Use Your Words, Part 2

This is the second half of my discussion of the vocabulary I developed at the International Massage Therapy Research Conference. They’re not in any particular order, but feel free to check out Part 1.

First, I’ll start with a story.

When I was in massage school in Ohio, big changes were taking place. We were going to be one of the last groups taking the Ohio Board exams, and the whole state was going to switch over to the MBLEx after we did so. This also meant a huge transition in curriculum. We were learning Kellogg’s techniques and terminology, and the newer students were learning someone else’s terms. So our last quarter, my instructors decided to give us a crash course in the new stuff, so that we could communicate effectively.

It got pretty confusing.

For a year and a half, “friction” meant friction between your hand and the client’s skin. Suddenly, it meant no such thing, but creating friction between one layer of the client’s tissues and another. Our old friction was now … gliding, maybe? I don’t actually remember. But we’d differentiated between friction, gliding, and stroking, and here they were all the same thing.

Then I got out of school, and not only did people not use the terms I’d learned the first time around, they weren’t using the new ones either. In 20 months of massage school, I’d never dealt with French terms like effleurage. I thanked my lucky stars for my one disastrous semester of college French and learned these too.

Then I’d read other therapist’s SOAP notes, where one had done trigger point therapy on a client, and another had done neuromuscular therapy, and I just prayed I was doing something similar enough to what seemed to be helping the person. What was the difference? How could I be sure?

All of it left me with the feeling that nobody knows what the heck anybody else is talking about half the time.

Where is the ... bathroom? Did I say that right? I hope I said that right ...

Where is the … bathroom? Did I say that right? 

So imagine how thrilled I was when I was at the International Massage Therapy Research Conference and learned that some smart people had thought about this already, and developed a common language for all of us to communicate with each other, both inside and outside the massage therapy community.

SUPER THRILLED, let me tell you.

The taxonomy of massage techniques accounts for all kinds of different massage techniques and names them in plain English. Direct pressure is just direct pressure. Resistive stretching is resistive stretching, and I no longer have to go into a five-minute explanation of how I’m not a Reiki practitioner when people read that I used muscle energy technique. There are names for some things I’m ashamed to say I never thought were important enough to make a note of before, like directed breathing. It’s like having one of those pocket bilingual phrasebooks on hand, only instead of English to Spanish, it’s Massage Therapist to Ordinary Human Being. And I kind of love that.

I know the taxonomy isn’t in common use yet. Untill it becomes integrated into our massage school programs, it’ll never be our lingua franca across disciplinary boundaries, common to all.

But even if it’s not every massage therapist’s go-to vocabulary list yet, that doesn’t mean I can’t make it mine.

Communication means nothing if you’re not understood. Now I have one powerful new tool to help me make that understanding happen. Great stuff!

photo credit: Javier Kohen via photopin cc

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Use Your Words! Part 1

words

I’ve dealt with a lot of toddlers over the years, and I can’t count the number of times I’ve told a kid “Use your words!” when they’d rather take/hit/yell as a form of communication. When you’re two, and brand-new to language, any use of words is a cause for celebration. Saying “Stop!” instead of shoving a friend away? That could make my week. Asking to use the toilet instead of peeing on the playground? Priceless.

But we get a bit older, and the standards for most of us rise beyond “More, please!” to more sophisticated uses of language. And so it behooves us (I love that word, but hardly ever use it. Behooves!) to use our words not only consistently, but correctly. And I learned some things about words at the International Massage Therapy Research Conference that I didn’t know before.

Efficacy and Effectiveness

I learned the word “efficacy” my senior year in high school. She taught me that it meant “effectiveness,” and I used the two as synonyms ever since. So was I ever surprised to learn that, in the context of research, efficacy and effectiveness are two different things! Mind totally blown.

As it turns out, efficacy is about how well something works in really controlled lab conditions. Efficacy studies are important because they allow researchers to get down to the nitty gritty of exactly what works, and how much, and why, without the variables getting too complicated. It’s also important so researchers can repeat the exact same studies over and over again. Without efficacy studies, you can’t really do great science.

