Monthly Archives: September 2013

Should I Massage With Shoes or Barefoot

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Few students and therapists really think about this.  Usually you fall into a routine at massage school, and bitch about it if you don’t like it, but mostly therapists continue doing what they’re used to.

Some modalities require that you don’t wear footwear.  Ashiatsu, pictured above, and Thai massage are examples of massage modalities where you use the feet as tools.  Many therapists don’t practice those styles.  This post is for therapists who normally work on the table and don’t use their feet as tools.  Also, this will answer why some schools require shoes.

If you’re at a school that doesn’t require shoes then it’s probably not a large chain school as they seem more concerned with professionalism.  If you work in a relaxed environment you may also see more therapists slipping off their shoes.  You probably can’t get away with this at a high end spa.  I’m going to present both sides and not pick for you.  YOU’RE RESPONSIBLE for knowing the consequences of your actions.  If your school or job requires footwear don’t mess with them.  When you’re on your own or in a relaxed center you choose.

Arguments for going barefoot.  You didn’t become a therapist so that you can dress up in a suit and sit in a cubicle all day.  We are supposed to be in a relaxed environment and enjoy our work.  Part of that allows us to have different standards on professional dress, listen to soothing music, having candles burning, or whatever creates a nurturing environment for you and your clients.  Going barefoot also helps you feel grounded.  Some clients have a lot of issues they will throw at you, or you may be going through your own things.  Getting to a peaceful place where you are safe and relaxed is important while massaging.  Finally, some therapists feel that going barefoot gives them a better grip.  I don’t like this reason, because I wonder what kind of footwear they’re buying that has such a horrible grip.  Isn’t grip a factor when you choose a shoe.  When I was in the restaurant industry I chose a shoe that gave me a great grip in case the kitchen floor was greasy or wet.  I remember seeing some servers take a fall, and after making sure they weren’t hurt, running around them pointing and laughing.  Well, maybe not in that order.  I don’t require the same grip now, but I still make sure not to get slippery footwear.  If you go this route PLEASE TAKE CARE OF YOUR FEET.  Even if your client is comfortable with your bare feet they don’t want to see your toe jam and dirt trapped under your toe nail fungus.

Arguments for shoes.  It just looks more professional.  Isn’t the industry constantly struggling with professionalism.  Does any other healthcare practitioner take off their footwear.  Can you imagine your doctor or dentist slipping off their footwear as they come in to check you out.  Also, safety and health concerns like a hot stone falling off a client onto your bare foot.  Your employers carpet may look clean, but when was the last time you saw it getting cleaned.  What if the last therapist in the room was barefoot, but they had althlete’s foot.  Your feet could become filthy, not to mention prone clients can sometimes drool.  Imagine effleuraging the back and drool falls onto your foot, or you step in a puddle of it.  Some clients don’t like feet.  Just seeing feet is enough to get them to shut down and you don’t want your client getting offended.  Sure they may never know, but some will open their eyes and not like what they see.  Worse they may not like what they smell.  On the other hand some clients like feet too much.  If a client is excessively pestering you about going barefoot this is probably a red flag that your client is interested in becoming aroused by looking at your feet.  I didn’t become a therapist to get people off, including with my feet, not that my feet would be arousing for anyone.  Shoes offer more support if your day is long, so you don’t start getting foot pain.  It would be ironic if a therapist got plantar fasciitis from massaging.

I’ve massaged both ways.  I get the appeal of being barefoot, but prefer shoes because I like the support and I feel my shoes give me a better grip.  Also, I don’t get lots of pedicures or meticulously clean my feet.  In truth after minimal care, wrestling, and martial arts I’m sure nobody wants to look at my beast feet.  I didn’t mention socks in this post.  They can be a middle ground, but hurt grip.  Whatever you decide make sure to get off on the right foot.  Hmmm, I’m leaving that last line in, but will apologize for it.

