Thursday, October 4, 2012

Massage Therapy Travel Log

Checking out other massage practices is something I enjoy, especially when traveling. It gives me new ideas and it's just cool to see how other massage therapists conduct themselves. This summer I went to Central America and had massages in both Honduras and Guatemala. In Honduras, I stayed at La Casa de Cafe, a B&B in Copan, where two of the staff provided massage for the guests in an outdoor ramada right next to my room. It had a roof with open walls on three sides and billowing white curtains that offered privacy yet allowed the breeze in. The massage ramada was equipped with a sink, lighting, a few shelves for storage and over looked a dewy pasture where cows quietly grazed.

The therapist that worked on me was a local with one year of experience. She'd graduated from a 500 hour program in Sao Paula, which is the nearest city and about an hour away. She listened and honored my request for gradual pressure with no forceful adjustments. Her boss asked me for an honest critique after the massage as she was going through a trial period and he was concerned her pressure wasn't as deep as his current therapist. My reply to him was that was a good thing as his guests more than likely would have various preferences for pressure. A more valued quality in a therapist is their ability to listen to the client and vary the massage according to those needs, which this gal accomplished (even with my limited Spanish and her limited English).
In Antigua, Guatemala, I visited the Prana Holistic Center. They had several massage therapists on staff, as well as a psychologist, chiropractor, and a few other health care practitioners.  Prana had a couple lovely massage therapy rooms and a large yoga area that faced a lush, green, courtyard. They offered a variety of modalities as well as several different yoga classes. They were having a baby class when I arrived, promoted as a bonding time with parents. The owner had two little ones herself and still took the time to show me around and answer my questions, all the while with her youngest slung across her hip.

Another massage therapist, who had worked in different massage centers around the world, visited with me too. She'd been trained in Canada and both she and the owner had graduated from 1200 hour programs. They'd been working as massage therapists for several years and had a more holistic approach with clients.

Although both massage locales were different in their presentation (spa vs. holistic) they tailored their sessions to the person on the table and provided a tranquil, relaxing environment. I hope to go back someday and if you get the chance to visit, don't hesitate.

Sunday, August 19, 2012

The Ergonomics of Parenting

     Lately, several clients have come in with pain issues that might be avoided with a review of their environmental influences. Usually these influencers are related to the work environment but home and family also play a role in ergonomics. Here's an article I wrote several years ago to address some of these issues.

      Ergonomics is the science of making improvements to your work space and daily tasks to more efficiently fit your body and routine.  Its goal is to prevent pain and injury.  How does ergonomics apply to parenting?  Many mothers and grand parents of young children sustain injuries from lifting and carrying them longer than they should.  Once a child starts walking they should be weaned from these behaviors as they can cause wrist, forearm, and shoulder injuries as well as lower back pain to the adult from their repetitive nature.  A better position to address a young child’s needs is getting down to their level by squatting, kneeling, or bending to eye level.  Holding their arm while speaking, hugging them, or sitting down and holding the child in your lap will meet their need for love and attention without increasing your own risk of injury.  The warning signs that can occur in your hands, wrists, arms, shoulders, neck, hips, or back include:
  • Numbness, burning, or tingling
  • Soreness, aching, or tenderness
  • Pain, throbbing, or swelling
  • Tightness or stiffness
  • Weakness or cold
      Using proper body mechanics when you do pick up a younger child will help prevent injury.  Bend your legs, keep your back straight, and then lift.  Position your body squarely in front up them and not off to the side swinging them up to your hip as many moms do.  This throws off your center of gravity and can hurt you.  Carrying your toddler on your hip often throws it out of alignment resulting in pain as well.  Varying positions frequently and switching hips is helpful.  As the child’s weight increases so does your risk of injury.  Putting your child in the car seat is another potential area for injury.  Keep the seat as close to your body as possible as you secure them; leaning out while carrying weight is much more of a load to the lower back.

      Another piece of the puzzle not often thought about in preventing pain and injury, is wearing shoes at home.  Many of us, here in Tucson, have hard surfaces we walk on in our homes such as tile, hardwood, or stained concrete.  Running around barefoot increases your potential for joint and lower back pain as the force from a hard surface with no give compresses the bones and vertebra.  A shoe or slipper offers arch support, shock absorption from the cushioned insole, and protection from the scorpions and spiders that live in the desert with us.  If you’re feeling lower back or hip pain think about these behaviors and how you can adjust to better prevent injury.  This not only makes for a healthier parent, it models safe behavior to your child as they learn and grow from watching you.

Tuesday, May 15, 2012

Goldilocks and the Three MTs

Finding the right massage therapist (MT) can really be a challenge. I know as that's what I've been up to lately and it's taken a bit of effort even for me. I was dealing with shoulder pain and needed more than just relaxation but also didn't want it to become worse as the result of too aggressive treatment. I wanted someone to give me the massage my clients receive; pain free, customized AND with relaxation. Finding the right MT is similar to finding most health care professionals. We want someone in a nearby location we connect to and who has the skill, education and experience to deliver.

Like Goldilocks, it took three tries before finding what I needed in a MT. The first one did not listen well and was too hard. She was all about her advanced training theory in a particular modality (please, we all have advanced training) with the philosophy it has to hurt before it gets better (not true). Needless to say, I won't go back to her again.