Effectiveness, on the other hand, is how well something works out in everyday practice. Effectiveness studies are important because massage therapy IS complicated, and great science isn’t always quite the same thing as great medicine. As individual massage therapists, we talk to our clients differently, work in different atmospheres, and adapt to what we encounter. We don’t typically work in labs where massage therapists always provide three strokes to the left forearm in the direction of venous flow, then three to the right forearm. I think most massage therapists would argue that being forced to work in such a way would decrease the effectiveness of their work. So we also do these real-world kinds of studies to find out what kind of good we’re actually doing for our clients, even if it doesn’t tell us much about the basic science of what’s going on.

Recommendation and Referral

Here’s another set of words that I thought meant basically the same thing, but have specific meanings in a healthcare setting.

You know a fabulous massage therapist who does oncology massage, so when your regular client develops cancer, you recommend this person. You do this the same way you might recommend your favorite babysitter or restaurant or brand of toothpaste. You can recommend that your client ask their primary care physician about some symptoms they’ve developed recently. It’s encouragement, but it’s casual.

A referral is more specific. It’s written down in an official way. A doctor might refer a patient to to you, a qualified massage therapist. But as it turns out, there are protocols for who gets referred by who for what. Referrals are often accompanied by a prescription for treatment. And that’s not a gray area that you want to get mixed up in at all. Sure, it’s just a word. But as Mr. Twain well knew, ”The difference between the right word and the almost right word is the difference between lightning and a lightning bug.” So stick to recommendations (which is probably what you meant to be doing anyway), and save yourself the hassle of explaining that you didn’t mean to overstep your scope of practice.

Proves

While at the IMTRC, I saw this word abused a fair bit in the flurry of Twitter posts about the conference. Speaker X talks about new study. Participant Y tweets, “New research proves massage works for ABC!” These folks didn’t mean to be misleading, they just reached for the short word in their vocabulary and used it liberally. Unfortunately, this is one of those words that usually doesn’t have a place in discussing massage research. Tracy Walton has some great stuff to say about “proves” here on her blog.

Some words we could stand to add to our vocabularies include qualifiers like

  • may
  • seems
  • appears
  • possibly/likely

as well as other phrases like

  • trends towards
  • positive correlation
  • indicates

and some important postscripts like

  • further research is required
  • initial study
  • small sample size
  • not clinically significant

That isn’t to say you need to be a Negative Nancy about all the cool massage research coming out. On the contrary, get excited! But save the proofs for geometry class and learn to speak with truthfulness and humility about what the research really says. To be honest, “initial studies seem to indicate that …” is more exciting to me than “proves.” It means there’s so much more out there to learn, a lot of which is low-hanging fruit for the amateur researcher. Congratulations, massage therapists, you’ve become cutting edge! Tell me that doesn’t feel cool.

Yet to come: What I learned about a resource developed to help us all use words that make sense to people both inside and outside of the massage profession, and how it’s resolved an issue that’s bothered me since I was in massage school. How’s that for a teaser?

photo credit: surrealmuse via photopin cc

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Leaving the Best Job in the World

Today was my last day at work.

I’ve never had a year fly by so fast. Normally I’m a bit of a “what’s next?” addict. A year into a job and I’m antsy for the next new thing. But working in a small nonprofit clinic has meant that there’s always a next new thing right in front of me. How can we attract new patients? How can we fix this place up? How can we serve our longstanding patients better? Where can we get a great vegan lunch in under an hour near the Cleveland/Lakewood border? I never once felt trapped. I never once felt underappreciated.

But Jef (that’s my awesome husband) got a job transfer to Dallas, Texas. And we’re going because

  1. The other option was getting laid off.
  2. While he makes more money, it’s much easier for me to get a new job wherever we go.
  3. COMPREHENSIVE HEALTH INSURANCE, BABY! Which I haven’t had for the last eight years.

As I mentioned, today was my last day. It was a slow day. I only had one client. And while most of our patients live with chronic pain, this particular client has been coming for weekly massages the last couple of months for injury rehabilitation. Today, our last day together, he was finally better. Full range of motion, full grip strength, no pain. He laughed and said, “I guess you cured me!” “You cured you. I just gave massages.”

