Crohnic Condition

“Curiously uncommon” should be a category of massage for some of the clients I see. Being the lead therapist at a clinically based sports massage facility in a one-of-a-kind city like San Francisco, places you in the crosshairs of some less than typical conditions.

A recent entrant into this category of mine was an 81 year old man with Crohn’s disease. Crohn’s is a chronic inflammatory bowel disease that affects the lining of the digestive tract which can lead to the removal of portions of the intestines. He’d had a third such surgery earlier in the year, and I figured he was here for post-surgical muscular tension relief.

Surprisingly, he was in zero amount of pain from the procedure! His chief complaint being the lack of any motivation to eat. His doctor recommended visceral massage but warned him it wouldn’t be a pleasant experience.

No problem. I just pulled out the industry standard massage manual on increasing a client's motivation to eat with a systemic condition. Piece of non-existent cake! There are numerous elements I’m aware of when it comes to proper digestion but none that would exactly target someone’s “I want a cheeseburger” center.

His daughter had accompanied him to ask if she should stick around to help manage getting him home after the intestinal mashing. I reassured her that my approach to massaging the viscera would more than likely lead to him napping rather than surviving the experience. She was visibly relieved and exited the room politely.

I decided to go with my instincts and feel for any soft tissue snags along his intestinal tract to free up the natural movement that’s initiated by swallowing. I also had a secondary strategy to utilize my foodie passion and rhetoric to tickle his auditory appetite center.

The strategy worked and before you know it, we were talking about our favorite home cooked meals and I was locating some productive snags under his belly. Our affinity for one another was undeniable and we shared many laughs. The massage was simple but our conversation was all over the place, and the session came to an end far too soon for either of us.

We’ve had three more session since then and his appetite has returned practically back to normal! As far as curious and uncommon for requests go, influencing someone’s appetite has to rank amongst the most unique I’ve ever heeded.

Family Tries

“Ecstatic” is just about how I would describe my feelings before receiving a massage, but, there are those that might better describe theirs as “forced to be there”. Tough to imagine, I know, but one such instance cropped up with a new client with some deeper family dynamics than I anticipated.

When I greeted him, he looked to be in his late sixties sporting a full head of sleek yet puffy gray hair. He created the impression of having an affection for avoiding a smile and forwent the usual “nice to meet you” pleasantries by getting right down to the heart of the matter.

He’d had neck pain with limited range of motion for many years, but expressed that he wasn’t too hopeful anything could be done about it. With such encouraging rhetoric, I was starting to get the feeling that maybe, he wasn’t too far off.

Once the hands on part of the session began, I wanted to know who it was that incited him to come see me in the first place since he had personally requested me. Before I could ask, he told me he was in Hawaii vacationing with his wife two weeks ago, when he decided to get a massage at the resort spa.

After his therapist felt the knots in his neck and realized her client lived in San Francisco, she recommended a great sports massage clinic she knew about that would be able to help him. He came out fervently to inform his wife of the great news.

She informed him that it was the same place she and her daughter had found that they’d recommended he go to at least three times...each! He didn’t have much to say once she detailed the numerous pains and conditions they’d both walked into my treatment room with that were now, mostly all resolved.

As the session drew to a close, I asked him to turn his neck so he could check the pain and range of motion. With a growing grimace, he relented and said it felt a little better. I asked if he had any questions for me knowing what he might ask.

“When should I come back for another treatment?” he inquired in the most matter-of-fact tone. A no nonsense person like himself gets down to business with no qualms. I suggested he come back sooner than he’d be able to find an opening on my schedule, so he should definitely book the next two sessions now.

He’s now come to see me three times and one of my colleagues once with significant improvements. His smile has ranged from “not there” to “is he grinding his teeth” for each of his visits. As I saw him in the lobby before his session with my co-worker, he pointed to his neck and said in a hushed tone, “it’s better.” A most satisfying review from a such a stoic individual.

17 Years In The Making

Tending to muscles’ aches and pains creates a strong bond with their owners. A sense of responsibility for a comfortable existence grows for these neatly stacked bundles of tissue as we, the practitioner, get to know the person to whom they’re attached.

I can admit that my feelings of empathy for what a client's body goes through run deeper the more I familiarize myself with them. My current PR for longevity with a client stands at 17 years and counting. She’s an artist and we’ve been trading my massage for her artwork for that entire time.

