Saturday, November 17, 2012


Yes that is a dog on the massage table.  To be an advanced massage therapist you also need to be flexible. 
Advanced massage begins with a goal for the outcome of the massage.  I have been observing myself while giving massage (being my own teacher) though the lens of "advanced massage" and identified that I pay attention. That may seem simplistic but I think this is very important.  Regardless of the goal for the massage (or series of massage sessions) my focus remains pretty solid.  Yes my mind will wander -whose doesn't? However because I know what I am trying to accomplish I stay on track.  I have a massage routine that I tend to follow-not stuck on it but the sequence allows me to be systematic about the assessment process.  The general full body massage that will lead to a state of relaxation ( primary goal) but is also the main assessment for the secondary goals of the session.  For example, I may be working on scar tissue limitations during knee movement. I feel strongly that spot work is limited in effectiveness and almost always provide a full body massage that moves the various tissue layers and moves all the joints. Again to me this is assessment  but to the client it feels like an excellent general massage.  During the massage if indicated I may perform some additional assessments such as a muscle strength test or an orthopedic test.  I do "clean up " minor tissue , postural and movement issues I find along my journey through the massage even if they may not be directly related to the identified goals because often -guess what- they are or involved in some aspect of compensation that no longer is desirable.  You know--might as well pick up the clothes on the floor while on my way to do the dishes-as an example. I don't loose my focus though. If the client goal is less back aching then my massage stays on that path.  I won't go off path in another direction to work on something- only address issues I find along the way.  You can't do everything in one massage for goodness sake! Advanced massage is about know when to quit as well as when to do something.

 I do not use a bunch of " methods".  For example - I don't think in terms of lymph drain, myofascial release, trigger point, energy work, deep tissue and the hundreds of other approaches out there.  I think in terms of how can applying mechanical forces to the body support a more normal function. I have to really understand anatomy and physiology and pathology to function this way.  For example, if something is swollen I want to know why.  Swelling can be a really good thing ya know.  If something hurts I want to know why.  Pain can also be a really good thing, If however, there is too much of a good thing that is now a bad thing. I wonder what massage can do to tip the physiology back toward homeostasis. So, if an area is excessively swollen and if I understand the reason why it is swollen, I may attempt to mimic the normal action of the lymphatic system with a rhythmic pumping action. If tissue is dense and lacking pliability and it is causing problems I might attempt to soften it by kneading and rolling it.  You get the idea I hope.  While doing this I position the client's body so I can most easily get to the area I am working on and apply the forces (ie tension force, compression force, shear force) as easily and efficiently as possible. I am really efficient and seldom need more than 60 minutes to be effective.  Rarely is there a need for the 90 minute massage.

Occasionally the client will endure an uncomfortable sensation such as a burning pulling sensation as I pull on bound down scar tissue or a localized tender point that I might focus on with some inhibitory pressure but it isolated, focused directly on the goal, feels right and is familiar. It makes sense to the client.  Sometimes the client may be a little sore to the touch  in an isolated spot but it is important that the massage does not make the client sore to movement or painful and stiff in large areas.

 I do not use a lot of stretching during the massage.   My research indicates that there is often more potential for harm than benefit. Besides most problems that people stretch for are related to hyper mobile  joint function.  The limits in movement are the body's attempt to stabilize the joint.  I may use localized direct tissue stretching but I am not supportive a aggressive stretching methods.  Passive and active joint movement to asses ROM.- yes. Movement of a joint beyond physiological limits and to anatomical barriers--NO! I use simple muscle energy methods, usually contract relax antagonist contract, and then gently stretch only those areas with hypo-mobility and only look for an increase is 5 to 10 degrees. I mess with increasing the range over a series of sessions and remember the GOAL is the GOAL!  Functional flexibility- good but too loose in the joints- REALLY BAD.

Goals for massage outcomes can be clustered into four categories   Relaxation/pleasure--( really really important), stress management , functional mobility, and pain management.  Often there is overlap but the good news is that a really good general massage with moderate pressure will address relaxation, stress and pain issues.  Mobility goals require the little bit of specific work. Not gobs- just some.

Finally-to be advanced you need to really understand the body as a functioning whole- all the anatomy and physiology together- not just individual muscles. Relaxation, stress and pain goals are related to the nervous system and endocrine system for goodness sake.  To be advanced as a massage therapist you need to put in your time and be your own teacher while doing hundreds of massage sessions. It is important to learn from experienced massage therapists who do not rely on gimmicks and complicated stuff  and want to sell you stuff and most important have practiced massage for years and years.  And to be advanced you have to care about your clients.

I hope this series has been  helpful.

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