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Carpal tunnel, pregnancy and massage

Carpal tunnel can be an extremely painful and uncomfortable condition that can affect anyone. However, during pregnancy the chances of suffering from carpal tunnel syndrome are greatly increased, particularly in the latter stages of pregnancy. The reason for the greater incidence of carpal tunnel syndrome during pregnancy is that there is greater retention of fluid (due to varying hormones during pregnancy) and that relaxin can soften the ligaments that form part of the carpal tunnel.

Carpal tunnel and pregnancy massageCarpal tunnel syndrome will normally manifest in the form of pain, numbness and/or tingling in the outside three fingers of either hand. In more extreme cases, the compression on the nerve through the carpal tunnel can lead to the forearm feeling numb. The fingers and the hands will feel weak and have poor grip strength and pain may radiate up the arm as far as the shoulder.

For pregnancy induced carpal tunnel syndrome the symptoms will be worse either during the night or first thing in the morning due to greater fluid retention as the arm is relatively inactive.

There are a number of steps to you can take to reduce the impact of the condition. These include:

  • Avoiding any task or action that causes pain
  • Elevate the affected arm to attempt to reduce the amount of oedema and swelling
  • Be aware of your posture. There is a tendency amongst pregnant women (+ office workers + people who drive a lot etc) to have their neck protracted ie their chin juts out. Even a little can add compression to the lower cervical vertertae so try to keep your chin back in a more neutral position.
  • Try to keep your wrist in as neutral a position as possible (some physiotherapists recommend the use of splints to maintain a neutral wrist while you sleep. If you are suffering from carpal tunnel from breast feeding then remember to bring the baby to the breast rather than move the breast to the baby and again be aware of your wrist position.
  • Some professionals may suggest modifying your diet (and/or lifestyle) to reduce your body’s general propensity for swelling

Massage for Carpal Tunnel Syndrome During Pregnancy
An effective massage for carpal tunnel syndrome is primarily aimed at reducing the amount of swelling in the arm through lymphatic drainage techniques and, when performed by a therapist who has a good understanding of the condition, it can be a highly effective treatment.

Routine for Carpal Tunnel Pregnancy Massage
This routine can be considered as being relevant for during pregnancy and also post-partum when the new mum can have wrist problems when breast feeding.

Start at neck with little or no lubrication and work very and gently. The movement of lymph at the level of the skin is the objective for the routine. Always proximal to distal with the order of the strokes but work each individual stroke in a distal to proximal direction. Stretch the skin and work down the arm all the way down to the hand. Again need to reiterate that the pressure should be very light as working deeply can be ineffective.
Repeat this series of strokes a few times.

  
Perform a lymphatic compression on the arm – scooping up and then hold each compression for a count of about 10. Pressure is still very light.

Compressive tissue release – keep wrists neutral and stroke down the forearm (both top and botton of the forearm) using thumb and fingers whilst applying traction to the wrist. This stroke can free up the nerve sheaves through the carpal tunnel.

If you feel that you need to stretch the fascia of the palm make sure that you keep the wrist in neutral. Work the joints of adjacent fingers in opposite directions.

By Richard Lane

Positional Release

Most people who have regular remedial or therapeutic massage in Sydney would probably prefer to have the therapist to get stuck into the muscles and the soft tissues. Certainly with our Sydney mobile massage business, deep tissue and deep pressure massage are more popular than Swedish or relaxation massage.
However, not all clients necessarily respond best to a stronger massage and recently I’ve some good results with incorporating positional release techniques within a session (particularly when the deep tissue techniques have not yielded the benefits that I would like to have seen).

Therapeutic relief through positional release techniquesPositional release is a gentle and relatively non-invasive technique that allows for pain relief effectively by the body healing itself. It relies on the use of placing the body or painful part of the body in a comfortable position so that myofascial trigger points can release.

Positional release can be incorporated into a remedial massage bodywork session to assist with reducing the pain for particularly stubborn area or it can be considered as a standalone session. In addition, once you have experienced pain relief from using positional release then it is possible to perform some level of self-positional release.
In order to perform positional release, then a therapist will locate the areas of dysfunction (most often affected by trigger points) and then they will manoeuvre the client’s body into such a position that the pain experienced from the trigger point is eliminated (or at least minimised). The client will stay in this position for up to 2-3 minutes (which may be assisted by the therapist supporting an arm, a leg or the head for example).

The philosophy behind of positional release is that painful muscles when put into such a position that they are shortened (without contraction) then the pain sensors within the muscle can in effect be “switched off”. The muscle may then be in a more relaxed state when the passive support is removed and the level of pain and discomfort can be decreased.