How to Make Massage Cream

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I mentioned I wanted to make my own massage cream that used only natural ingredients and gave a good drag for deep tissue work.  I wanted something that would absorb well, have a light scent, a good shelf life, be unlikely to trigger allergies, and should wash out well.  Here’s my chemistry experiment.


These are my five ingredients: grapeseed oil, coconut oil, jojoba, cocoa butter, and beeswax.  I’ve worked with all of them before except the grapeseed oil.  I needed a gentle way to warm them for blending.


Using a water bath is popular.  You place a glass bowl in a pot or saucepan with water.  If using this method be careful of getting water in your cream.  Also, make sure that you have a glove or something to protect your hand when you remove the bowl.


Another popular method of delicately heating something is using a double boiler.  I don’t own a double boiler so I improvised one from a metal bowl on top of a pot with water.  Don’t fill the water so high that it touches the bowl.  You still want the glove or oven mitt.


I’m pretty sure I should have timed out when to put in which ingredient, but I decided to keep it simple and put all the ingredients together from the beginning.  I used a 1/3 cup of each ingredient.  I was worried it might come out too thick, so I went with a small batch for now.  I know that the solid cocoa butter wafers and beeswax have space between them, so they don’t technically fill up the 1/3 cup.


I didn’t boil the water.  I just had the heat on medium.  It was enough to steam the water.  Here the coconut oil and most of the cocoa butter have melted into the grapeseed oil and jojoba leaving mostly beeswax.  It took about 20 minutes to melt it completely on medium.


After it finished melting I poured it into a 20 oz tin with a fork to stir it every fifteen minutes or so.


Here is what I thought was the finished product.  It actually became slightly more solid than this and slightly lighter in color.

I’m happy with this as my first run.  I gave it a small test run.  It spreads the way I want and then begins absorbing allowing me to still slide but with grip for deep tissue work.  In the past I’ve used an all natural cream made from olive oil, beeswax, and coconut oil.  That cream was, I don’t want to say gritty, but maybe felt a little more grainy when I first spread it.  This definitely has a more cream like texture and a little goes a long way.  It matches mostly what I wanted.  The cocoa butter scent is definitely there with hints of coconut oil, but I don’t think it is overpowering enough to be a deal breaker.

To prevent cross contamination of my tin I went to the local restaurant supply and bought metal ramekins a.k.a sauce cups.  Now I can scoop out what I need for each session keeping my tin clean from cross contamination.

This is just a beginning recipe.  Alter as needed and enjoy.

My Favorite Online Massage Forum

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More therapists are getting online and I think that’s a great thing.  When I first became a massage student there weren’t many online resources.  Add that many massage therapists first entered the field because they didn’t want to deal with technology and you see why it took a while for this field to start getting its share of the web.  Now we’re using the internet as a tool.  It allows us to learn things, network ourselves inexpensively through social media, and there are many online programs that help us handle communication, scheduling, and documentation.

I wish I had found a good forum when I was a student.  I don’t know if I would’ve posted.  I probably would just sit back and read all the posts.  It’s nice to hear what other therapists and students experience, struggled with, and how they overcame their mistakes.  My favorite massage forum is

This forum has a simple layout that is easy to navigate.  Most members are very welcoming and you can read the occasional debate.  The posts are also geared toward the professional massage therapist or student.  There is a section for clients to ask therapists questions.  Too many other massage forums are unprofessional or they simply do not have the number of therapists needed to keep it going.  This forum has been around for some time and I even like the layout more than my association’s forum.

Even if you never post please visit as it is a great way to learn more about the field without costing you anything.  Now with facebook groups therapists are not posting here as often, but if you’re willing to dig through past posts you’ll find a lot of information.


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Sa Sa Sartorius!  So many students end up singing sartorius to the rhythm of No No Notorious from Notorious B.I.G.  There are several questions about this muscle that may pop up on your licensure exam.  We’ll explore attachments, actions, and etymology.

