women?” And when I first started in massage school, I agreed. - I even started saving up for one of those tables. Then I got some real training.

Every massage therapist should come out of massage school with a basic knowledge of how to do a prenatal massage without hurting the mother or baby. However, there is a difference between a basic education and a specialist with advanced training. One of the first things I learned when pursuing my over 80 hours of advanced prenatal and infant massage certifications was that those table holes are not only not recommended, they can actually cause more harm than good.

How? Well, the human body is not stupid. Since we learned to walk upright, our bodies have learned to adapt to the forces around us, including gravity. The laws of gravity say that a heavy object will pull straight down to the center of the earth. When a pregnant woman’s belly begins to grow, there are muscles under and around the belly, particularly one known as the broad ligament, that knows to grow not only out, but also slightly down, working with gravity to support the growing belly. Now take that belly that is growing out and down, and pivot it 90 degrees as if the woman is laying flat on her stomach. The contents of that belly aren't a solid mass - things move in there, so when the stomach is then put at an angle to be affected by gravity, that heavy belly will be pulled straight down and the ligament that is designed to grow out and down, is now being pulled straight out and up. This can cause a strain on that ligament and ultimately more pain in the belly, hips, and low back.
When baby becomes a plumb line - why "table holes" are not advised for prenatal massage

The second reason this type of table is discouraged is because those holes are a universal size, shape, and location. Pregnant women are not a universal size or shape. The chances that that hole is going to properly fit every pregnant woman are slim to none, so how exactly is squeezing yourself into a hole not made to fit you comfortable (or safe)?

These reasons are why I use a side-lying position with specially designed pillows, bolsters, and wedges that allow a woman to relax in a more natural position with everything properly supported without adding any extra strain to anything. I can still get to the back, shoulders, and every body part that needs work without causing the already tense and strained muscles any more problems.

So why do those tables exist if they cause so many problems? Well, the purpose they were designed for is to allow people with that basic training to work on pregnant clients without having to alter their routines or work with a very limited knowledge of how to do a proper prenatal massage. They are especially found in spas where the therapists are instructed to do massages a certain way within a certain time frame, so the tables allow things to stay “as is” without having to add time to the massages, or provide the need for extra equipment or therapists with special additional skills. They are basically an excuse for therapists who don't have advanced skills to charge more for a "specialty service" without having the skills to back them up. Will those tables cause problems for every pregnant woman? Probably not. However, for something so specialized as a pregnancy massage, do you really want to take a chance? You probably should want to look into a therapist that has the skills and training to do the massage correctly, not what is easiest.

Think of those tables like iPhoto. iPhoto allows you to do some very basic editing of pictures, take away red eye, blemishes, crop, etc. They can take a so-so photo and make it ok and it is a fabulous tool for that. But if you are getting married, and need a professional photographer, what would you think if they only used a cell phone and iPhoto for your wedding pictures? You would probably prefer to hire a photographer that had a real camera, multiple lenses, and used photo editing software that would make the average person’s head spin. Prenatal Massage is the same. You could see a therapist that has a tool to make the job 'easy', or you hire a professional who knows what they are doing in depth and the end results between the two will be very different. There is a difference between “giving a pregnant woman a massage” and “Providing a prenatal massage for a pregnant client”. The difference lies in the skills and training of the therapist as well as the tools used. Leave the holes to donuts.

Side note - I know that there are alternatives to both side-lying positions and table holes such as body-positioning systems and so called “Preggo Pillows” both of these solutions claim to also allow pregnant women to lay face down, but also provide more customized and more moveable support to prevent the strain and other issues I’ve spoken about above. There isn’t as much research on them, however this is where I use personal common sense. When a pregnant woman is laying face down, even with support, she is laying ON her baby - with her whole body weight. Even with support, add in the pressure of the massage on her back, and it can’t seem good for the baby - or comfortable for the mom. However, I know therapists and women who have sworn that these systems are fabulous so I can’t condemn them the way I do table holes, but looking at simple physics and having been pregnant myself and knowing how it feels to 'roll over' on the baby, I personally would never recommend those systems.

Prenatal massage can help the pain that comes with being pregnant - a lot. But just like everything else in the world, products are created to monetize and capitalize on solving problems without actually needing the skills to solve the problem. The health care world is no different. So before you schedule your next appointment in massage - or anything else relating to your health for that mater, don't get blinded by what fancy or trendy tools will be used, but do your homework then decide for yourself if something that looks trendy is the best thing for your health and comfort.

Don't believe me? Here is more info to back me up:

Wednesday, March 28, 2018

What Do We Have To Be Afraid Of?

