Saturday, April 4, 2015


I collected all my MENTORING TIP TODAY posts from Facebook. They are listed from new to old.   Here ya go:


·        Entry level education in my opinion is cluttered with the concept of multiple styles and specific routines. I think of prenatal massage or infant massage or sports massage as examples. Instead we should be teaching students how find relevant content( is excellent) to adapt. based on condition, medication, stamina, coexisting conditions and so forth. For years, as I have written textbooks, I have gently but consistently pushed for more competency in entry level education. At the same time I have advocated for less focus on adjunct methods and more on critical thinking and ability to adapt massage to client outcomes and unique situations. I have also shown that many methods are not unique, but instead a modification of massage to more specifically target a physiological function - fascia or fluid movement for example. Lets get rid of the clutter in entry level massage education..

·        Part of the problem are all the gimmicks. I have a real hard time with applications that become complicated such as "stone" massage. I teach it and present it in the textbooks as a thermo therapy and mention it as an implement to use during massage but honestly it is so cumbersome to prepare the equipment, fish out the stones, make sure they are not too hot, etc. Heat is nice--what happened to the good ole hot water bottle.

·        We actually do have competency guidelines that can be used. They are from COMTA and I have supported using these for entry level education curriculum design regardless if pursuing accreditation or not. They are good. You can find them on the COMTA web site by searching for Competency Table: under the resources tab.

·        Another way entry level education gets cluttered is by using too many textbooks especially by different authors. I know this may sound self-serving but better to really use a book to its fullest then to have a bunch that are barely opened. In an entry level massage textbook each chapter or unit -depending on the organization should be more than effective for an individual course.

·        .So in my opinion you need a text that focuses on massage application and professional practice and a science based text that covers anatomy, physiology and pathology. I am not a fan of the huge comprehensive A&P texts typically used in college general A&P courses. They are overwhelming and really expensive. I think they should be a library resource. I have written Essential Sciences for Massage Therapy which is a comprehensive but focused and functionally relevant science text targeting massage. Even when students have to take general A &P such as occurs in some community college programs it is helpful to have a functional science course for massage students. I am not the only author with textbooks that fit these criteria. Depending on the science text, an additional muscle skeletal anatomy text and or pathology text may be used so at most 4 books. I use 2- 625 hour ELAP content covered and based on COMTA competencies.

·        Educators : Remember ELAP as you update your curriculum content. -Oh and by the way. Update curriculum content.

·        When providing massage therapy we use mechanical force application to mimic normal physiology. Therefor if we are going to provide intelligent massage therapy we better know what normal is.

·        Simple is usually just as effective as complex--How about that!

·        SCHOOL OWNERS- So I just got off the call with COMTA and the outline of the proposed certified /endorsed curriculum is a great step forward for uniting the entry level educational standards without undermining the uniqueness of each individual program . We need to remember that COMTA is still in the development stage. I will say to school owners out there. In order for any program to be successful there needs to be a critical mass for buy in. Even if in the initial stages it does not seem as if there is an immediate return to the school and even that the workload may increase a bit there are times when it is important to do things because it is the right thing to do.

·        My goodness there are a lot of myths and fear based "rules" about working with women who are pregnant. Most are related to the myth that massage can cause miscarriage. More miscarriage does happen in the first trimester but unless the massage involved pounding on the abdomen massage has nothing to do with it. Correlation vs. causation is the fancy way to say it. True miscarriage is a traumatic event and there is a small possibility that the women, looking for cause, blames the massage because both occurred in the same time frame. This is sad but not a reason to deny women who are experiencing a normal pregnancy.