Sometimes things wrap up nicely like that, like a touching made-for-TV movie. Most of the time they don’t, but I felt grateful for the closure it provided.

So now I’m going to have a whole lot of new things to write about. Getting licensed in a new state. Finding work in a town I’ve never even visited before. Plus, I still have ALL KINDS of goodies from the International Massage Therapy Research Conference I want to talk about. It’ll be a busy summer! After I’m done bawling my eyes out about leaving my family, my hometown, AND my dream job all at one go, I’ll be sure to get down to writing about it.

It’ll be an adventure, for sure.

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Science: it won’t kill you!

Maybe you’re like my sister. She ran out of science classes to take at our high school and ended up having to fill her senior year with elective classes. If this describes you, keep what I’m about to say in mind for your friends who aren’t so scientifically inclined, because it doesn’t apply to you.

It applies to people like I used to be. In elementary and middle school, I had two separate teachers who informed me that I was terrible at math and science. They told me this. They told me I wasn’t the type. They told my parents I should stick to the arts.

My parents were appalled, and tried to convince me otherwise, but the damage was done. I believed it.

I would have kept believing it, too, had I not been introduced to the work of one man: Carl Sagan. In his TV series Cosmos, Sagan managed to humanize science. He put it into a personal and historical context. When he talked, I understood. And I came to realize that my problem was with poor teachers, not with science.

So if you’re an artsy, right-brained person in massage school, or thinking about it, or have managed to graduate but with difficulty, and the idea of science fills you with something akin to horror, maybe I can share some truths I’ve learned to make it a little less scary.

1. Science is about imagination within boundaries

When you create art, you use your imagination within certain limitations. You know that if there isn’t enough light, you won’t end up with a photo. No tuba player means no tuba solo in your song. But you make art anyway: you find enough light, you write for piano and voice, you dance within your physical limitations, you stick to oil pastels. Science is the same exact thing. You’re given a set of guidelines: gravity pulls people on earth towards its center. Muscles shorten and then relax, they don’t grow longer with force. Imagine, then, what sort of muscles might pull the knee up to the level of the hip, and how would it kick back again?

It’s like jazz. Here’s the song, now let your imagination run wild.

Science is about making stuff up, and then seeing if it fits within the boundaries known as reality. Wrote a sonnet that turned out to not actually be a sonnet? That’s cool, you got some practice and learned something. Had a hypothesis that didn’t stand up after testing? Same thing. Start again. It’s the process that’s beautiful.

2. Science is about patterns.

Why are rhyming, rhythmic poems so much easier to memorize than free verse? Why doesn’t the experienced tanguera miss a single step while dancing with a partner she’s never met? Familiar patterns. Two verses in ABAB. Two steps to the left followed by a high cross. Epi- followed by peri- followed by endo-. The muscle will have an origin. It will have an insertion. The former will be closer to the center than the later, and the action will pull them closer to each other. There’s a rhythm to scientific knowledge. Once you find the beat, it will be much easier to get in the flow.

3. Science won’t kill your inner artist.

This is a legitimate concern people have. If forcing your brain to focus heavily on facts could permanently kill your muse, well … it might not be worth the chance. Fortunately, the exact opposite is true: new knowledge feeds the artistic spirit. Julia Cameron (author of The Artist’s Way) talks about needing to have new experiences in order to create art. What’s more full of novelty than engaging in the study of the human body and the natural world?

4. Like art, science takes practice, but it can be learned.

Practice learning science every day, religiously. Practice what your teacher asks you to, but don’t forget to explore and improvise. When you feel burnt out, remember that your art is still there too. Keep going, and eventually you’ll learn to take all that new knowledge and make something truly beautiful.

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Not the Massage You’re Looking For

The other day I received a message from the AMTA Find a Massage Therapist service. This was the entirety of the message:

do u give a soft sensual massage

Name: Nick
Email: [not going to share that on the blog]
Phone: 555-555-5555 (this is the actual “number” provided).

