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.

Using the Evidence to Promote Your Practice

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These days it's not difficult to find sources for massage therapy (MT) research information. Pop in on FaceBook and many practices have their own page. Several of them post research articles as a way to promote MT and don't mind sharing (like mine).  Maybe we should define what a research article is. A research article has been peer reviewed and published in a scientific journal. It's usually based on an investigation of a subject the authors were interesting in learning more about and they want to communicate their findings to other interested parties. Here are some great FaceBook evidence resource pages:

• Massage Net
• Evidence Based Massage

Often, you'll hear someone say, off hand, they're doing research on something they're interested in learning more about. This is a form of expanding one's knowledge but it is different than the research we're talking about here. Research in MT uses the scientific method. Additionally, many students are required to write a "term paper", not usually a research paper. A term paper is most often a review of the scientific literature (referred to as a lit. review). There's not usually any actual, hands on research being conducted (although, sometimes there is).

Here is a link from Columbia University that explains the research article format. It's pretty standard and helpful for reading through a research article. Let me just say, it takes a while to fully comprehend what you're reading in a research article. How could you, unless you've been on a research project or gone through graduate school? For the time being, just read through the abstract. The abstract is a summary of the research article. Read the background (AKA the intro) and then skip down to the conclusion. If you're still interested, then see what methods they've used in this study. After the methods, check out the results. Then, it's good to read the intro and the conclusion again (because by now the 'ole brain is clicking). If you're still interested, now's the time to read the entire article.

Why should we care about research anyway; we just want to practice, right? Lots of reasons including:

• Other health care practitioners will take us seriously;
  (because it puts us all on the same page).
• Research helps us understand our work;
  (at a deeper level and it WILL make you a better practitioner).
• You can use research to promote your practice;
  (which is what this blog is getting to).

Research articles provide evidence of the effects of an intervention; in this case, the intervention is massage therapy. Because of the evidence, we can now say massage therapy is effective for decreasing anxiety, depression, blood pressure, and heart rate. We also know there is evidence that MT might be effective for non-specific lower back pain (both sub-acute and chronic). Massage therapy has also been found to increase the weight of pre-mature infants. You can use this information to support and promote the treatment you provide. Potential clients like this data, the bio-medical community respects it and you will gain confidence in your work as a result of knowing the evidence exists (that's how it's most often referred to in science, as evidence, not so much as research).

A few tangible ways of providing the evidence that I've heard other MTs say they've found success with:

A. Printing off the article and providing it to clients in the reception area of your practice;

B. Sending abstracts to clients via e-mail;

C. Taking several abstracts along to doc visits, fitness centers, networking events or where ever else you are trying to establish a MT referral source;

D. Posting it on your FP page, LinkedIn, Twitter, or any other social media site.

Here are two of the top online sources to finding MT research articles:

• Massage Therapy Foundation
• PubMed

You might find the Massage Therapy Foundation (MTF) site easier to navigate the first time around. The MTF site has a wealth of other valuable research information too. Both links ultimately end up at PubMed, which has many science journals and is a good place to get to know if you're really interested in the MT evidence. When you do a search on PubMed, clear the search box (click on the tiny x at the right), type in the area of interest, and massage. For example, you could start by typing: "non-specific lower back pain AND massage." Currently, this search results in 15 articles. If you look to the right hand corner of the page, you'll see you can filter your results further. Click on reviews and you will get the consensus of evidence for the effectiveness of MT on non-specific lower back pain (when I looked today there were three).

Clicking on the link for the reviews, I see one of the three articles that came up has free access to the full article. Click on this link and then look again to the right corner. There you'll see the journal, in this case, Medicina. Follow the link and you'll find the connection to the PDF. This article is written in Lithuanian; yikes, I don't read Lithuanian, do you? To avoid this, go back to the main search page and look for limits at the top of the page under the search box. Here you can narrow your search. I usually do this in the beginning of a search and narrow mine to the last five years of publication, English, and abstracts with free full texts.

Your new research knowledge can enhance your MT practice. Just keep at it, a little at a time, and be patient with yourself; it will come. If you have any questions, shoot me an e-mail, I'll do my best to find you an answer. If you're really gong ho, here are a few more reputable links you can check out:

a. The Cochrane Library
b. Poem 

c. Research Methods for Massage and Holistic Therapies 

Marketing...