She’d originally come to see me for arm numbness and pain back when she was still moonlighting as a bartender. Amazingly, our client/therapist relationship began as she was going through a major artistic technique change using a palette knife. The thousands of dots and scrapes she applied to canvases would come to define both her work and sources of constant tension.

The first session proved to be fruitful by preventing a follow up visit to her doctor for the explorative surgery he’d suggested a month back. Yikes and thank goodness!

Since then, I’ve seen her at her place near the Palace of Fine Arts, my previous wellness center, my house when I had a dedicated massage space and at the clinic I’ve been at for twelve years every three to five weeks. A dozen of her paintings add life to my home, work and the abodes of my best friends.

She’s been amazing at expressing how the bodywork helps to make her art possible at a comfortable level. Since we started our trade, she’s risen through the ranks of national recognition and her artwork hangs in some of the most respected galleries out there. I don’t mean to gloat, but her paintings could be a major part of my retirement plan, if I’d allow anyone to pry them from my clutches.

My quality of life improves as much by having her artwork in my life as hers does by receiving the massages. My wife and daughters simply adore her vision as much as I do and her husband has benefitted from sessions with me when he’s needed them.

There’s no substitution for how much a relationship that’s been years in the making can enrich your professional career as a practitioner because these muscles are attached to some pretty interesting folks.

The Straw That Broke The Seals Back

Pain is a funny thing if you can get past the fact that it hurts so much. There’s little predictability for it and its genesis can sometimes be a little wonky. For instance, it stands to reason that if you work out too much, you can expect areas in your body to be sore from fatigue. You don’t, however, expect to be sore in places for not working out enough.

That’s what happened to a nine year, recently retired, navy seal who came to see me a few months ago. He’d just been through a short program manager crash course and made a quick transition into the office professional life. His low back, neck and right shoulder were quick to respond to his new found profession by giving him some trouble.

Now, there’s nothing at all odd about office induced pains being birthed, but what was out of sorts was where I had to massage him to find relief. It was his hip flexors, abdominals and anterior neck muscles that were the culprits, which we didn’t come to until the third session. More often than not for desk desperados like this, low back, glute and shoulder muscles are the offenders but our first two sessions had disproven this to be the case.

When you think about it, he’d gone from significantly beyond normal human physical capability to sit-in-front-of-a-desk-finger-jockey in an instant. It’s reasonable to conclude that ‘unique’ would be a trait the source of this ex-seals tension would carry with such a drastic physical exertion shift.

As homework, I told him he needed to physically challenge his body more because it was screaming for greater activity than his keyboard was providing. It pains our body to make exorbitant changes to our physical output routine one way or the other. I also showed him some stretches and self-massage techniques that continued with what we'd accomplished in the session.

After a few more massages, his low back and neck pain had been resolved and his right shoulder was significantly better. I can never predict with certainty what muscles I need to target to turn the tide on a client's condition but half the fun is being challenged in the first place.

Trouble...shoot!

It’s not a frequent occurrence for a client to come in after having had a massage the day prior, agonizing over an escalation in pain they originally came in to have relieved. As fate would have it, two of the three sessions I had the other day were of this variety.

Both client’s surge came after seeing other therapists...phew! I happen to know both practitioners well and they were two of the best I’d ever come across. Clients were known to delay international flights just to squeeze into a session with them, so back-to-back trouble shooting sessions from them was sort of shocking.

The first client left a voicemail at 3:00 in the morning after being woken up by an incessant shoulder pain that started a couple of hours after an “awesome session” with her therapist. Thankfully, she squeezed herself onto my schedule for the very next afternoon moments after someone cancelled a session with me.

The second one was with a client whose spasms were reignited the morning after a session with a therapist I’d personally referred him to see when I wasn’t available. The low back strain we’d slowly been working out over the past few weeks, suddenly spiked to reliably unbearable.

I made sure, with both of them, to get a detailed account on how things escalated. Did the added pain start as soon as the session was over or did it take some time before they could initially feel it? Was it a rapid intensification or a slower buildup before it reached its zenith? Had they experienced pain similar to this before or was it wholly unfamiliar?

I reassured them both that my first priority was to alleviate the symptoms and not try to “resolve” their overall condition. Their heads nodded and shoulders relaxed after hearing me say those words.

I’ve got to imagine that a client or two has found themselves on another therapists table after a session with me in the hopes of mitigating that less-than-pleasant-post-massage-feel no therapist aspires to achieve. I’m of the opinion that, as therapists, we should share a kinship that drives us to never throw our fellow practitioners under the bus with their clients. We’re all doing the best we can with the tools we’ve cultivated.