In the past I would have freaked out a bit, or gotten offended. But I’ve been through enough ethics trainings (yay ethics!) and talked enough with other, wiser massage therapists and friends to think the situation through rationally. Stripping the situation down of its initial icky feelings, here are the facts:

  1. Nick is looking for sensual massage, and quite possibly (but not necessarily?) sex.
  2. Nick is aware that some people who provide this kind of service advertise under the guise of mainstream massage.
  3. I don’t provide sensual massage, nor do I sell sex.
  4. Nick isn’t aware that I’m not the massage provider he’s looking for.
  5. If I happened to be a prostitute, this question wouldn’t be awkward at all.
  6. But I’m not. Due to this misunderstanding, we get AWKWARDNESS! Yes!

So what to do?

Nick,

No, I do not provide sensual massage. As you can see from my profile, I focus on chronic pain management. As a hint, AMTA members tend to focus on therapeutic massage, so the Find a Massage Therapist website probably won’t help you much. There are plenty of people advertising sensual massage in the Cleveland area. Contacting one of them will almost certainly prove more fruitful.

I’m pretty impressed with how far I’ve come in just a couple of years, because even a hint of sexual suggestion would have thrown me completely for a loop when I first started massage school. Allissa’s been teaching me to use my big girl voice. I’m discovering that my big girl voice is still a gentle one, but more assertive than before. It’s still a work in progress.

So, you’ve seen it now for yourself. How am I doing?

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On Words. (Or, my yoga adventure)

If you’re a good massage therapist, and what you do works, how much does it matter what you say?

I recently went to a yoga class for the first time in my life. I typically stay the heck away from yoga, because stretching is really bad for my body. People don’t believe me, and often try to convince me that it’s not. When I take their advice, I end up injured. Like, difficulty-walking-for-nearly-a-month injured. If you think it’s hard to find a massage therapist who understands that you’ve gone through a lot of trouble to try and decrease your range of motion, try explaining that to a yoga teacher.

Nope, nope, nope. Not happening.

But this place was supposed to be different. For one, they charge something like twice what any other yoga school in the area does. They claim to have very stringent teacher training requirements. And what’s more, they are supposed to specialize in yoga for people like me. Which is to say, people who have physical issues that normally prevent them from doing yoga. The lady at the front desk said that theirs was a “serious” yoga studio, whatever that means. I had the opportunity to take a freebie class, so I did.

And it actually felt good. It didn’t feel like much at the time, just gentle joint mobilizations combined with some meditation, but the next day I felt great. It seemed to be just what I needed.

But the teacher, who is a wonderful person, said something about using only the knee joint when making small circles with the lower leg. The knee is a hinge joint. Basic body awareness should tell you that that kind of movement requires hip involvement.

And then a gentle passive stretch was described as “strengthening the core muscles.” I know that core strengthening is all the rage right now, but there’s no reason any kind of stretch would strengthen anything, aside from one’s comfort with stretching.

And then something or other was described as toning the female reproductive organs, which was when I lost it. There are some things that can tone the uterus, none of which happen in a yoga class. But even if she was referring to the pelvic floor muscles, we weren’t using them. Experiment over.

The yoga felt good. It may have helped. Going back and shelling out an indecent amount of cash for more classes might help even more. But if I can’t trust you to know basic facts about the body, I certainly can’t trust you to know what’s safe for my body.

Your massage matters. But your language matters too. If you’re going to use the language of metaphysics, use it well and consistently. If you’re going to use the language of science, do the same. But whatever your background or purported area of expertise, don’t screw it up. Admitting that you don’t know is fine sometimes. That’s what Google is for. If you forget the name of fibularis longus, most clients won’t fault you for that. But misinformation, when caught, isn’t the same kind of mistake. It builds mistrust. And nobody can afford to spend their money one a massage therapist they don’t find trustworthy.

Unfortunately, my yoga adventure is over. Don’t let your new client’s massage experience be the same.

photo credit: BrittneyBush via photopin cc

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Between Justice and a Hard Place

The doctor where I work came into the back room while I was typing up some notes the other day. He was concerned about a client’s lack of mobility, and wanted to know my thoughts. I tried to do my little “you’re the doctor, you know better than I do” dance to weasel out of answering, but he never lets me get away with that one.