Sartorius’ claim to fame is that it is the longest muscle of the body.  Make a note of that, because you may see that question on a school or licensure exam.  This muscle runs diagonally across the anterior femur.  It is also the most superficial muscle of the anterior thigh.  It’s a thin muscle, so despite it being superficial it is hard to differentiate.

The sartorius originates from the ASIS (anterior superior iliac spine) and inserts on the proximal, medial tibia through the pes anserinus tendon.  The ASIS is the bony landmark on your hip that sticks the farthest anterior (forward).  Pes anserinus means goose foot.  It is a special tendon that three muscles, including sartorius, attach to.  The way the tendon splits for the three muscles gives it the appearance of a goose foot… to somebody.  Names are never creative, but sometimes what anatomists see can be.  Sartorius’ actions can actually be explained by what sartorius means.  It is derived from sartor, the Latin word for tailor.


Once upon a time tailors would sit cross legged on their tables while handling their garments.  The actions of the sartorius are hip flexion, hip lateral rotation, hip abduction, knee flexion, and medial rotation of the flexed knee.  I imagine you’re sitting as you read this.  I want you to use your right leg.  We’re going to try to get close to anatomical position.  Start with a straight leg position with the heel touching the ground and your toes pointing up.  Now I want you to flex your hip (raise your lower limb so your foot is up in the air).  Then I want you to laterally rotate your hip (turn your lower limb so that your toes are pointing to the right).  Now slightly abduct your hip (move your lower limb slightly away from center towards the right).  Finally flex your knee (bend your knee until you have crossed your leg across the left thigh).  You have successfully used your sartorius.

I didn’t forget about the final action.  Most students think that you can’t rotate your knee.  Usually you stick your leg in front of you and try to turn your foot out without using the femur.  If you try from a straight knee position you’re correct, it’s impossible.  But if you try while seated you’ll see it’s possible.  I want you to sit with both feet on the ground.  Now lift the heel of one foot up leaving the ball of the foot on the ground.  Begin swinging your heel back and forth, like you’re trying to put out a cigarette with the ball of your foot.  Magic, your knee rotated without breaking.

You can strip this muscle from attachment to insertion using your fingertips or palm.  Sometimes I like to follow this muscle using sun and moon on the thigh.  If this muscle is tight it could stop piriformis from getting a good stretch.

Recap: longest muscle of the body, most superficial muscle of the anterior thigh.  Runs from ASIS to proximal, medial tibia.  Innervated by the femoral nerve and its actions are hip flexion, hip lateral rotation, hip abduction, knee flexion, and medial rotation of the flexed knee.

Characteristics of Emollients

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What you’re looking for in your preferred emollient will depend on your style of massage, clients, income, environmental, and health concerns.  I can’t tell you what characteristics are important to you, but here is a list to consider:

  1. Viscosity:  The thickness of what you’re applying will determine drag, spread-ability, and staining.  If it’s easy to spread it won’t give you drag.  For example oil spreads on great, and gives little friction for a nice Swedish.  Cocoa butter was tough to spread, but gave me plenty of drag for slow, deep strokes.  You know how I love those slow strokes.  There are exceptions like coconut oil which is solid at room temperature, but becomes liquid when applied to the body.  The more viscous the less it will spill.  The less it spills the less you have to worry about washing out.  Some of you don’t care because you’re lucky enough to not worry about laundry.
  2. Absorption:  The more absorption the more you have to reapply.  Too little absorption and you risk the client feeling greasy.  Grapeseed oil is often praised because it is light and absorbs well leaving the client feeling silky after the massage.  If it absorbs into the skin there is less chance of staining sheets and clothing, and there is the health benefit for the skin.
  3. Washing Out:  Therapists that love oil will sometimes stop using oil because of oil stains in sheets.  If this is becoming a problem for you remember to wash often and use hot water.  Don’t misunderstand- even lotions and creams can stain.  It just happens more with oil.  You may consider that coconut oil and jojoba will both wash out well and apply as oils.  The real problem with stains is that they look unprofessional and make sheets smell rancid after time.
  4. Smell:  Don’t get anything that smells strongly, even if you like it.  Ever.  This is for the same reason that you’re told not to wear cologne/perfume in school.  If you use something scented make sure you have a back up.
  5. Artificial Ingredients:  There has been such a push to go green that more emollients are using only natural ingredients.  Remember some ingredients aren’t necessary like artificial fragrances.  However, if you get rid of preservatives then you have less time to use your lotion.  One option that has been around a long time is Santa Barbara Massage Cream.  They only use three natural ingredients- olive oil, beeswax, and coconut oil.  You could also make your own. Or just use oil.
  6. Shelf Life:  Even if you do use a pure oil you have to remember that some oils are unstable and have a short shelf life, like avocado oil.
  7. Allergies:  Some oils are listed as hypoallergenic.  Many therapists read hypoallergenic and think it means that it causes no allergies.  This isn’t true.  It means it’s less likely to cause allergies, but a few will still be allergic.  For example shea butter has some natural latex in it.  My wife is allergic to latex and discovered that stealing my body butter resulted in her having a rash.  That involved some laughing and pointing on my part.  Lot’s of therapists like using wheat germ oil, but those with celiac disease question using it.  It’s preferable to use oils that it’s rare to have an allergy to or have a back up that wouldn’t trigger the same allergy.
  8. Health Benefits:  While you’re working muscles and making them feel better it would be great if you could be using something that will make their skin healthier.  Some oils are high in vitamin e and are great for the skin like wheat germ.  Some oils don’t stand up though.  For example I’ve been scared to order tamanu oil, despite how great its supposed to be for the skin, because of its scent.
  9. Price:  For some therapists using only the best ingredient will do, while others are attracted to using a similar alternative for a fraction of the cost.  Many therapists don’t use jojoba because of cost, but some go halfway by blending.

So I’ve finally decided to make my own.  I want natural ingredients and control over drag.  I’ve heard it’s tough coming up with a blend, so many therapists stick with one or two ingredients.  I’ve mentioned somethings I’ve used in the past.  Also looking at my list and all of the oils, butters, and waxes available I’ve decided on five ingredients.  Grapeseed oil, coconut oil, jojoba, cocoa butter, and beeswax.

I’ve never used grapeseed, but I’ve heard it leaves you feeling silky and absorbs well.  Coconut oil washes out well and many therapist praise it.  The other three I’ve used and hope I can get a good drag out of mixing in the cocoa butter, beeswax, and the jojoba as it absorbs.  The beeswax helps emulsify so the cream won’t separate, and the others absorb well, don’t smell strongly, have a good shelf life, don’t trigger many allergies, and should wash out well.  I’ll let you know how it turns out once I get the ingredients and go mad chemist in my kitchen.

Lotions, Creams, Oils, or Gels

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Most likely you didn’t choose your first lotion.  Many schools provide lotion for students and when it’s free, hey I’m not going to argue against free.  Even after graduating some therapists end up in spas or clinics that provide lotion.  Some spas even require you use the lotion or oil provided and then try to sell it to the client afterwards.  On the other hand, some students start to experiment with different lotions.  Once on their own many therapists start looking for a lotion that suits them better.  This post will look at the different substances therapists use and what traits are important.