By the end of both sessions, their resuscitated pain had been quelled by at least half and neither of them felt that a trip to the ER was imminent. Call it what you will; healing crisis, compensatory pain, comes with the territory, or par for the course, pain resulting from a massage session is the biggest, double-horse pill a therapist has to swallow. Don’t feel too bad about it because it happens to the best of us and always look to support your fellow therapist so they’ll do the same for you.

 

 

 

Deja Vu Massage

Every massage is memorable in its own way, but some leave lasting impressions more than others. One such session that included near-failed deja vu on my part quickly rose to become my best first session with a client.

A client was on my schedule whose name was familiar to me because I’d seen him booked with other therapist’s at the clinic. Once I introduced myself, I recognized his smile from the times I saw him exiting therapist’s rooms with that classic post-massage hazy, euphoric grin.

As it turned out, he happened to be one of the clinics longest standing clients, and his beaming smile was coupled with the sweetest personality. He requested a focused low back session with some glute and quad work. I exited the room to allow him to undress and get under the sheets.

When I came back in the room, he was in his speedos, shirtless, and lying face down over the fitted sheet having removed and folded the flat one because it was unnecessary. Impressive. A sign of an experienced massage client. As soon as I looked at his back, there was something quite familiar about it. I couldn’t pin down why, but I felt like I’d worked on it before. “Have we worked together before?” I had to ask.

“No, we haven’t but I’ve been here a lot,” he responded.

My mistake...time to move on, but something wouldn’t allow me to. A sudden feeling of deja vu swept over me and the remembering part of my brain went batty. I felt compelled to ask again, “Are you sure we haven’t worked together before in all that time you’ve been coming in? Because you look so familiar.”

“I’m positive. I’ve wanted to see you for a while now but haven’t had the opportunity to get on your schedule.” His reassuring smile was unwavering.

I tried thinking about something else as I worked on his back for the next five minutes, but I couldn’t shake the feeling of having done this not once but numerous times before. “Look, I know this is going to sound funny but I really think we’ve…” and that’s when it hit me. I’d been staring at his back nearly everyday for years!

A framed photo of an unknown swimmer in a freestyle stroke pose with his back to the viewer hung in the room which the owners had asked clients to pose for years back. “This is you here on the wall isn’t it?” I suddenly blurted out in excitement.

“Yes, that’s me,” he responded with a smile that was half “got caught in the cookie jar” and half “how’d you ever know?”

“I knew I had recognized it, I mean you, from somewhere,” I said in a tone of satisfaction. After staring at his back for so many years, I felt I knew it more intimately than I would with someone I was working with for the first time. The rest of the session felt like I was getting to finally know my long-time massage version of a pen pal. We hit it off beautifully.

I’ve now been seeing him for over seven years and since that initial encounter, he got married and had a daughter. I see his wife regularly, and his daughter holds the distinction of being my youngest client ever when they brought her in some weeks after being introduced to this world. Memorable in its own way as many sessions, unexpectedly, can turn out to be.

On Slanted Table

I don’t often have open disagreements with clients during a massage, but one did surface recently. A client came to me in desperate need of some elbows between his shoulder blades. The intake was nothing more than a quick hello and him pointing to the spot that needed my willing elbows to be placed before I exited the room to allow him to get on the table.

As soon as I came back in the room, he asked me very matter of factly, “Could you please raise the table up a little.” I had to pause for a second to try and make sense of how raising the height of the table would change his comfort level. How was it even noticeable as he lay there?

All I could ask in my momentary confusion was, “What do you mean raise the table?”

“Well, it’s too slanted toward the head and it needs to be leveled,” he responded.

That would make sense, if the table actually had the option to be tilted! But in the ten years of using it, that was never a feature made available to me. “You mean you feel tilted downward towards your head, and you want me to adjust it the other way?” I asked in order to clarify what he was asking.

“Yes,” he said as if it was something he always requested.

“Well, the table doesn’t actually tilt like that. It can only go straight up and down,” I responded thinking that would clear up the matter.

“Okay, but if you could only tilt it just a little, that would be perfect,” he reiterated.

I tried adding hand gestures the second time around thinking the visual element would help. I put my hand out flat and mimicked a tilting motion, “It doesn’t go like this. It only goes up and down.” I raised and lowered my hand as flatly as I possibly could.

His blank look did not reassure me that he was a visual learner either. A light seemed to turn on at that moment, however, and he murmured slowly, “You mean it doesn’t tilt?”