“What I really think? She needs to be here for a massage weekly, she needs to be seeing Buddy (our nurse) at least once a month, and she needs to be in physical therapy twice a week.”

And then,

“But who’s going to pay for that?”

There’s this painful place between justice and reality, where you can see all the good you could do in a perfect world. And while the act of compromise is heart-wrenching, you know that what you can do is still better than what would have been done in your absence.

It means I’m still proud to be here. Even when it hurts.

photo credit: melodramababs via photopin cc

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New Year, Heck Yeah!

2012 was my first full calendar year as a massage therapist. And you know what? It was awesome.

  • I started, and quit, two kind-of-awful jobs that taught me all kinds of great lessons about where I don’t want to work.
  • I started, kept, and still hold one fabulous job with plenty of challenges of its own.
  • I injured my wrist, recovered, and got serious about better body mechanics.
  • I saw some clients show dramatic improvements that blew my mind. I saw some clients’ pain not respond to massage at all. I learned how to deal with both.
  • I started my other dream job, writing for other massage therapists under the direction of the fabulous Allissa Haines.
  • I took classes in all kinds of useful things, from diabetic foot care to research literacy to grant-writing.
  • I started to feel really legit. Less like a fake, and more like a professional. I still feel pretty green compared to the superstars I hang out with, but that’s all right. What else is a new year for?

This year, I’m going to do a few things differently.

  • I’m going to land at least one grant for the center where I work, however many applications that takes.
  • I’m going to do more of my own marketing, with at least 1/3 of my clients being those I’ve found myself.
  • I’m joining the YMCA so I can join their pool fitness classes. Just because I have a ligament disorder doesn’t mean I can’t be in good shape. It’s time to start spending some money on my health.
  • I’m going to be more involved in my state AMTA chapter. I didn’t really get involved in 2012, and I regret it.

All in all, I’m pretty psyched for 2013. What’s new with you?

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On Risk

You know what doesn’t scare me at all? Writing. I’m good at it. I’ve written for a byline, for $20, for $400, for a cup of tea and undying gratitude. I write because if I didn’t I’d feel incomplete, and that’s totally cool for me.

So when I sat down to write my first grant proposal, I did not expect to be met with nearly-crippling anxiety.

What comes easily for $50 is apparently an entirely different skill when $15,000 is on the line. This is, of course, ridiculous.

I don’t give a different, more expensive massage to private pay clients than I give to those who are paying with Medicare. I sing the same songs to kids as a neighborhood volunteer that I sang working in the high-end day care for a major corporation’s international headquarters.

It’s important that I remember that failing (whatever that means) at this task isn’t going to cost my employers $15,000. It’s going to cost me several hours of my life, and quite possibly about $10 in hot beverages, since I prefer working in coffeeshops. But this is a skill I want to develop, and I’ve paid a heck of a lot more than that for continuing education before. When you get down to it, there is essentially no risk in trying. So what’s my hang-up?

Part of it is the likelihood of failure. If my competence were judged by how funny or informative the narrative was, I’d feel pretty confident. But being in competition with others means that it’s not unlikely at all that my best simply won’t be good enough. That freaks me the heck out, honestly, because I take a lot of pride in being a great writer. Not just okay, but pretty darn great. I have a long history of slacking off if it looks like I might be caught failing while doing my best. It ain’t pretty, let me tell you.

The other part of my anxiety surprises me more. I love my little not-for-profit clinic. I love the staff, the patients, the volunteers. I love the guy called Spider who patrols the street and occasionally pops his head in to make sure everything’s okay. But applying for a grant means I need to take a really honest look at our strengths and weaknesses. At the lack of leadership on our board. At the way we’ve failed to adapt to new regulations. At the total absence of a cohesive plan for growth. All that honesty is good, but it’s also scary. It’s hard to write about all the good you’re doing when you know you could be doing so much more.

So really, what I’m risking is my Pollyanna side. The side of me that thinks my writing is always brilliant, my workplace is ideal, and every time a person gets a massage, a crippled kitten is adopted by a loving family who will care for it for life. But there’s the chance that, in giving up the ideal, I could bring reality a step closer: I could become a better writer, build a better organization, and offer more people massage. I’m not saying it doesn’t still feel like a huge, scary risk, but at least I have some talking points for when I’m trying to convince my freaked-out side to hear the voice of reason.