·        Other really stupid stuff: Massage causes the immune system to attack the fetus. Massage moves toxins to poison the fetus. Avoid massage on the ankles because there are acupuncture points that cause uterine contraction. Common sense people. Learn more about the process of pregnancy and make logical and biologically plausible decision for each individual client. Here are some realistic adaptations. Avoid essential oils since the sense of smell related to hormonal changes is altered and they may smell unpleasant. Hormonal changes do affect the pliability of connective tissue including the ligaments. Caution with stretching. Side lying is likely going to be the most comfortable position as the pregnancy progresses. By the way side lying position is a GREAT position for massage for everyone not just those who are pregnant. I am not a fan of the tables with openings to accommodate the .abdomen. They are too rigid. Lots of bolsters that can be moved and squished around work better. Watch for signs of preeclampsia (look it up on Medline Plus) and refer immediately. This is a medical emergency. Offer the restroom. Do not keep the women in the flat supine position for very long when in the third trimester- the weight and mass of the baby can interfere with breathing and it is uncomfortable for most women. Do not talk about your own pregnancies Ya got to be tough to be pregnancy and give birth. Pregnant women are not fragile- just changing based on the stage of pregnancy. If you are scared then refer. Also massage does not make breast milk toxic.

·        This one is for educators. I think there is a terminology gap related to educational language and how massage therapists who are now teaching understand the language. We have some excellent educators in the massage profession that have not been formally trained in education. There can be a point of confusion when those of use who have formal educational background use unfamiliar terms. If is likely that educators coming from the field are actually using many of the processes but may not have the formal language. Terms that come to mind are formative and summative assessment. The goal of formative assessment is to monitor student learning to provide ongoing feedback that can be used by instructors to improve their teaching and by students to improve their learning-think a quiz or informal hands on assessment. The goal of summative assessment is to evaluate student learning at the end of an instructional unit by comparing it against some standard or benchmark such as a midterm or final exam. Another example is concept mapping. A concept map is a drawing of ideas, information and relationship as boxes or circles, which it connects with labeled arrows. It is kind of like brain storming which most people are familiar with but work with understanding relationship more than solving a problem. SO-- educators, when using terminology that may be unfamiliar to others let’s begin to define the terms within the posts to reach a broader audience and include examples when possible.

·        What is a massage session? A session includes greeting, intake, assessment, the client getting ready, the massage , the client redressing, post assessment and saying goodbye. The hands -on portion of the massage session is only one aspect of the therapeutic interaction. A massage session may be 30 minutes long, 60 minutes long, 90 minutes long, but the actually massage will be less time. Typically 5-15 minutes of a session is allocated to “non- massage “activities. This means that we have to be able to be efficient both with massage and non-massage aspects of the massage therapy session. It is important that you practice time management. The concept of the therapeutic hour as 50 minutes of time spent with the therapist is common in many professions. Scheduling is most easily done “on the hour”. This would mean that a common scheduling for a massage session would be on the hour mark and the actual massage portion would be about 50 minutes. There is ongoing confusion in many areas of the massage therapy practice. For example the concept of the 60 minute session being an example of the therapeutic hour-50 minutes. So the confusion is about session verses hands on the client. Does that mean that assessment time is not valuable. Assessment includes conversation as well as other activities. Education works off of the 50 minute educational hour. So if I pay for 1 hour of education what does that mean. Some of what is being discussed is semantics and terminology. Others have asked-where did the 60 minute massage come from anyway. It is kind of like the 500 hour massage program that is now being altered by ELAP to 625 hours and where did that come from???? My concern is the entry level job market and as educators we have an ethical obligation to make sure graduates can perform in that market. If many of the entry level positions are based on the 50 min. massage than our graduates need to be able to do that.

·        The concept of the 50 minute therapeutic hour is not new. Students should be trained to provide full body general massage sessions meeting the outcome of relaxation in this time frame. And please, when providing a full massage session DO NOT spend more than 10 minutes on the back. The 50 minutes allocated for the massage needs to be efficiently used to address legs back, front and sides including the gluteal area, the abdomen because the low back begins at the linea alba, the anterior and lateral thorax, arms, shoulders, neck, head and face. Do not skimp on the feet and hands and head.