“Exactly, but if you feel that you’re on a slant we can make some adjustments. “No thanks,” he responded.

I was finally able to work on his back and shoulders, finding that spot he had his sights set on. When he turned face up, I said “If it still feels slanted, I can grab some pillows and we can make some adjustments, or you can rotate to have your head on the other side.” He lay face up for a brief moment and said, “I must have been hallucinating because it feels fine now.”

For a moment, it really felt like the first half of the session was going to be consumed by a lengthy discussion on table geometry. Once I was able to decipher his request and then explain the table manufacturers poor vision on the variety of table adjustments made available, I was able to offer up some sort of solution. Amazingly, even after our initial disagreement, he came out and booked himself for that rare next day follow-up appointment!

“Do you want to grab a beer?”

Over the years, I’ve had a few clients tiptoe past my boundary line by asking me to join them outside of the massage room. One of the most memorable instances was more of a “bro-ship” bid than a request for a date, but it still required tactful maneuvering on my part.

I’d seen this client, who came across as somewhat socially awkward in his interactions, a few times for back tension. Even though I noticed his odd demeanor from the onset, my conversations with him still maintained his needs as my priority. He noticed the thorough attention I give to my clients and became somewhat enamored over the bond that was being created between us.

He expressed how his massages had become one of his weeks’ highlights. I saw the writing all over the wall, yet I was still shocked when he popped the question, “Do you want grab a beer, sometime?”

It sounds innocent enough, but it’s the seminal request for starting a bro-ship. Now, I’m not one for avoiding a good connection when given the chance, but this felt like I was being put in a situation I didn’t want to be in. As I contemplated the question, I felt that if I said no, I could be insulting him and risk the chance of hurting his feelings. If I said yes, I might be in a relationship I didn’t want to initiate. I didn’t know what to do.

I followed my instincts and said no. He was taken aback by my answer and wanted to know why I couldn’t join him for just one beer. He said he’d even let me choose the date and time. What he wasn’t aware of was the unspoken client/therapist rule that you don’t generally ask each other out in the massage room. And if you do and get a no, you don’t ask why not and put the other person on the spot.

Does that mean therapists never strike up friendships with clients? Heck no! People become good friends or even end up getting married after meeting each other during a massage. It happens; but at the same time, everyone needs to be respectful of each other’s boundaries.

I saw this client for a couple more sessions and after he made his best attempt at fishing for whether I was more of a wine enthusiast than beer, I politely asked him to see one of our other therapists. It wasn’t easy, and I knew he would feel rejected, but it was beginning to affect my ability to give him a massage. He understood after some added explaining on my part, and I didn’t see him again after that.

It’s not easy trying to manage personal feelings while conducting a massage, but I don’t like sending the wrong message to my clients. Even though a beer is just a beer, unwarranted bro-ships aren’t my thing. My time outside of the massage room is my own, and sometimes I have to clarify that to my clients.

Fart, Snore, Gurgle...Time For An Ice Breaker!

As a bodyworker, you’re never quite ready for the unique sounds a body can make. Unexpected farts that squeak through or loud snores that wake your client mid-snort catch you and your client off guard. The other day, it did so in three consecutive sessions with me.

These potentially embarrassing client scenarios occur all the time, and over the years I’ve learned that ignoring them leaves an air of unspoken tension for a client who knows you probably heard it and would rather you hadn’t.

The first stymieing moment occurred early in my first session of the evening. My client’s stomach let out an audible gurgle that was one part dishwasher two parts squishy putty. Before she could react, I said “It sounds like freeing your hip flexors is releasing your intestinal muscles, too. Good!”

”Oh, I’m glad you’re getting to those,” she responded quickly, seeming to evade embarrassment. My saying something instead of staying silent served as a real lifeline for her before she started to get self-conscious.

The next session involved the all-too-embarrassing fart that made its way through a client's defenses. Once she realized it squeaked through, I was there to immediately rescue her. “Sounds like your body is really doing a great job of letting go.”

“I apologize,” she said meeky.

“Don’t worry about it. It happens all the time when I’m massaging peoples glutes. It’s part of the letting go process,” I said in my most conciliatory voice.

Her body started relaxing again after we both let out a little giggle, and we were able to move on as if nothing had happened. I think it’s good for clients to hear that these are normal occurrences and that they’re no big deal. Recognizing them only reinforces the fact that it’s nothing to be embarrassed about and that you’re not twelve years old anymore.  