The next MT gave a relaxing session but was too soft. She didn't seem to know what I meant when asked to focus on my area of pain (although she'd nodded in agreement). She had a routine and was stuck to it. I may go back to her again at some point, but only if a relaxation massage is in order.

Finally, the third MT was juuuuuust right. She listened carefully to what I told her and used a gradual approach with increasing pressure based on my body's reactions and to verbal feedback. When I needed more pressure I asked for it and she obliged. This MT actually had the same advanced training as the first one I'd seen but a whole different philosophy on approach. I've seen her twice now; after giving her additional feedback regarding the first session she has adjusted accordingly. She's a keeper.

So, here's what I learned from my recent experience that might help you in finding the right MT:

1.     Ask someone you know for a referral. Word of mouth from someone you trust counts for a lot in finding a new MT. This can save you time and expense in narrowing your search.
2.      If you don't have a referral and are starting from scratch, go to the two largest MT professional association provider lists: AMTA and ABMP. They'll give you local therapist’s contact info and list their skills and experience.
3.     Check out their websites to see how you relate to them and find out if they're within your budget.
4.     Call the MT or send them an e-mail asking questions related to your purpose in seeking the massage. Keep the dialog going until you feel you're in good hands. The most important questions I asked after explaining my situation were:
                           "What is your approach to addressing shoulder pain?"
                           "Do you think it has to hurt first to get better?"

              5.   Your appointment:

                       How much availability does this MT have?
                             Does their schedule work for you?
                       Did you complete an intake form?
                       Did you create a treatment plan together?
                       Was it based on your health history/session goals?

                  6.   The treatment session:

                             The MT should ask about your comfort at the start.
                                   Ex: support for your back, feet, neck; room temp.
                             Does draping agree with your degree of modesty?
                             They should check in about pressure during the session.
                             Give feedback.
                                   Ex: "back off a little" or "deeper please."
                             The MT should adjust pressure based on your feedback.
                             Ask questions or remain quiet; you set the pace.

After the session, did you feel attended to or disappointed? You'll know if the MT is someone you can work with after the first visit. In my experience, it’s a combination of the massage therapist   appropriately addressing the pain issue, communication, and adjusting to feedback. As with any client/practitioner relationship, your experience is unique to you. Every MT is different based on their education, technique and experience. Keep trying until you find your best fit. Good luck!

Wednesday, April 4, 2012

Pain - The Ultimate Body Cue

Is this you?
     We’ve all suffered pain; most of us try and avoid it - sometimes to our own detriment. Pain (and it's precursors) should never be ignored; rather, it should guide us. Pain in this sense has a purpose; to keep us from further injury. Take for example, low back pain (LBP). By the time you’ve reached your forties you’ve more than likely experienced some episode of pain, stiffness, and limitation in regards to your lower back. Often this resulted in time off from work, fun activities, and adequate sleep, to say the least.

     Which is why future episodes of LBP should guide your current decision making. If you’ve been raking the yard all morning and your back starts to hurt, do you acknowledge it and stop for the day or push on into the afternoon until the task is complete (regretting it the next morning)? How about road trips? You can drive until the full tank of gas is gone ignoring the dull ache that has slowly started creeping up your spine or you can stop every two hours to fill up and move around. With this change of position you improve your circulation through movement and it will
make a difference to your body.

     Most of us work with computers these days and know what a time suck they can be. Before you realize it, you’ve been sitting there for hours. One way you can deal with this lack of motion is by varying your job tasks so you are forced to get up and move around. Keeping books, files, the printer, even the stapler out of your reach has it's benefits by getting you up and moving. If you have to, set a timer to go off every 30 minutes and then stand for a second, do the been sittin too long shimmy (shift your hips back and forth), and then sit back down. If you’re working on a laptop, try moving it to a higher level, like a counter top or cabinet, where you can stand and work for a while. There are also many sit/stand work options available these days to support these efforts (here's an interesting large scale case study on health care cost savings at a company utilizing adjustable work options).

    Make sure you’re not leaning into the screen either, which can wreak havoc on your neck or upper back as well as contribute to LBP.
The rule of thumb is, your line of reading should be approximately two inches below the top of the screen. Adjust the height of your chair, if you can, or elevate your monitor in some way (text books are good for more than just reading). The point being, don’t ignore your pain or be afraid of it; do let it guide you in your decision making process. For those of you who spend your entire day at the computer, you may be interested in this office yoga or a free download with pop-up reminder exercises you can do at your desk (it's not just for kids). Remember to pay attention to your other body cues too, such as:

  • Numbness, burning or tingling;
  • Soreness, aching or tenderness;
  • Pain, throbbing or swelling;
  • Tightness or stiffness;
  • Weakness, fatigue, or cold.
     Of course, this article has been about physical stressors on relatively healthy individuals. The stress most of us are more familiar with, anxiety, also plays a significant role in contributing to pain (I'll blog about that another time.) I should also mention there's a lot we don't know, both in clinical practice and research, about LBP. The recommendations made here are observations from my own clinical experience with clients and the science literature I've reviewed. However, there is growing evidence that massage therapy has the potential to help you manage both anxiety and pain while increasing your awareness of body cues, thus reducing your risk of injury and illness.