·        Remember ELAP. Following is an example of the use of ELAP terminology. Example: The goal of the massage is to increase the length of the soft tissue in the calf. The massage therapist will choose an anatomical tool (forearm), to apply a force (push and pull) at the back of the leg just below the knee(point of application) using moderate pressure (magnitude) and push the tissue toward the ankle(direction) The applied force loads the tissue causing tension stress and the tissue changes shape due to the strain..

·        Friction and Traction: The Importance of the Feet. Body mechanics for massage begin at the feet. Ground reaction forces at the foot and floor are one of the most important—yet often the most overlooked—aspects of massage application. For our purposes, we can say that ground reaction forces occur when the body pushes into the floor and the floor pushes back, so long as no slipping occurs. Friction is the force that prevents slipping. Traction is required to prevent slipping. Traction is the maximum frictional force that can be produced between surfaces without slipping; this applies, during massage, between the foot and the floor, or in the contact with the client's body.

·        Friction that allows ground reaction forces works for the massage therapist by enabling the pressure exerted during massage to move toward the client's body. Massage should not be performed in bare or stocking feet, because this hinders the ability to perform massage and also is unsanitary. The only way to ensure adequate friction (and therefore the ability to generate force) is to wear shoes that have a rubber-type sole and that can be tied or strapped around the arch (e.g., athletic shoes) Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby, 2013. VitalBook file.

·        When we nourish faith, we find strength to survive, thrive and help others.When we nourish hope, we can endure, create, and plan for our future.When we nourish love, we care, have empathy, and support vibrant life in all its forms and bring respect and strength to support what is right and good. Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby, 2013. VitalBook file.


·        SCHOOL OWNERS AND PROGRAM DIRECTORS. An entry level training program does NOT benefit from lots of textbooks. Students become overwhelmed and books from different authors can be contradictory confusing students .In massage there are 2 distinct but overlapping content areas. Methods/ professional behavior and practice  and Sciences. Each unit or chapter in a textbook becomes a “course book” An entire entry level curriculum should be able to be presented using no more than two or three books.

·        Outcomes not modalities.

·        I was listening to a farmer explain sustainable farming practices through intermingling diversity. He said" Nature resists monoculture and thrives in poly culture." Made me think about massage these days as groups embrace one method or teacher (monoculture) instead of searching and learning how to integrate many methods and teachers into their professional journey. Poly-culture.

·        Recent AMTA fact sheet indicates that over 50% of people seek massage for medical reasons. This DOES NOT mean clients wants you to fix them. It means they want you to help them feel better. They do not want a method, they want an outcome: to relax, reduce stress, manage pain sensations and move easier. I dislike the term medical massage as much as I dislike the whole deep tissue thing. Provide an excellent massage adapted to the client.

·        The connective tissue, myofascial, and trigger point assessment and interventions methods are adapted massage. When combined, these approaches form the basic techniques of many different fascia based methods and neuromuscular therapy. Understand that just because something has a different name does not mean it is a different method. Usually the name of a method is a marketing strategy especially if the name does not describe what anatomy, physiology and pathology is being targeted by the approach. For example, this combination of approaches has been incorrectly called "deep tissue" massage. Pressure is a modifier used to adapt massage application. Deep as a descriptor is much too abstract and is a directional term. There are many layers of soft tissue in any given area all superficial or deep to each other. The name “deep tissue massage” is inaccurate, confusing and should be avoided.

·        Since I have worked for many years with professional athletes and celebrities I can tell you that everyone has a intergluteal cleft, also known as the natal cleft, the vertical gluteal crease, the gluteal cleft and no one is more special than anyone else. It is unethical to name drop or brag about who you have worked with. All clients are important.

·        Study to be able to ask intelligent questions and find relevant information. Avoid excessive memorization of facts. You can look facts up if you can ask an intelligent question.

·        Clients pay for service, results and compassion.

·        Clients really do not pay for modalities unless whatever it is provided results.