...is not an easy task. After finishing my full time research training, the past two years, I've found it necessary to practice build once again (my client base had dwindled from lack of attention to marketing). After reviewing what other MTs had to say on the Massage Professionals website last year I considered running a Groupon ad. Turns out one must have a number of positive reviews on Yelp to be eligible to run a Groupon ad. Now I have positive reviews all over the web, because I've been running my business for a number of years; not to mention a whole page of testimonials on my website. But if you are in practice rebuild mode you must stay current and that means going along with Yelp for the time being. So, I asked several clients to post reviews (some old, some new) and they did; only to have them filtered within a few days. That's five reviews down the drain friends! I've decided not to worry about it and just run an ad on Yelp anyway; I'll get to Groupon, or Living Social, at another time. I also have an ad with Google (who did post my reviews); I appear to be breaking even with them so far.

Here's a crazy idea I've liked better than running ads: handing out cards for half priced sessions to various folks I know socially who won't allow themselves massage with their current finances; like students and young moms. I've also e-mailed clients who aren't regulars anymore and offered them the same deal for specific times and dates. For example, I sent out an e-mail a day or two before at a time I knew was good for them on a day that was slow in my schedule (a last minute fill the slots special). One week I targeted seniors, the next teachers, etc. So far, about one third of these folks have responded and we're both happy. Keep in mind, at half off my regular rates I'm still making double what I would with a Groupon ad. I'm also not undercutting other MTs because these are my clients who haven't been getting massage because of the economy.

I've also followed through with old clients who can afford full price but have gotten out of the habit of wellness massage for one reason or the other (usually they just got too busy). For the past month this has worked out about 90% of the time and they are all happy to be back. These are follow-up things I should have been doing all along but did not make time for while going to school in addition to seeing clients. Any who, I've doubled my clientele over the summer with considerate and respectful folks who are a great fit for my practice. Yes, most of them were my old clients, so they knew me already, but it still counts. I also know that most of the friends I've offered the half off sessions to aren't going to become regulars, but I don't care. They're people I know and like, and they'll tell other people AND it creates momentum in the meantime (it's as good as comping a session). I'm also in the process of joining a site called Hands for Heroes which offers veterans free massage. Hands for Heroes is meaningful to me as I'm a veteran and am happy to support their efforts.

Then of course there are all the social networking groups. I've done this a lot over the years and decided to start with the online groups I'm a member of already. So for me it has been a matter of updating sites and getting back into regular communication with places like LinkedIn and Face Book. This has resulted in a couple bookings and I pay nothing for these memberships. There are also a few local on-line groups; I just haven't made time to re-connect with them yet.

The next step for me is to physically attend a couple local networking events. I plan to soon but first wanted to re-connect with old friends and several practitioners I know over coffee, lunch, or an after hour drink. Supporting each other through cross referral is a great source of increasing both our businesses. I even refer to other massage therapists. It might be the client is closer to the other MT's office, they offer a service I don't provide or a time when I'm not available. I have found however, you must be clear, direct and realistic with how they can help you too, for example, pointing out a modality you provide that they don't. Then it's important to stay in touch with your network so they don't forget you!

Marketing never ends. It's not just new MTs that have to deal with marketing, as you can see, it's us long timers too. If your business needs a pick me up, you know what you have to do, some of the old and some of the new, some tried and some true (not so much a poet and I know it). That reminds me, there are many successful MTs out there who are happy to provide ideas and advise about marketing; Laura Allen for one. She's a business dynamo and among the best; check out some of her videos if you haven't already for more marketing ideas. Yes, that may mean pushing outside your comfort zone as you did when you first started out; big deal, just do it.

Next up: Using research to promote your business.

Next Up

Well, I've completed one additional year of CAM (complementary and alternative medicine) research training through the NIH fellowship. I learned CAM theory and methods of research, along with studies in medical anthropology, ethno-medicine, and bio-statistics. I was also involved with another service learning project that worked with several inter-city resource organizations. My participation with Project Reach continues, as well, as we close out our first year of collaboration with local chiropractors and begin the second with acupuncturists.