There are five categories of substances that therapists use:

  1. Lotions:  This is usually the first substance students use.  It’s harder for students to spill than oil.  This makes it attractive to schools that don’t want to worry about their carpets every weekend.  Currently where I teach students are even told they are not allowed to use oils except in their hydrotherapy class.  Lotions often have a preservative helping them last longer.  Lotions usually absorb best helping clients feel less greasy after a massage, but you may need to reapply more often as you lose too much glide.
  2. Oils:  Oil is at the other end of the spectrum providing the most glide, but may spill and stain sheets.  They also absorb slowly, so therapists have trouble pulling on tissues, and clients may complain of feeling greasy.  Feeling greasy may also be because students pour it on like a kid pouring maple syrup on his pancakes.  Use less and blot with the sheets after.  Often therapists choose oil because they want a pure substance without artificial preservatives like parabens.  Some oils have shorter shelf lives so care must be taken.  Oils from companies like Biotone or Soothing Touch are often blended and still have artificial ingredients.
  3. Creams:  These are popular options.  They make the most therapists happy so many spas and clinics will provide a cream.  They are thicker than lotions and also absorb well, but slower than lotion.  This means you have to reapply less often.  Like lotions you don’t worry about staining (probably stain even less) and can get a good stretch from the tissues.  They don’t pump as well as lotions though, so care must be taken to not contaminate large jars of creams.  Refillable tubes work well.
  4. Gels:  Gels have a liquid consistency, but absorb faster than oil.  When first applied a gel may feel slick like oil, but then absorbs and acts more like a lotion.  It will stain less than oil.  The change in slide requires a therapist more time to get used to, but gives a chance to work superficially to warm tissues and then deeper as it absorbs.
  5. Other:  The above are much more popular.  Some therapists use butters like cocoa or shea.  I have used 100% pure cocoa butter in the past.  It’s pretty solid so you can’t spread it like a lotion.  It smells great and clients love that they don’t feel greasy after the massage.  It can’t be used for a full body.  It gave me great drag for myofascial strokes to a local area.  Some therapists will also use talcum powder.  I’ve heard this gives little slide.

The above are general guidelines.  Even within one category you can find variations.  I’ve heard that Biotone’s Deep Tissue Lotion is horrible for Swedish, but good for local work.

When I started as a student the school gave us Soothing Touch’s Herbal Lavender Lotion.  I’ll never forget the smell, and not in a bad way.  I just felt that I needed to reapply too often, especially on students with dry skin.  So, I went on to try Biotone’s Advanced Therapy Gel.  It gave great glide, especially on my problem students.  I also liked how it worked with leg hair and while giving a Swedish with gloves.  But as I advanced through school and stopped needing to make everyone frictionless I figured it wasn’t right for me.  I started using a slower deeper style.

When I graduated I started working in a rehabilitation setting and used cocoa butter for myofascial strokes and then using Biotone’s Advanced Therapy Lotion to thumbstrip muscles and to make nice.  Eventually I went to spa where they provided Biotone’s Dual-Purpose Massage Creme.  It’s a very popular choice and I used it for some time.  It gives glide without losing much drag.  I decided that I didn’t want a cream with almond oil as its base.  So, I switched over to Biotone’s Herbal Select Creme.  Since I was doing Swedish at the spa I enjoyed this cream that gave me more glide and decided to switch to the Herbal Select Oil.  Eventually I started getting out on my own more and wanted to come back to more drag.  I started using Sacred Earth Botanical Cream which is similar to Dual-Purpose and advertised as vegan.  At the time it was sold in a large pump and I enjoyed using.  Then I wanted something more natural and I started using Santa Barbara Massage Cream.  I enjoy it, but I want to try my hand at making my own cream.  I’ll keep you posted.


Deep Tissue: 10 Tips to Give a Deeper Massage

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New students, especially smaller women, say that they can’t give good pressure.  They’re not able to go deep.  If you think this, you’re wrong.  First pressure is not equal to depth.  I will speak about the difference.  Then I will present some strategies to help you work deeper.  Please understand that depth is not about working harder, putting more muscle into it, or needing to be bigger.  Often I feel deep tissue work is easier than a light Swedish.

