I don’t get ranty very often (or at least not online) but I will expound on these topics here. I have opinions and if you ask, I’ll share.Being here at the blog is like asking for my opinion so buckle up.
1. Perfect is a myth. There is no perfect modality that will work for everyone. There is also no modality you “need.” You need your hands, and your brain.
Any modality or technique may work for one person and not another. Or may work for someone one day and then not work well again. Everything we do is input into the nervous system and the nervous system likes input that is safe, but novel. So be predictable and creative at the same time and you’ll be fine. ;) That might sound contradictory or difficult but it’s actually simple. (Notice I didn’t say easy…nothing about manual therapy is easy!)
You already have the skills you need to treat anyone that gets on your table. You have your hands and your brain. If you learn to listen to their body, ask good questions, think critically and get creative with your input, you can have a successful treatment for 99% of patients. And you can stop chasing all the modalities.
2. Ditch the formula. There is no A + B = C in massage.
Formulas are simple, people are not! The sooner you get comfortable with complexity, the better for you and your patients. When you went to school, you probably learned something like this. This condition has these symptoms, and this time frame for healing, treat it like this and expect these results. This is a great starting point, but it’s not the end game. Very occasionally, people show up like this. But so often they don’t present or respond like they “should.” Probably because there are a million other factors interfering.
So what do we do with this? Start with understand the nervous system, how it takes in input, processes it and generates an output. Factor in stress, environmental conditions, their support network,their other conditions, nutrition, inflammatory load, and then another dozen factors. Treat with compassion and awareness. Be humble enough to ask if something feels better, the same, or worse. If your current treatment plan isn’t’ helping them, change it up! Trial and error (and correction) will get you farther than any black & white formula ever will.
3. Safety First, second, third…and last
A safe feeling nervous system allows change. If your patient is hanging on in high alert mode, their system wants to protect and change feels like a threat, Nervous System safety is where massage starts and ends. It’s the only thing that matters. Is that an overstatement? No it’s not and I’ll fight you on this one. The state of the nervous system determines everything about how the experience of the world.
No matter how you treat, what your focus is, what modality you are using... if your patient doesn’t feel safe, nothing works as well as you want. Learn to notice their safety signs. It’s better for them and more effective (and less work for you!) By the by, this doesn’t mean you have to be fluffy and gentle and wave feathers over them. Therapeutic,sports, lymphatic, parasympathetic, cups, hot stones, scraping, exercise…treat however you want, but make sure their system tolerates the input and responds well.
4. Before you add pressure…add attention,and novelty.
Working harder and firmer and deeper isn’t always the answer. Your patient might think that’s what they need, but maybe it’s because they want you to overwhelm the noise in their head with physical sensation. If you can draw their attention to the work in another way, they might shift without you having to get your elbows out or injure your thumbs.
Studies (and experience) show that when your patient is paying specific attention to the work, you get better outcomes. Try any of these tools!
- Ask them to notice the tissue, describe how it feels with specific words
- Ask them to notice the sensation of the work you are doing, describe it to themselves
- “Bring your attention to this area, notice the sensation, take 3 deep breaths and notice if it changes.”
- Ask them to compare one side of the body to another, or one region to another.
- Ask if the tissue feels better, the same or worse after you try a technique.
- Vary your pace or pressure and have them choose what they like
- Have them imagine your hands are drawing lines or moving light around the tissue.
Novelty! The brain loves novelty, as long as it’s still safe…(don’t surprise them with something weird and dramatic!) Try different sources of input. Remember those mechanoreceptors you learned in school? And thermoreceptors? Remember the proprioceptive system? Of course we do. Here are some tools I use all the time:
- Stretch the skin. (All the things you learned as fascial techniques, done gently and held for 90 seconds or so)
- Vibration (your hands, or a massage tool)
- Still compressions
- Affective touch (slow and light pressure)
- Heat and cold
- Movement around a joint, passive, active, and/or r esisted: get that proprioception fired up
- Rocking (great for the vestibular system)
- Pressure: of course you can use more (or less pressure). Some people thrive with firm pressure, it’s just not the only tool!
5. Trauma informed work is for everyone!
All the skills and the mindset you learned in your education or that trauma informed course you took are necessary for every patient (Haven’t taken an extra TIM course? Stop reading and go take one. I promise you won’t regret it)
It’s not just a patient with PTSD that needs the extra consent, creative treatment techniques, super patient-centered approach and the work of creating safety. It’s everyone! Life is hard, people are masking all the time…be the place they can put down the mask, the mental load and the pretending. Allow them to be honest about their pain, stress, what they want out of treatment. Offer them a silent treatment so they don’t have to fill the space with words, let them listen to a podcast or audio book so they can stop ruminating in the quiet, tell them they can leave their clothes on if they want, or stay covered under the sheet/blanket for the whole treatment. Let them direct the session as much or as little as they want. Give them total autonomy or take on the mental work of decision making, both can be trauma-informed approaches.
6. Get some help for yourself.
Here’s an extra one for you blog readers. Don’t carry it all alone. Massage is hard work. Get some support. Talk to a counsellor, get a massage for yourself, have a night with friends to decompress, tend to your own nervous system. Here are a couple of things you can incorporate right now:
- When you ask your patient to take breaths,breathe along with them
- If you don’t need to be watching your hands, try focusing on one precise point and then use your peripheral vision to notice what’s around that spot. It’s a great nervous system regulation technique
- Give yourself enough time between patients to eat,hydrate, make clear notes, clean your room and breathe for a minute.
- Lay on your table for a few minutes at the end of the day. Throw some heat on your back or shoulders and close your eyes.
- Find a great play list that both you and your patients love
- Visualize! You can do this before or after treating,and during treatment. Visualize your body as relaxed and fluid, visualize the effect you are trying to create for your patient, go to your happy place in between sessions. The mind is powerful!
I’m sure I have more hills I’ll die on. But these will do for now, there’s only so many hills I can handle at once.
