Author Archives: Dan

MBLEx Content Changing

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Eventually most students prepare for license examination.  A few states have their own state exam they administer, but the majority use one of two tests.  These tests are made by two different boards, the NCBTMB and the FSMTB.  Some states allow you to obtain your license by taking the exam from either board.  Florida is one of the states that allows you to take either.  Well the MBLEx created by the FSMTB has decided to change its content effective July 1, 2014.

First I want to review the current breakdown:

  • Anatomy and physiology- 14%
  • Kinesiology- 11%
  • Pathology, contraindications, areas of caution, special populations- 13%
  • Benefits and physiological effects of techniques that manipulate soft tissue- 17%
  • Client assessment, reassessment and treatment planning- 17%
  • Overview of massage and bodywork history/culture/modalities- 5%
  • Ethics, boundaries, laws, regulations- 13%
  • Guidelines for professional practice- 10%

For a more complete breakdown see MBLEx content

The changes include the following:

  • Anatomy and physiology- 12% (reduced from 14%)
  • Benefits and physiological effects of techniques the manipulate soft tissue- 14% (reduced from 17%)
  • Ethics, boundaries, laws, regulations- 15% (increased from 13%)
  • Guidelines for professional practice- 13% (increased from 10%)
  • Healthcare related and medical terminology, currently under anatomy and physiology, will be revised and move under guidelines for professional practice.
  • Common pathologies, under pathology, will be revised

Not massive changes.  Recognize even though anatomy section is shrinking, part of what it’s losing isn’t really gone from the test, just moved to a different section.  Also notice the areas that are increasing.  If you think that your school’s business or professional development courses are just a waste of time then open your eyes.  You need to understand that material to be a successful therapist.  Massage school is too expensive to just burn out after two to three years.  If you want to last longer please take time to develop the business side of yourself.

The largest sections of the test, after the effective date, will be Client assessment, reassessment and treatment planning, followed by Ethics, boundaries, laws, regulations.  Guidelines for professional practice will also increase.  These three sections are where you’ll get scenario and dilemma questions.  The kind that make you think.  If you don’t master your anatomy and pathology you may have difficulty with assessments.  The ethics and practice guidelines sections combine for over a quarter of the test questions.   Is your attention in your professional development class (or whatever your school calls it) adequate?

 

 

How to Check Pressure

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Most schools teach a number scale usually around an optimum therapeutic zone (OTZ) that “hurts so good”.  This is the pressure you give to maximize the benefits of the stroke.  Usually this is a ten scale.  One is feather touch, two to three is palpation, four to six starts to feel good, seven to eight hurts but still feels good, nine to ten just plain hurts. OTZ is when somebody says “oooh, right there!”

A lot of students don’t like to explain the number scale and stop using it.  They resort to “how’s the pressure?”  In response you almost always get a short monotone “it’s good.”  It’s like you fed them a horrible dish and they know you’ll be offended if they didn’t like it.  Staring at them with wide eyes you ask “how’s the hog rectum?”  Sweat dripping slowly down their forehead they answer “it’s good.”  You nod in agreement.  That’s not how it should be.  If you don’t use the number scale at least ask them “do you want me to use more pressure, less pressure, or the same?  This stops them from copping out with “it’s good” response to “how’s the pressure” or “yes” response to “is the pressure good.”

Sometimes clients aren’t honest.  Society taught them not to be honest to avoid confrontations.  You may need to follow up with “could the pressure be better?”  Remember it’s your responsibility to get an accurate pressure level from the client.  And NO you can’t magically feel if you’re at the right level with experience.  Don’t ask too often, but check two to four times during a relaxation massage.  Check more often during a clinical massage.

What are Muscle Knots

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“I’ve got knots in my back,” is a common complaint.  When students get to massage school they learn what knots are.  Well, they think they learned what knots are.  The truth is the explanation you heard was one of several theories.  Don’t believe a theory just because you’ve heard it so often, “it must be true.”  This post is going to explore the theories of metabolic accumulate, trigger points, myofascial adhesion, muscles sliding, and fibrous tissue.