Everything’s a bit of a risk. But sitting on my butt and doing nothing is the biggest risk of all.

photo credit: Sakurako Kitsa via photopin cc

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Don’t Be a Meanie: being a trans-friendly massage practice

Quick, pop quiz! I will only give you a massage if you truthfully answer this multiple-choice question:

Circle one. Are you:

A.) a frog
B.) a Martian

What will you do? Answer “Martian” because you imagine them being intelligent like you? Answer frog because hey, at least they’re from earth? Would you worry, knowing that you might receive a massage based on the best medical treatment for a frog, when it might not be suited to you after all? Would you worry about my being horrified at seeing your lack of webbed feet?

This is, of course, a ridiculous analogy. (That’s right, I KNOW it doesn’t capture reality.) But it’s also an example of the kinds of situations trans people run into in massage businesses every day.

Hold up, they didn’t exactly cover this in massage school. Who are trans people?

Trans folks are people who don’t conform to society’s expectations of gender based on the genitalia they were born with. You may have heard “transgender” and “transsexual,” and trans (the T in LGBT) includes these, but is not limited to them. Like any other arbitrary category of human beings, trans people aren’t a homogeneous group. Some folks have fully embraced being “male” or “female.” Some are androgynous. Some are genderqueer. Some are intersex. Some “pass” for the gender they prefer, some don’t, and some don’t try. Some are open about being trans and some aren’t. Some have had hormone therapy or surgery, and some haven’t. Some don’t ever want to. Trans people can be elderly or kids.

And the odds are that you have met a trans person before. But have you invited them into your massage business?

How can I make trans people feel comfortable coming to me for a massage?

Institutional Checklist

  • Do you ask for gender on your intake forms? Consider whether this is essential information. Is it any of your business? Does it matter?
  • If you must know, offer an “other” option for people to share what they consider to be their gender identity with you.
  • If someone does note that their gender is not one of the Big Two, ask what pronouns they prefer. It’s common courtesy.
  • Are your bathrooms gender-segregated? Do they need to be? Is there a gender-neutral option for those who don’t feel safe using either one?
  • If you have a public statement about welcoming diversity (some folks choose to), have you included trans folks?
  • If you have employees or other folks working in your space, are they meanies to others based on gender or sex? Don’t share space with meanies.

Personal Checklist

  • Are you comfortable with the idea of people who are not cisgendered? Could education help you overcome any hesitation?
  • The clothes we wear have a large impact on how people perceive us. Are you comfortable with the idea that the body you see on the massage table may have characteristics that do not match the gender you perceived in the waiting room?
  • Are you aware of special issues that can affect some trans people? Post-surgical scarring may be an issue for some, while another might be dealing with the symptoms of undergoing a second puberty due to hormone therapy. A man may be embarrassed to tell you he’s suffering from menstrual cramps. And stress … with all the misconceptions and prejudice in the world, I don’t think I need to expand on sources of stress.
  • Are you a meanie? Don’t be a meanie.

I was talking with a trans friend of mine (who also happens to be a massage therapist, way cool!), and ze told me that the most important thing to remember in most cases was: in a non-medical setting, somebody’s sex is none of your business. In a medical setting it could be helpful to know. Just like asking about any other aspect of someone’s medical history, allow people to feel safe telling you what you need to know.

I’m cisgender, which means that not only do my gender and my sex match up, but I act in ways that are mostly acceptable for women these days. When I was born, they said I was a girl. I grew up as a girl, and turned into a woman after a while, and I’m cool with that. Most of you reading this are probably in the same boat. This gives us a lot of privilege. I don’t know anything about being trans from personal experience, which means I don’t know much, period. But I do know a thing or two about not being a meanie. And I think if more people knew that by making teeny, tiny changes, they could be a little more welcoming themselves, they would do it.

Let’s all commit to getting rid of just a little bit of unintentional meanness in the coming year. Your trans friends (and your cis ones as well) will thank you for it.

photo credit: Nutmeg Designs via photopin cc

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Kat Mayerovitch