·        There are four main evidence informed outcomes related to massage therapy. They are: Relaxation, Stress Management, Pain Management, and Functional Mobility. Relaxation, Stress Management and Pain Management outcomes are directly related to how massage interact with the autonomic nervous system. The approach to massage that is most apt to achieve these outcomes is a general, full body nonspecific, non-painful, pleasurable massage using moderate pressure and moderate drag on the tissue and lasts about 60 minutes. This approach is the single most important skill set you will deliver as a massage therapist. Typically the interaction is to quiet the sympathetic output and support parasympathetic relaxation, restoration and rest. Often called relaxation massage, you may find people who indicate that this approach is only basic and does not take much skill. On the contrary, the ability to intelligently, mindfully and compassionately perform this approach to massage requires great skill and much practice.

·        Terminology changes.

·        Be excellent at delivering a nonspecific full body massage in 60 min. This massage approach should be your palpation and joint movement assessment foundation.

·        Claims made for massage therapy effects and benefits need to be biologically plausible. Biological plausibility refers to cause and an outcome that is consistent with existing biological and medical knowledge.


·        Take care of your hands. Wear gloves out in the cold and when working outside.

·        Learn to read research articles.

·        We are most likely to harm our clients when we are too invested in fixing them.

·        It takes a mixing bowl of assessment information to intelligently provide a teaspoon of intervention.

·        Career focus changes as experienced is gained. Sometimes massage therapists will begin to feel limited or discontented by the environment where they practice massage therapy. Often individuals begin to dislike the practice setting and begin to degrade the value of massage offered in a particular environment. It is likely that these feelings indicate that you have out grown and are no longer challenged by the type and focus of massage in that practice setting. Instead of complaining or being frustrated, get additional training if needed and move on.

·        Pay attention to actions of the Federation of State Massage Therapy Boards

·        Massage is a general system meaning it influences all body systems and functions directly or indirectly in a nonspecific way. This is a good thing.

·        My advice to the entry level educators—get over thinking entry level education content is something unique. We should all be teaching same content at entry level. Quality comes from HOW the information is delivered-NOT WHAT THE INFORMATION IS.

·        The massage profession continues to be misunderstood because of the many unique names for what is really an adaption of massage to more specifically target a particular tissue type or physiologically function. For example, one significant difference between myofascial release and massage is the use of a lubricant. A lubricant reduces drag on the tissues making it hard to move the tissue. Instead, lubricant supports sliding over the tissue. Targeting fascia requires that the tissue is moved into a variety of directions with the tissue maintained in a tension or torsion stress state. If you are going to be a professional it is important to logically evaluate and to use research to prevent being confused by multiple names for essentially the same approach.

·        No CE class replaces experience.

·        If it hurts or strains you to apply a massage application then don't do it. Figure out another way to get the same result. DO NOT injury yourself for a client.

·        I am aware that compensation for massage therapist is a difficult issue. In my most current blog state that I believe $15 per hour on site based on a 40 hour work week for a typical 600-900 hour entry level vocational education is a reasonable starting wage. There are other blogs I have written that can further clarify the issue. My concern is that split compensation common in the franchise industry. - minimum wage is on site and $15 when doing massage. The amount earned each week is then averaged. While gratuities are common in the service industry massage therapy is considered health service and the whole tip issue is confusing. In a typical 40 hour work week it would be realistic to expect a massage therapist to complete 20 -25massage sessions- not 40. If you want to considered this pay rate on a per massage basis that would be $25-$30 per massage paid to the practitioner. Be realistic and compare earnings of other professionals with equal or more education.

·        Many times the abdomen is given only superficial attention during massage—avoid this tendency. This is an important area that deserves effective massage application. The abdomen has an expansive fascial system that influences lumbar and core stability via connection to the deep fascia laterally and posteriorly and abdominal muscle pull to maintain a taut fascial girdle surrounding the entire thorax.