One of the oldest explanations was that some minerals and metabolic waste got left behind and began accumulating.  So you’ve developed a local deposit of minerals and stuff that needs to be broken down manually.  Well the problem is the body is actually very efficient at removing metabolic waste.  Even in sedentary individuals it doesn’t take that long.  This explanation has fallen out of favor.

The explanation that most students probably still hear is that muscle knots are trigger points.  The basic definition of a trigger point is an area that is tender when pressed on and it refers pain towards another part of the body.  Trigger points are actually well mapped out and were considered scientifically accurate, but lately some therapists began looking back and discovered that this was more pseudoscience.  The problem lies with when you ask why does a trigger point develop into a “knot?”  The explanation is that it is a local twitch response.  Not a spasm, because that would involve the whole muscle.  The problem is that even if you’re looking at just a muscle fiber, the fiber does not contract in just one spot, a fiber contracts all or nothing.  I’m not completely throwing away trigger points.  I, as well as many therapists, got good mileage out of using their theories, but it doesn’t completely hold up to scrutiny.

As trigger points fall slowly from use the next most common explanation currently doled out is that knots are actually adhesions between two fascial layers.  These fascial layers are connective tissues that run through and about all parts of the body creating order and support.  If two parts that were supposed to slide past each other get stuck together then you’re going to experience limited range of motion, pain, and a knot.  Fascia has been made popular by structural styles like rolfing and kinesis, and also gentler styles like myofascial release.  I love how slow fascial work feels, but many therapists are questioning if fascia really has the properties it is attributed to have by the above styles.  Turns out fascia probably can’t stretch out to the extent we thought and when you find out one thing is untrue the rest is questioned.  The possibility that cross fibers can reach across adjacent layers seems plausible, especially in sedentary individuals or people immobilized by an accident/trauma.  I imagine this will stay popular for a bit more.

A theory that is getting attention, and may be the next popular one is that a knot is just muscles that overlap.  As you put pressure or manipulate the knot the superficial muscle will slide over the the deeper muscle and you’ll feel a bump slide back and forth under your pressure.  This is probably true for some of the knots you feel.  This explains the knot commonly found by the inferior trapezius as it slides above erector spinae muscles.

Another explanation that makes sense is that a knot is just fibrotic tissue.  It could be especially fibrous muscle or tendon that has extra connective tissue.  This may be due to some sort of stress like poor posture or a repetitively stressful activity.  An example is how common it is to find a fibrotic levator scapula attachment at the superior angle of the scapula.  This could be due to the common head-forward-posture and sedentary lifestyle.

So what’s a knot?  I’m going to guess one of the bottom theories, but only because I want to be ahead of popular and accepted theory.  If you want the most company you’ll want to stick with trigger points.

10 Tips for Giving a Better Massage

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After getting some basics down students start learning about different modalities.  They start wondering which modality they would enjoy receiving and giving.  Inevitably they ask their instructors “what type of massage do you do?”  They want an easy answer of one to two modalities, but that’s not how I think about massage anymore.

What’s involved in my style of massage:

1. Throw away modalities.  When you learn a modality you get a style to emulate and a reasoning why it works.  The truth is we don’t know the real reasons.  Using only one modality is cutting off techniques you could learn or be “allowed” to use.  Don’t restrict yourself.  I didn’t care for my time in the spa when I worried if they asked for Swedish massage for example, I shouldn’t use such and such technique because it is a myofascial technique.  Why can’t I use the stroke that is best at that time for the client?

2. Make sure clients are always comfortable.  If they’re not comfortable then I’m not nurturing trust, and they’ll be tense and unable to receive the benefits of a massage.  Comfortable means I let them know upfront that I’ll accept feedback at anytime about anything that is making them uncomfortable.  It’s my responsibility to empower them to be in control of what happens to their body in my session.  Sometimes clients won’t offer up feedback willingly, so you still have to check in occasionally and prompt them for a response.