Pressure is the force that a therapist uses, hopefully through body weight, not muscle.  The amount of force you use, even if equal, will be perceived differently by different clients.  This perception is depth.  Even the same client may perceive depth differently from session to session.  That’s why agreeing to give the same massage as last time can be a trap.  Students quickly make the link that depth can be achieved through pressure.  Client wants more depth = I need to use more pressure.  It’s not the only way to achieve depth.  How to achieve depth:

  1. Use Pressure: Yes, you already know this method.  Still it is a common way to increase depth, and I must remind you to use body weight, not muscle to increase pressure.  Clients sometimes want deep tissue to be affected deeply for a specific complaint, but mistakenly ask for a full body Swedish with deep pressure thinking they are the same.  Deep tissue relies on anatomical and technique knowledge, not necessarily more pressure.
  2. Master Body Mechanics: If you are going to use body weight properly you must master body mechanics.  This deserves its own post.  If you don’t change your stances, bend your knees, and lean in then your muscles are doing the work.  Goodbye full work day.
  3. Lower Table Height: Don’t limit body mechanics by having your table height too high.  If it is you must muscle it again, and this time you’ll be muscling with weaker muscles.  This is important with larger clients and side lying.  Drop the table down.
  4. Stand a Proper Distance:  If you’re too close to your work then your arms will be bent and cramped.  They’ll fatigue too quickly.  You don’t want to lock out your arms, but you want them to be straight.  If you’re too far from the table then your body weight won’t transfer through your arms, even if they’re straight.
  5. Watch your Tempo:  You must slow down and sink into the tissue to achieve depth.  Remember my rules of giving a better massage.  Don’t bulldoze through tissue.
  6. Use Less Lotion:  If you use too much lotion or oil, then you won’t be able to control tempo.  Your stroke will be too fast to sink into tissue.  Taste the tissue first.  By that I mean palpate to see how much oil the skin already has.  Remember if you use too little salt you can always add more, but once too much is added you can’t take it away.
  7. Use a Sharper Tool:  If your tool is sharper, the client will perceive greater depth.  This is similar to lying on a bed of nails.  If you lie back on a board with ten thousand nails it won’t pierce the skin.  Lie back on one nail and greater depth is achieved.  If you use your whole ulna on the erector spinae, and your client wants more pressure, you lift your arm to use just the olecranon of the ulna.  Without changing the pressure you have changed depth.  Sometimes a client likes the depth, but not the pressure.  This happens when the client feels they can’t breathe because of the pressure on their back.  Change to a sharper tool so you may work with less pressure while maintaining the client’s perception of depth.                                   
  8. Work Muscle Attachments:  Massaging only the muscle belly is doing only a third of the job.  The muscle has an origin and insertion.  These attachments are full of proprioceptors that impact the tension in a muscle.  Work attachments and you may find yourself having to spend less time on the muscle belly.  You may also get better results.
  9. Change Techniques:  Sometimes the techniques you’re using won’t work.  You should switch techniques allowing use of better body mechanics and a sharper tool.  Sometimes the technique you’re using isn’t the most direct way to the tissue you’d like to affect.  For example if you work splenius capitis by the vertebrae then you’ll find trapezius in the way.  You could pressure through it, but don’t forget part of splenius capitis is superficial by the occiput.  Psoas is another example.  Most therapists try to slowly pressure their way through the intestines.  Instead why don’t you sneak in through the side and slide under the intestines?
  10. Stretch Tissue:  I’m not speaking about stretching itself, even though stretching is wonderful.  I’m speaking about elongating the tissue through your massage stroke.  When you’re going through your stroke are you solely pushing on the muscle causing a compression, or are you working the fiber direction trying to stretch the tissue with your stroke?  This is especially good on long muscles.  You have to know your muscles to do this, and you must not use too much lotion, or you won’t have the friction necessary.

Remember sometimes clients lie about how much pressure they can take.  Listen to what they say, but also watch how they respond to your pressure.  Also, just because a client is thin and petite doesn’t mean they will break if you give them a lot of pressure.  Client sets pressure.  Don’t assume for them.


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.