MASSAGE Magazine spoke with several experts in these areas to take a dive into each of these core elements, and how understanding each one can help you be a better practitioner of whatever massage techniques you use.
We’ll start with the work of assessment: gathering information from the client about their physical issues and health conditions, then evaluating the client’s needs and deciding on the best possible approach to addressing those needs.
Assessment, said Whitney Lowe, LMT, director of the Academy of Clinical Massage, is one area not focused on enough during most massage therapy education. “Assessment is not taught anywhere near as thoroughly and as comprehensively as it needs to be in a massage school,” Lowe told MASSAGE Magazine. “And consequently, many people have to rely on learning that once they get out of school.”
The need for thorough assessment is also somewhat dependent on the environment in which you are practicing massage; if you are doing mainly Swedish massage techniques for relaxation and stress relief, most of your clients may present with stress and tension rather than any special medical conditions. “But, if you’re treating some type of compromised health condition, especially pain and injury conditions … then [assessment is] very important,” Lowe said. In that situation, “some form of assessment needs to be done every time—because that’s how you’re making decisions about what you’re going to do in your treatment session.”
Assessment should always begin with a thorough intake. A detailed intake form can help you learn more about the client’s needs and possibly contraindications for massage, but building time into your session to go over the form and ask more questions is also important. Find out what parts of their bodies feel tense, stressed or painful, then ask follow-up questions so you can determine the best massage techniques to apply, and if necessary which areas to avoid. You should also inquire about any chronic health conditions so you can adjust your massage techniques if need be.
Critical thinking skills are crucial to good assessment, Lowe said. Massage therapists tend to focus on muscles, he noted, but other body structures and the body as a whole need to be considered. Of course, diagnosis is outside the scope of practice for massage therapists, but gathering information isn’t the same as diagnosing a condition.
“Performing tests, asking questions, palpating things—all those are parts of the information-gathering process,” Lowe explained. “And you may formulate an idea in your head about the nature of somebody’s complaint, but you don’t tell them or announce that they have any particular condition, because that’s when you’ve entered in the process of diagnosis.”
He also recommends doing relevant tests, such as muscle testing, if they make sense for a particular client. Tests should be “done in a way that helps the person with their critical thinking process, and it’s not just a laundry list of tests that you run through,” Lowe said. “Because unfortunately, a lot of times the way assessment is taught is just, ‘Run through all these tests for the shoulder region and that’ll tell you what’s going on with your client.’ That doesn’t really work, because … it’s just not as simple as performing a group of tests. You need to understand, when is it a nerve injury? When is it a ligament injury? When is it a tendon injury?”
So, how can you improve the quality of your assessment? Your skills in this area will grow the more people you massage and the more conditions you see clients present with, but seeking continuing education is also a good idea. In addition to formal education, Lowe recommends learning as much as you can about the conditions you encounter, which will help you ask the right questions and design the best massage experience for each client.
You may think of the human body as muscles, tendons and bones, but massage is also about fascia, the connective tissue that holds it all together.
“Every time you put your hands on the body, you are feeling through one, two, three, four layers of fascia before you get to any muscle,” said Tom Myers, the founder and creator of Anatomy Trains, a method that provides an understanding of fascia and how the body shifts between stability and mobility. “We say we’re stretching the muscles, but you’re stretching nerves; you’re stretching epithelium; and you’re stretching fascia.”
Fascia, Myers explained, has four basic properties: elasticity, plasticity, viscosity and remodeling. Elasticity describes fascia’s ability to elastically recoil like a rubber band, while plasticity describes its capability of being lengthened by sustained stretch, like silly putty or pizza cheese. Viscosity, the changing consistency of fascia, either protects us or makes us sticky depending on the hydration of the tissue—Myers described better-hydrated fascia as having the viscosity of Jell-O, versus less-hydrated fascia being more like putty.
Fascia can also be remodeled—changed over time from the inside. The human body is “remaking your fascia all the time. Your tissue is breaking every time you train, for instance, and that remodeling happens really quickly. A broken bone takes longer to remodel. Your old connective tissue is breaking down and your cells are coming along and saying, ‘Oh, got to repair that part.’ There’s a constant breakdown and repair that goes on in your body,” said Myers.
If you only focus on muscles and don’t address fascia, he noted, the client may enjoy only temporary benefits from the massage. Fascia “will return to its previous state if you only relax the muscles and do not change the length of the fascia,” he said.
Formal research into fascia is still relatively young, Myers added, but improving your understanding of it through continuing education and reading references on the subject will help you provide more effective massage therapy. “Everybody’s fascia is different and we’re only beginning to discover those differences,” he said. “It’s the fabric that holds us in the shape that we are.”
The human body is designed for movement and always in motion, said Bob Lehnberg, a continuing education provider in Body-Mind Centering®, Qigong and other somatic practices, explaining that we experience movement even in the womb, before our nervous systems are fully developed. “Life has a movement,” he said. “Just the ability to sit still and feel the buzz, the magic, the miracle of life within the cells is movement.”
Human movement may feel automatic and simple, but it is a complex series of interactions between the brain, nerves and tissues. As a highly simplified explanation, an article on the Medical News Today website outlines that the brain sends signals, via nerves, to muscles; the nerve signals cause a calcium-based chemical reaction that makes skeletal muscles contract and relax, moving the body. As we grow, various complex coordinations of movement we use frequently, such as those needed to walk, become second nature to us to the point that we don’t realize we are thinking about them at all.
