Monday, September 21, 2015

What makes a massage good? What can make it better?

Terminology in the world of massage therapy can be difficult to navigate, even for an experienced massage therapist. Where does that leave the customer? For example: if you know that you have persistent pain, and you want someone to help you get rid of it, what type of therapy will get the best results? Do you want sports massage, deep tissue, myofascial, or trigger point therapy? What are the differences, and do any of them work better than others? Believe it or not, there is no clear science on this. All the hype you see spinning around a certain modality is anecdotal, and is usually created by the people selling that style!

The truth of the matter is that the majority of these titles are legally unregulated. I have a couple of these titles myself, which I earned for completing long and complex continuing education programs. When such titles are proprietary, it is because they are trademarked in order to make money, not help patients. Anyone, even with the most basic education in massage, can brand themselves as any of these things. This is a major problem in our industry, since the customer is left guessing whether they are seeing someone with real practical skills and knowledge.  If I tell everyone to forget about these titles, I'm going to have to attempt to give the customers (and anyone else) a little guidance here.

Massage is more effective when certain conditions are met.
...and this is often contrary to the way our (American) culture looks at massage.

For one thing, you need to have good communication and rapport with your massage therapist. This means finding someone whom you trust and going to them regularly to build a strong therapeutic relationship. Massage is a type of communication between the hands of the practitioner and the nervous system of the recipient, and communication is always more difficult with strangers. With the current focus on getting cheap massages (think Internet deal sites like Groupon) we have started a race to the bottom in this regard. The same goes for spas that focus on the trendy add-on services (think foot scrubs, reflexology, or aromatherapy) rather than the building of therapeutic relationships. The idea that providing more services creates a better experience takes you directly into a quantity of quality model.

Also, massage shouldn't be painful. You have probably heard the exact opposite, and it was probably couched in the myth that massage milks lactic acid out of muscles, or physically breaks up tissue nodules (knots, adhesions, trigger points) through deep pressure. This is simply not true. It bears repeating, massage is a conversation, and painful massage is like trying to improve a conversation through shouting and intimidation. New therapists are often very soft in their approach, and after being reprimanded repeatedly, they either quit massage or learn to give deeper work. If learning to give more pressure is a good thing, when is there too much of a good thing? There is a clear line, and when you have studied several dozen modalities as I have, it begins to emerge as almost universal. Pressure should feel significant, relevant to the goal, and should not exceed that line.

Science, art, or skill?

            There are some basic necessities for any decent massage therapist. Every massage therapist should have a good working knowledge of anatomy, human physiology, and a decent grasp of basic science. Clinical reasoning is absolutely essential and often overlooked. They should have the confidence to evaluate themselves, their practices, and come to rational conclusions about different therapeutic approaches. Also, because our services involve physical touch, an understanding of ethics should not be forgotten once we get into practice. I am increasingly convinced that for best practices, a course in modern pain science should also be required!

I am often criticized for taking too clinical an approach to massage. I am interested in getting a clearly trackable goal for each session and keeping records to see progress. I am quick to read and report what the science shows can and can't be done by massage. I am candid about what I know, what I don’t know, and I am also very dismissive of the many myths and tropes on which other massage therapists continue to cling. Massage is often sold as an intuitive, natural healing art. Healing because it channels some ancient pre-language energy that holistically guides the receiver to better health. I think there is a nugget of truth to that idea. I also think it opens the door to ignoring reality and therefore must be avoided. 

Every good massage will have "non-specific effects" which can cause the practitioner and the recipient to believe it is magical. Research, however, shows that these effects are often fleeting, unreliable, and temporary. One has to have something else behind their approach, or failure and client-shaming are soon to follow. I've heard it said by many other massage therapists. Calling their clients "energy vampires." Saying "that client is so negative, he/she really drains me." Or worse, telling the client that it is their negativity, their inability to let go that prevents their symptoms from improving. This takes me back to the conversation analogy, lousy conversations are not improved by telling the other person that the lousy conversation is their fault. It is up to us, the massage therapists, to guide that conversation back on track, to change the subject when it is obviously causing strife, or to end it when there is nothing to be gained.

The business of massage and other things I don't really know.

I have seen some recent musing about whether we, as massage therapists, have "patients," "clients," or "customers." After 8 years in practice, I honestly don't know. I use them interchangeably for that reason. Every person comes to me with a unique story and a unique set of needs, and I do my best to provide the right service to meet those needs. Some people have chronic pain, some have acute pain, some have anxiety and/or depression, and some just want some time to feel good. None of these are bad reasons to get a massage, and none of these have any greater need for my services than any of the others. Our field has an identity crisis, is it supposed to be a luxury service or a medical practice? I think it is both and neither. Therapeutic touch is too essential to be called a luxury, and too vague and unregulated to called medicine.

Another stumbling block is pricing and frequency. We, as a field, really do not know how much to charge or how often you should get a massage. For certain physical conditions, you have clear limits, but for most people, the sky is the limit. Monthly, weekly, perhaps daily? My answer for this is often, at least as often as you have the desire and the means. Let your body be your guide. What then should it cost: $40, $60, $80 an hour, or more? I value my work, and charge $75 an hour. But then I offer all kinds of price-breaks and discounts and deals to first-time and regular customers. I have often toyed with the idea of making my business a Pay-what-you-will model. I would do it too, if I thought it wouldn't be alienating to those who have been kind enough to see me regularly at full price.

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