·        This is an important one. All of us are responsible for being informed about what the massage organization are doing, the status of the Model Practice Act put forth by the Federation of State Massage Boards, the process of evidence informed massage practice. We are also responsible to be proactive in the important topics.

·        There really isn't anything brand new or unique in massage and bodywork. It is all recycled. That doesn't mean we shouldn't renew our skills and passion for the work we do.

·        When you purchase a textbook or reference book you are saving yourself hundreds and hundreds of hours of necessary research and fact checking that the author(s) have done for you.

·        Learn to be quiet.

·        When providing massage in the client's home be prepared for the entire family to want a bit of attention.

·        When providing massage in the client's home put a flat sheet on the carpet and set the massage table up on the sheet. This protects the carpet from marks from the table legs or lotion, gel or oil drips.

·        Massage does not always have to fix something. The goal of pleasure is enough

·        STOP OVER WORKING AND STRETCHING ATHLETES. I get so tired of hearing about being sore from the massage. If the client is sore than the massage created inflammation. It really bugs me.

·        Do not spend so much time on the back.

·        Greet clients warmly and professionally.

·        Understand the difference between an assessment and an intervention. Realize general nonspecific massage is assessment but ya have to pay attention. Interventions intend to change something. Out of a 60 minute massage session- 45 min. general massage pleasantly exploring tissue and joint mobility. No more than 10 min of intervention and only if the change relates to client goals.

·        No one owns information.

·        Even when is gets frustrating it is important to believe in the integrity of our leaders and peers. Most people are good and responsible and miss steps are often related to lack of or poor information. Thank you to all who took the time to comment on the Model Practice Act. This event is an example of why we must be diligent and informed. Focus on process--not people.

·        We all have to pay attention to issues around us. We must not allow ourselves to be uninformed be it changes in political issues or massage research or changes in massage based terminology. We are all busy but that is not an excuse.

·        Lots of changes. That is OK. Stay informed. Let situations sort. Avoid getting your fascia in a twist.

·        Every time I revise a textbook I get to fact check myself and challenge my beliefs about massage-- We all need to do this- especially teachers.

·        If you look professional and act professional you will be treated as a processional.

·        Ask for help. Find a mentor. Respect the mentor's time. Be the type of massage therapist they will want to invest time. Avoid being a pain in their acetabulum.

·        Teachers of massage therapy---It is absolutely necessary for all of us to remain up-to-date. Information changes and so must we.

·        Be attentive to professional appearance. What you think looks professional may not look professional to others.

·        At least once a month log on to Pubmed and search for massage related research. Read the abstracts and think about how the information influences your massage practice. Sometimes there are free full text article. Read though and see if you can figure out how the research was conducted.

·        Study anatomy and physiology more than a method.

·        Include the abdomen in the massage and don't spend so much time on the back.

·        More is not better but you do need enough.

·        A really good foot massage makes a difference in the quality of the client's experience. Ya don't have to call it reflexology.

·        This tip is actually from my mentor Dr. Leon Chaitow. I read it in a comment he posted. Soft tissue work involves pulling against restraint much more than pushing against a block.

·        The more complex the client history the more basic the massage.

·        Distinguish theory from facts question validity of what you hear and read. Most of the methods used in massage and bodywork are theory based not fact based. This makes a huge difference in the claims that can be made.

·        Avoid gimmicks and gurus.

·        If you are having difficulty maintaining a retention client base take a good look at yourself. Do you provide excellent massage skills, look and act like a professional, charge a reasonable fee and have excellent client service? All the marketing and advertising will only get clients on the table for the first massage. If they do not rebook the issue often is something you are doing. This is a tough luv statement.

·        Be skeptical of those telling you that you can make a six figure income doing massage. You can make a solid income as a massage therapist but we are limited by the number of clients we can see. Yes there are opportunities for supplemental income from rentals and maybe products but these endeavors take time too.
Finially a new one just for this Blog: Those who walk a path of service will never be paid enough money. Compensation includes knowing you made a difference.