Self-Positional Release
If you are having problems with soreness in your neck then lie on your side on a pillow and using your fingers or thumb find a spot that is particularly tender. Often these points are just below the occiput (ie just under the bone of the skull at the back of the neck). Now very slowly and very easily move your head in different directions whilst monitoring the pain you are experiencing. You may need to tilt your head backwards, forwards or to the side or even rotate it in one direction. Hopefully you will move into such positions that the pain will be reducing – if you find that it is actually increasing then move in the opposite direction.

  
Once you have found a position such that the pain is minimised then support your head as much as possible in that position and just stay there for a couple of minutes (no need to keep monitoring the pain with your fingers at this time). Gradually ease yourself back into a normal position and hopefully your pain will be less. If you need to work on the opposite side then simply turn over and repeat.

Obviously never force your head into uncomfortable or strained positions whilst you are attempting to perform self-positional release and if you have any concerns regarding the pain and discomfort you are feeling, always consult a health care professional.

By Richard Lane

Dry Needling

If you have been a regular recipient of remedial massage over the years then there is a reasonable chance then at some stage you would have been offered the opportunity to try dry needling. More and more massage (and for that matter physiotherapists) in Sydney have been trained to provide dry needling. Some of the therapists who work with Inner West Mobile Massage are trained to provide dry needling treatments.

But what is dry needling, is it different to acupuncture and is it effective?
Deactivation of trigger points through use of dry needles in SydneyA technicial definition is that dry needling uses a variety of needling techniques to initiate change in soft tissue dysfunction which are the results of physiological loading causing inflammation or irritation of the soft tissue. A more normal description is that dry needling is used to de-activate trigger points in the muscles (for information regarding trigger points then there is more information here). The insertion of a needle is considered as being an effective way of relieving the pain and discomfort which may be attributable to the trigger point.

For a dry needling treatment, then a thin needle is inserted into the trigger point (which the therapist has identified through palpation). If the needle is positioned correctly then there will normally be a local twitch response, an involuntary reflex as the muscle fibres of the taut band of the trigger point contract.

As with any bodywork modality, the effectiveness of a dry needling treatment is directly related to the skill of the practitioner. Obviously just sticking needles into the muscles and hoping is not likely to provide good results. The therapists palpation skills and knowledge of anatomy are critical to the success of the therapy.

Dry Needling and Acupuncture
Although both modalities use needles to initiate healing for the body there is a distinct difference regarding the philosophy behind dry needling and acupuncture. Dry needling aims to reduce pain through the de-activation of trigger points. The needles are inserted into the trigger point but they are not left in the muscles for much more than a few seconds.
Acupuncture uses needles to enhance energy and chi flow through the meridians of the body. An acupunturist would normally leave the needles in the meridian points for an extended period of time.

Now whilst there is a huge underlying difference in the intent of the two modalities, there is also a significant area of commonality. It is often reported that there is an overlap of somewhere between 70-90% for trigger points and the meridian points used by acupunturists.

Effectiveness of Dry Needling
Research on the effectiveness and efficacy of dry needling is fairly limited. Some commentators will argue that many positive findings are based on small sample sized research studies which may or may not have flaws with respect to methodology. One of the major problems is similar to research studies into acupuncture: the skill, training and knowledge of the practitioner is a variable largely out of the control of researchers. Also most practitioners will vary their approach depending on issues that the client presents with and for them, there is no standard treatment.

  
Dry Needling – Inner West Mobile Massage
Whether or not dry needling can be clinically proven to provide pain relief through de-activation of trigger points may be considered as being a mute point anyway. The issue is whether it can work for you.

If you are interested in trying dry needling then a couple of the therapists who work with us are trained and qualified to offer this therapy. Give us a call on 0421 410 057 if you would like more information.

By Richard Lane

Online Bookings for
Mobile Massage in Sydney

A couple of the therapists who work with Inner West Mobile Massage have their diaries online and it is possible to book directly with them.

For a demonstration of how to make a booking then check out this video.

Mobile Massage Questions

We have been operating our Sydney mobile massage business now since 2005 and so it is fair to say we have a reasonable understanding of the questions that people ask. This article will talk about a few of the more common questions that we get asked.

Do you bring your own massage table or will you massage me on the bed?

We will bring a massage table – we won’t be massaging you on your bed or the floor.

What do I need to provide?

Nothing other than a suitable space to work in. We will bring the massage table, towels and oils. Some therapists may bring a music player but if you particularly want music then it might be an idea to organise this in advance.
We do not bring candles but if you wish to create a relaxing ambiance and environment for the massage then feel free to light some candles.

My apartment/house is small – how much space do I need?

From our point of view the more room the better but don’t let this be a reason not to consider booking a home massage. We have yet to come across a space that we are not able to work in.