I am a chronic procrastinator. I've done it since I was a kid. If I had a project or report that was due in a month, I'd be pulling an all-nighter to start it. My procrastination has spilled over into adulthood. Loading the dishwasher - doesn't happen until the tower of dishes in the sink is unbearable. Usually I always have an excuse such as "I'm too busy", "This isn't a priority right now", etc. Sometimes things I procrastinate on cause me to be annoyed, and other things have caused me major anxiety. So recently I've been taking a look at my procrastination to get to the root of why I do it so much. I've discovered I have poor time management skills and I'm a little lazy. I also shut down when I get frustrated, hoping that my defiance will fix the situation which never works. But I have discovered that a small part of my procrastination stems from an odd sense of fear.

I have a window in my massage room that faces the parking lot. I decided that I wanted to remove the blinds and put decorative contact paper on the window to allow more natural light through but keep the window not see-through so I purchased the window film - 5-6 years ago. Then it sat in my closet. Every so often I'd look at it and say "I really should do that project", but always found a reason not to - I didn't have time, I didn't have the right tools, cutting/measuring supplies, etc. Always had a reason.

Finally, the window had enough of my procrastination. I was pulling up the blinds and heard a 'CRACK' before the whole thing fell on my head. The blinds were unsalvageable, so I decided this was finally my opportunity to end the procrastination. As usual, I found excuses to not come in the next day - or the day after that. Suddenly, a new client scheduled a last-minute appointment. Now I was out of excuses and out of time. So I packed up every supply I could think of and went in early to fix the window. Turns out the project went really easily, took almost no time, and ended up looking amazing. The whole staff complimented the result and has been raving about how good it looks since then. Now I look at the window and think "What took me so long?"

So I started thinking about it. I decided that the big thing that was holding me back from doing the project was fear. I was afraid that: 1. I overestimated my skill level in being able to do it so I wouldn't be able to do it right, 2. The end result wouldn't look good and the building owner would be mad at me, or 3. My clients wouldn't like it. I was afraid of failing at the end result so I chose not to pursue it. But did I really have a reason to fear it? Would it have been the end of the world if the window treatment hadn't worked out? I could have found an alternative. I'm good at finding unconventional solutions, so why did I let something so simple stop me? I started thinking about other places that I procrastinate and realized that fear is a big driver. I will put off scheduling meetings because I am afraid I will say something wrong and make a fool of myself. I put off tasks that could potentially cause a conflict. Dishwasher - that's just laziness - I can't blame fear on everything. But why do I have these fears? Is it my personality? Do I have some sort of chemical imbalance? Is it that people have repeatedly told me throughout my life that I will most likely fail and I don't want to prove them right? Why am I afraid of seemingly small and trivial things?

I guess scientists have been studying fear forever and why people are afraid of things, so it is no answer that I can give. The only thing I can do is train myself to recognize when I am using fear as an excuse and try to make myself answer - is this something that really needs to be feared? Is this fear justified? Will there be real consequences if my fear comes true?

How different would our lives be if we didn't let stupid, unfounded fears stop us? The fear doesn't always show up as fear - it can show up and hide itself as lots of different things, so how do we know that our excuses are or aren't fear? Fear is so often portrayed as a weakness, I think people don't want to admit that they can be capable of being afraid. For me, I'm trying to start recognizing this pointless type of fear when I make excuses and trying to ask myself "why am I afraid of this" and "Seriously, what is the worst that can happen, and is that really so bad?" If I start to do this with my routine fears, I wonder if I'll be able to let this spill over into bigger things, and who knows where that can lead?

Wednesday, March 14, 2018

Will a Prenatal Massage Send Me Into Labor?

Massage therapy has many incredible benefits, especially during pregnancy. However I have had pregnant women tell me is that they are in pain, their backs and muscles ache, but they won't get a massage because they don't want to go into labor. There are a lot of myths and old wives tales about how massage can affect the body. Some are based in fact, some are nothing more than urban legends.

So where does this come from? Several places, actually. One of the most common thoughts is based on the concept of accupressure - an generalized term for types of massage that utilize pressure on certain points in the body and that pressure makes things happen in other parts of the body. The fear comes from the thought if any of these points are touched on a pregnant woman during a massage, the body will immediately try to "eject" the baby. This simply is not true. First of all, the points used in acupressure are not that sensitive. In order to do any type of pressure or point work, pressure must be put on the point and held for 3-5 seconds. A simple massage will not make that happen.

This does not mean that acupressure has absolutely no effect on the body. There are a few points that, when pressed at the proper times, may be able to help labor progress and help strengthen contractions, but it can't initiate anything. (I am speaking on this not just from research, but from personal experience: my oldest daughter was 2 weeks late and I was looking at an induction so I spent the whole weekend before that rubbing and putting so much pressure on every point that was supposed to "send me into labor" that I had black and blue marks. Did it work? Not in the slightest.)