“Movement is a way to inform our cells and a broader range of cells and the different tissues of our body, and different movement qualities inform cells differently,” said Lehnberg. Regular movement practices, such as tai chi or Pilates, work to train the brain and body to move well, efficiently and without injury. Via movement of tissues administered by a trained massage therapist, the brain receives signals to relax tight muscles, easing tension and helping restore range of motion.
“The mind is the director; it creates the image and directs,” said Lehnberg. Then “the mind becomes the witness, and witnesses the experience of the body, and basically the education of the cells.”
Through movement, “We actually grow our cellular intelligence.”
In massage therapy, a deeper understanding of how our bodies are designed to move can help you assess and address your clients’ physical conditions. It helps, in your assessment, to find out more about the movements they perform often, such as lifting objects, sitting with bad posture in front of a computer all day, or engaging in various sports. Knowing the basics behind the muscles, tendons and joints involved in their frequent movements can guide your choice of movement tests as well as your treatment choices. Also, if you have a good grasp of what a healthy range of motion is for various joints, you can more effectively choose massage techniques and use your skills to help restore mobility and healthy function in those areas.
Stretching is, according to a recent MASSAGE Magazine survey, among the top three techniques massage therapists want to learn. Judy Stowers, LMT, CST, CMLDT, owner of Apex Bodyworx in Scottsdale, Arizona, finds it to be a powerful tool that delivers excellent results.
“You could read a hundred arguments for stretching and a hundred arguments against stretching,” Stowers said, “and the overall experience that I’ve had is that when somebody does actively stretch, they feel younger, they feel healthier, they feel happier, they feel more free, they move better.”
Stowers starts her sessions with an assessment, which includes some specific range-of-motion tests as well as feedback from the client on areas of pain or tension. Based on their needs, she assists them with the stretches that will be most impactful, and then gives them access to videos of those stretches to use at home in order to maintain their results between appointments. Encouraging the client to stretch on their own helps extend the benefits of your session work and aids in their ability to help themselves, she said.
“When they start releasing the restrictions in their body and they’re able to help themselves through that process, it’s empowering to them,” Stowers said. She has found that clients who stretch are better able to avoid injury, and that maintaining their flexibility allows them to be more active as they age. Stretching becomes “the gateway for people to avoid injury and just really maintain the fountain of youth through improved mobility and flexibility.”
Clients are much more likely to commit to a stretching program when they know what to do on their own. When stretches are broken down into safe and effective pieces, stretching feels more doable and more enticing, regardless of where they are. “It doesn’t matter if you’re in a hotel room or on the beach or in an airplane, there is a stretch that you can do to help yourself feel better in any scenario,” said Stowers.
“As a therapist, I love seeing the change and the progress that people make when … they follow through and actually do the stretches on their own because they know how good they feel,” Stowers said. “Every client that comes in for stretching loves it—and they rebook.”
While the efficacy of any given massage session is subjective and largely based on how the client feels and moves before and after, we can say with certainty that massage therapy works—because an increasing body of research supports that statement.
“We have data to show that massage does work,” said Robin B. Anderson, LMT, BCTMB, CEAS, MLD-C, president of the Massage Therapy Foundation. “And we can explain it to clients; we can explain it to patients; we can explain it to professionals, and [we are] able to say, ‘This is how it works. This is how it can affect your body. This is how it can have an impact.’”
As an example, Anderson references a three-part series of research studies. “The Massage Therapy Foundation, Samueli Institute, and the American Massage Therapy Association (AMTA) have partnered on a collaborative project for a meta-analysis of massage therapy for pain,” notes the Massage Therapy Foundation’s website. “The results of this collaboration were published in a three-part series in a peer-reviewed journal and discussed at the International Massage Therapy Research Conference May 12-15, 2016 in Seattle, WA.
“The state-of-the-art, comprehensive database houses data from the 99 randomized controlled trials included in a systematic review and meta-analysis that investigated the impact of massage therapy on function in three types of pain populations: 1) populations who would typically visit their general healthcare practitioner with complaints of pain; 2) patients undergoing or recovering from surgical/operative procedures and 3) cancer patients.”
As another example, Anderson points out a 2016 systematic review published in the journal Pain Medicine; it reviewed more than 60 studies of massage therapy and its use for pain management. The review concluded that compared to no treatment, massage therapy should be “strongly recommended” for dealing with pain.
“In my personal opinion … that was such a pivotal revolutionary point for our profession,” Anderson said. She also noted that this and similar research bears out massage therapy as a viable choice versus taking opioid drugs, which have been fueling an addiction crisis in the U.S. for several years.
“People are starting to see [massage] more as a purposeful treatment or modality, as opposed to just something that’s a treat,” said Anderson.
Through a thorough understanding of and honing of your skills in the foundations of bodywork—assessment, fascia, movement, stretching and research—you equip yourself to offer clients massage therapy not only as a stress-relieving treatment, but as a true health care practice.
Allison M. Payne is a freelance writer and editor based in central Florida. Her recent articles for MASSAGE Magazine include “The Self-Employed MT’s Guide to Getting Health Insurance” and “Claim Your Google My Business Page to Get Free Publicity for Your Practice.”
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