As a closing act to my chorus of sessions, a client startled themselves awake with a roaring snore that half the studio easily heard. He woke up mumbling, “Was that loud? I’m sorry.”

“Not at all. Just enjoy and don’t worry about it. You falling asleep is a compliment to the massage itself.” He laughed and went back to his slumber.

When bodies are relaxing, sounds happen. Red-faced reactions are not necessary, however. I enjoy coming up with creative excuses for clients who would otherwise choose to crawl under the table if given the chance. No matter what I say, they’re always appreciative of dodging a potentially stressful situation. Even if my client never says, “Thanks for not making me feel bad for farting,” I know it’s what they’re thinking.

“Hi, I hate massages.”

It’s not often that a client starts the session off by saying “I hate massages,” but that’s what happened to me today. It wasn’t the first thing they said, but it was near enough to the top to take notice.

Initially I felt the session was doomed, but before my face could contort itself into a “What are we doing this for then?” gaze, I asked what sort of experiences she had with her previous massages. She detailed more than one bruising session with unforgiving practitioners that left her worse off than when she walked in. I could understand her affinity for a massage-free existence.

Once the session began, I asked her about the pressure early on to ease her worries that this would not be like her previous encounters. “I’ll be asking you about the pressure as I go through the session so I can make sure I’ve got it right. Is that okay with you?” She answered, surprised to hear the question, “Yes, thank you.”

Once I learned she was a mother of four young children, I felt she deserved some praise just for getting herself to the session. “It’s great that you could take the time to be here. Your kids will be happy to have a more relaxed mom.” I could sense that one session would go a long way in chipping away some of the layers of tension, but regular ones would start to get to those deeper not-gonna-let-go layers that make for more comfortable existences.

“How were you able to carve this time out for yourself with such a busy schedule?” I just had to know.

“I ask my nanny to come early on Fridays when I have something scheduled,” she remarked.

As I got to know her, I discovered an amazing individual who happens to have chronic back pain as a result of caring so much for her family. I wanted her to comeback and not because I needed to fill another appointment next week or meet my quota. It’s a proven fact that the people I see frequently feel more comfortable in their bodies and don’t have nagging pains that they’ve given nicknames to.

I felt compelled to say something. “Why don’t you come back in a couple of Fridays from now. If I can get to your back and shoulders again, I feel we can decrease Spike, the nagging pain that keeps coming up on your shoulder. Take a look at my schedule when you talk to the receptionist to see what I have available. Okay?”

She booked herself for a follow up appointment as soon as she got out to the front desk. As it turns out, she didn’t hate massages after all. She’d just been given ones that were a total mismatch to what she was looking for. Fortunately, my interest in people’s lives led to a more insightful connection with one of the most memorable starts to a massage I’ve ever had.

Professional Skills 101

A successful massage practice comes in many shapes and sizes. From a relaxed spa setting to the high volume corporate variety. The definition of ‘thriving practice’ is different for each of us depending on where we work and our overall goals. Although, I will say, the most successful practices have no gaps where there should be clients instead. 

As you delve into the reasons for the prosperity of accomplished practitioners, inevitably you discover that their success is due to their ability to deliver on our vocations prized professional skills. As dissimilar as our schedules might be, these attributes that represent us best are universal.  

  • Good Listening
  • Being Articulate
  • Professionalism
  • Positive and Polite
  • Adaptability
  • Empathy
  • Confidence
  • Punctuality
  • Humility
  • Ambition
  • Attention to Detail 
  • Problem Solving
  • Emotional Stability
  • Ability to Rebook

These aren’t randomly selected traits that employers look for, although they do, but a conglomeration of what brings clients back to their therapist. 90% of what makes a practice go from ‘there’ to ‘thriving’ is built on repeat sessions with the same people. If those clients know they can expect a session that starts on time with someone who’s confident in their skills and will be empathetic to their needs, then they’ll rebook!

Chances are you’re not going to find a workshop titled “Emotional Stability for Massage Therapists” as much as you wouldn’t find one named “Being Positive and Polite in the Treatment Room.” However, high doses of these is what drives practices to prosperity. In many ways, these are traits that help you achieve success in service oriented careers and in ours, they’re just as essential.

No matter what form or shape my practice has taken, success is rooted in strengthening these essential skills so I can build strong client/therapist relationships. Gaps in my schedule seem to be filled with returning clients and new clients my regulars refer over to me. Inevitably, it turns out to be a comfortable routine I maintain in every environment I step into.