This summer has been about healing for me. I worked really hard this past year and felt like my health needed attention. So, I've been slowly decompressing by getting back to a decent sleep schedule, eating right, and getting enough exercise. Time with family and friends has been of top priority too and I've enjoyed catching up with them. I've even had time for fun, and much needed mindless, activities like NetFlix, badly written memoirs of interesting people, and a trip to the coast.

My next focus will be on my practice. I haven't spent time marketing, networking, or promoting it in any way. Thank goodness for a strong client base that has sustained me through this rough economy. I've learned so much from my clients and my practice has always been my real passion. It is through our connection that I continue to grow and why I've pursued higher education in the first place. It is time, however, to practice build once again. There are so many resources out there to help me and I've got a couple methods I'll dust off and reuse. If you have any ideas you're willing to share, let me know, I'd love to hear them; stay tuned.

Exciting Ecuador

Just back from 18 days in Ecuador. A much needed break from school and the Tucson heat where we are losing patience waiting for our monsoons. Lots of rain in Ecuador. Wonderful people and climate. It must be the fruit capital of the world too; avocado and banana trees everywhere; not too mention the sugar cane, papaya, kiwi, and mango's. Obesity is not an issue in Ecuador; neither is smoking. I also noticed a public health campaign targeting litter awareness. Garbage cans with clown faces, garbage trucks with what sounded like Christmas carols resonating from within, and little "no littering" logos on all the food packaging.

I learned as much about their traditional healing as I could while in Ecuador. The first week I was given Guayusa leaves, to drink as tea, for some menstrual irregularity I was experiencing; fixed me right up. Looking it up online I find it is used by the Amazonian Jivaro Indians for a number of issues; including to promote dreams during healing rituals. It supposedly contains caffeine and acts as a stimulant. It had the opposite effect on me and settled me down.

The following week my partner and I got really sick after eating in a local cafe and recovered from a blend of boiled onion mixed with fresh orange juice and honey. It soothed my stomach and opened up my sinuses. The Amazon rain forest has so many medicinal plants, orchids, and other flowers, fruits, and vegetables. What a wonderful place to explore the culture and learn from the Ecuadorian indigenous tribes.

Massage therapy is readily available in many towns and cities in Ecuador. They have skilled therapists, many of whom are certified from other countries. I do not know about Ecuador's MT regulation or requirements. Massage therapy does seem to be appreciated and acknowledged in Ecuador as part of a health maintenance routine. I've noticed that same awareness when in Mexico too; much more than in the US. Just my observations...

Indigenous Healing Practices

Last week was incredible; thrilled to spend so much time in the northern AZ tribal communities. Traditional healing approaches with the Navajo and Hopi are similar to CIM practices; holistic and client centered. I found them to be respectful, gentle, and unassuming people who honor their heritage, are spiritually dialed in, and speak simply and with meaning. I met two massage therapists (Navajo and Hopi), worked on one elderly Navajo women who had recently suffered a fall injury, and found people receptive to massage therapy in general.

At the swap meet in Gallup, New Mexico (which is held every Saturday) I spoke with Pueblo Indians, Ute', and Paiute'; all from Utah. There I found pow wow music, various medicinal plants and herbs, fresh green chilies, and juicy red cherries.

I also got to see some incredible country including the Grand Canyon, Colorado River, Ship Rock, the Hopi Terrace Gardens, Window Rock, and Canyon de Chelly. I learned to sheer sheep too!

Check out the Peach, the Hualapai kids radio station sponsored by Kidstar; they rock! Also, here's a video I made of our trip; complete with peyote songs from a couple navajo locals in the area. Their personal statement on the back of the CD I purchased says "through these songs, we learn to live strong, support one another and have faith thru the Native American Church ways."

CIM Therapies and LBP

Check out this study that considers the unanticipated benefits of CIM therapies on lower back pain. It seems, our work gives people hope and hope heals....you knew that already but it's nice the science guys think so too.

Speaking of healing...I'm spending next week in northern Arizona tribal country on a service learning field project. I hope to observe traditional healing and learn about their use of herbs and other medicinal plants. Details later.

Glad my friends are having fun at the CIM conference in Seattle; go Jan, Jolie, and Rosemary!