Now you may know someone who has had the experience of "she got a massage and that night she went into labor." Well, that may be partly true, but mostly a coincidence. The answer behind this phenomenon is a little less tangible. What happens in this case is that the massage is most likely not what "started" the labor. Instead what the massage did was relax the body and take away some of the physical and mental stresses that the body was under. The human body doesn't like to do anything, especially anything new or big, when it is under a lot of stress, so when the body relaxes and the stress goes away, it allows the hormones and nerves to act like a signal to the body that says  "Ok, everything is good - go ahead with starting that big thing you need to do." So it wasn't the massage that started the labor, the massage relaxed the body enough that labor was able to start.

Having said all of that, I have in my studies met people who claimed that were certified in something called “Induction Massage”. I have tried to look up information on this, but personally I have yet to find anything about this as a technique or a modality taught in a school. I also asked an advanced prenatal massage instructor about it and she had not heard of it either. So I’m not saying that it is completely impossible for there to be a type of massage that can send someone into labor, but as a disclaimer, I have not been able to find any specific information about this particular certification.

There is never anything wrong with a pregnant mother wanting to be super careful about what happens to her body, and going into labor early is way up there in the top “pregnancy fears” for every mom. But the benefits of a nice, relaxing prenatal massage can far outweigh the fear that it will trigger labor. The best way for a mom-to-be to protect herself is to make sure that any prenatal issues or conditions that may have discussed with her doctor are disclosed to the therapist before the massage, and to make sure she is seeing a therapist who is a Certified Prenatal Massage Therapist, not just one who “can do prenatal massage”.  When in doubt - ask the doctor both if massage is safe for this particular pregnancy, and if he/she can give a referral to a properly trained therapist.

Wednesday, February 21, 2018

"Don't your hands get tired?"

Don't Your Hands Get Tired? A Caring Touch: Massage Therapy - One of the questions I get asked most frequently as a massage therapist is "how do you do massages all day and not have your hands get tired?" Well, I never really thought about it until recently. I was in hour 4 of a marathon 8-hour corporate massage day and the I-lost-count-ith person asked me this question. My usual response to this question is "proper training" and a joke then the question usually dies there. But what exactly is it about this proper training that lets me keep using my hands for so many hours at a time without getting tired? There are a few factors involved:

1. Muscles - the right ones
The 'proper training' I refer to means that in learning how to do the actual massage strokes and techniques I use, I have also learned the proper way to do those strokes and techniques. I've learned how to properly hold my hands, move my arms, how to apply pressure by using the right muscle groups and positions. You know how when you ask someone like your spouse to rub your shoulders and they squeeze for a few seconds then complain their hands hurt? That's because they are probably just using their fingers and top parts of the hands instead of the whole palm and forearm muscles - the fingers have smaller muscles than the palm of the hand, so they get tired more quickly. Learning how to use the proper larger muscles to do the work instead of the smaller hand muscles demonstrates how proper training in how to do things rather than trying to replicate what it looks like to do things can really make a difference.

2. Things aren't always as they seem
A Caring Touch: Massage Therapy -
So hands aren't the only thing I actually use to do a massage. Yes, look at any massage video and it appears that hands are the only things being used, however in addition to using my hands, I also use something that can't be seen - gravity and my body weight. I use my hands to a point, but I also use what is called "Proper body mechanics" to press harder and apply deeper pressure without using my actual muscles and therefore not tiring myself out. Yet another benefit of proper training.

3. I have a past...
One thing in my past gives me an advantage to not getting tired doing massages that has nothing to do with proper training. I used to be a professional dancer, which although many people think isn't a big deal, as far as body conditioning and endurance goes, I qualified as an elite-level athlete. I was used to beating my body up with cardio and strength challenges for 12+ hours a day, so standing and using significantly less muscles for multiple hours is not a big deal because instinctively my body is used to a lot more.

4. Proper self care
After many years of beating myself up, massage may be "easy" on my body, but it isn't all easy. I'm significantly older and heavier than I was when I was dancing, plus even though I still teach dance, I am nowhere near keeping up with the cardio work that I used to do, so  I have to rely on other things to keep myself functioning well. Nobody can function in any way if they don't practice some levels of self care. I rest when I can, I massage myself and use heat on my hands when I've had a particularly long day. Massage has left my hands very sensitive especially to cold, so I own multiple pairs of gloves and almost always have a pair nearby to keep my hands safe and comfortable. I get massages myself when I can (not nearly enough - I know, but who follows their own advice?) and I rely on the amazing chiropractors/Applied Kinesiologists at Integrative Health Care Associates that I work with to keep me running. There is much more self care I should be practicing to make things even better, but for now, I'm hanging in there.
A Caring Touch: Massage Therapy -

All in all, there is no one answer to "Why my hands don't get tired". (Although, they do - I'm human after all, but I know how to work with and through the fatigue and how to best treat it afterwards.) The only important thing to know about my hands and massage is that as a properly trained professional, my goal is to provide you with the best, most effective massage that I can give you - using whatever "tricks of the trade" I need to make that happen.