3. Leave your ego at home.  To make sure they’re comfortable you can’t bring your ego into it.  I see students and teachers who want to improve, but upon receiving feedback they get frustrated, disappointed, or worse angry.  The moment that happens you just nonverbally said that you don’t really want feedback.  Yeah, you went to school for this and you may “know better”, but it’s their session and body.

4. Don’t plow, allow.  Give yourself time to sink into the tissue.  Don’t just bulldoze through it.  I’m not a fan of “no pain, no gain.”  If they tell you it’s too much, you don’t know better.  You don’t have to go deeper to “work it out.”  They decide what is deep for them and that can change each session.  If they say no, and you don’t listen, I think you just committed massage rape to their tissues. Learn how to check pressure.

5. Understand your anatomy.  This can never make your massage worse.  Understanding anatomy helps you understand pathology.  Understanding musculoskeletal anatomy helps you plan your massage.  It gives you the ability to muscle test, stretch, and work the muscle competently.  You could forget them when you work at the spa and just work the area.  However, if you want the pleasure of seeing your client struggle to walk like a new born fawn, because of an awesome massage, then you need to learn to work muscles from attachment to attachment.

6. Cultivate mindfulness.  Everything is multitasking, no more doing one thing as well as you can…except for us.  Your client paid for your attention.  Most students are hungry to learn as many new techniques as possible.  New strokes are nice, but they only get you to average.  Mindfulness is bringing your attention and awareness to what you’re doing.  Have you ever driven down the highway while thinking about groceries, rent, errands, arguments, and then notice you passed your exit five miles ago.  That is the absence of mindfulness.  While massaging you shouldn’t pay attention to mental chatter or be distracted by your phone.  It’s blasphemous.  Your touch feels horrible and you told the client that some text message is more important than the price they paid. What deserves your attention?  Body mechanics, nonverbal cues from the client, objective data you notice, and time management.  Don’t think you’re doing them a favor by going over time.  You may be making them late while decreasing the amount you earn per hour for massage.  Massage is not a volume business.  Protect what you make per hour.

7. Master flow and transition.  To take your massage up a level you must connect with the client at the beginning, then flow and transition through the massage.  Really it’s the quality of touch that makes the massage, and not the number of techniques you use.  Quality of touch includes relaxed hands.  Don’t jump around the body, and do try to build your strokes on top of each other.  I imagine orchestrating a symphony with each stroke having the purpose of building on the stroke before and also preparing the tissue for what follows.  Since it is so hard to teach, it often comes with experience.  The best experience for mastering connection, flow, and transition is to pay attention while receiving.

8. Slow down.  To continue increasing the quality of your massage you must slow the pace down.  Beginning students don’t know enough techniques.  You worry that your techniques won’t get you through an hour massage.  Eventually you know more techniques than you could hope to use in an hour.  Instead of cutting some out you decide to speed up so that you can fit them all into the session.  That massage sucks.  Use less strokes and slow down.  Even if you’re behind and feeling time pressure- slow down.  Nothing communicates I messed up and you’re getting short changed like a therapist hustling through a body part.

9. Immerse yourself in your new craft.  I was watching Jiro Dreams of Sushi and this chef is at the pinnacle of the sushi world.  He charges $300 a plate, has no appetizers, and you must make a reservation a month in advance.  His advice is to immerse yourself.  Now when I say to immerse yourself I’m not suggesting you go broke taking every continuing education class available.  Yet, you need to continue doing things to improve.  I read about research in the field.  I also read books, blogs, watch videos, and take CEUs that I deem worth it.  Keep increasing the number of techniques you know.  Continue brushing up on your anatomy.  Join an association that will keep you current.

10. Be professional and personable.  I never want a client uncomfortable on my table.  When I’m with friends I may act inappropriately, but not when I’m working.  You don’t know who you might offend.  That doesn’t mean that your client wants a robot.  You want to give clients a reason to come to you over another therapist.  You think that other therapist isn’t going to smile, give a decent massage, and offer water at the end.  What sets you apart?  Preferably both your massage skills and personality.  You need to learn the balance that gets people returning to you.

What’s that?  You still want to know what kind of massage I give.  Let’s just call it that slow cooked, melt off the bone, style of massage.