My house is not suitable for mobile massage (for example, I share with other people)- do you operate out of a clinic?

No – sorry we only provide mobile massage services. We do not provide clinic massage services.

I’m concerned about letting strangers in my home – how can I trust you?

This is very much a personal decision and we respect your right to be mindful of who you let into your home. All we can say is that we are professional therapists and as such we are registered with professional associations. Should you wish you can check our credentials with the relevant organisations.

I’ve had unsatisfactory massages from other people in the past. How can I be confident that you will be different?

We are mindful that when we arrange a therapist to visit you that we need to be confident that the therapist we send will be suitable for you. If we do not believe that we have a therapist suitable for you at the time you want then we will not just send someone for the sake of an appointment.
We back this up with our guarantee – if you are not happy with the massage that you have received then just let us know and we will gladly refund you. You do not even have to explain why you were not satisfied

Sydney mobile massage questions

What areas do you cover?

We provide mobile massage to the Inner west of Sydney. For the suburbs we may visit then please check out www.innerwestmassage.com.au/suburbs.php

Can I choose a particular therapist (or a particular gender)?

Yes subject to availability and some geographical constraints. If you live on the fringe of the area we cover then some therapists may not be available.

However, one restriction is that female therapists are only available for female callers. Men who wish to receive a massage from a female therapist will need to get a female who knows them to call on their behalf.

What happens when you arrive and how do I prepare for the massage?

When we arrive, we take a couple of minutes to set up the table during which time we will ask you to complete a questionnaire so that we can understand your requirements for the massage and any health problems you may have (or had in the past) that may impact on the massage. We will take a few minutes to discuss particular issues so that we have a clear understanding about what you want from the massage and what are your expectations.

At this time we will leave the room whilst you get undressed.

We are invariably asked what you need to wear for the massage. The answer is as little as you are comfortable with. If you are comfortable wearing nothing (if for example you have just got out of the shower) then that is fine. If you feel that you would be more comfortable wearing underwear then again that is perfectable ok with us. If you are not sure then it is probable better to wear underwear. You can always choose to disrobe completely for subsequent appointments as you feel comfortable with your therapist.

Many people like to have a robe handy to change into after the massage, particularly as many people like to have a shower straight after the massage to make sure that any excess oil is removed. (As an aside, this is a great advantage of having a mobile massage compared with going to a clinic where you have to put your clothes directly on over oiled skin).

How do I book a massage?

There are two ways to book depending on your preference:
(1) Most people phone 0421 410057 to make initial enquiry and/or a booking.

(2) Some therapists are available for online bookings (for real time bookings).
Click here for more information.

Pregnancy Massage Tables

Pregnancy massage is an important part of our Sydney mobile massage business. Although we believe that for many people there are great reasons for choosing a home massage over a clinic, these advantages are magnified for pregnant women – particularly in the latter stages of their pregnancy. It just makes sense for a woman to have a therapist visit her at home so that she can truly relax post massage rather than having to traipse to and from a clinic.

Whilst there is a fair amount of discussion about massage in the first trimester of pregnancy (check out http://www.innerwestmassage.com.au/first-trimester.php for more information) there is no debate that after the first trimester then massage can be considered effect therapy for a pregnant woman (assume that there are no pregnancy massage contraindications). However, as the pregnancy progresses then it reaches the stage that the woman is no longer able to lie prone (or on her stomach) for the massage on a normal massage table.

Often we get calls from women who are aware that there are massage tables with holes that have been cut out for the stomach (and occasionally the breasts) looking to have a massage lying on their stomach on one of these tables. Click here for an example of such a table.

Pregnancy massage in side-lying positionHowever, we only ever massage pregnant women who are too large to lie prone in a side lying position. There are good reasons for this and the vast majority of experienced pregnancy massage therapists would never consider using a table with cut out hole(s). More information about our pregnancy and pre-natal massage service is at http://www.innerwestmassage.com.au/pregnancy_massage_cushion.php

The issue about the merits (or otherwise) of pregnancy tables with holes cut-out was recently conducted and some of the comments have been included below.

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Nasal congestion and breast tenderness are some of the issues that a lot of pregnant women deal with and prone position is just going to aggravate that. Pregnancy tables don’t take different bodies into account so I think those specific tables are a waste of money but there are plenty of body cushioning systems out there so you can adjust to each woman. However, side-lying position is a widely under-used position and that is a shame because of the ability to move the shoulder and hip through it’s full range of motion and the fact of how nurturing and relaxing this position actually is. There is always a possibilty of increasing lumbar lordosis or uterine ligament pressure in prone especially if you are not monitoring her and as long as she is very good at communicating with you when she becomes uncomfortable. Oakworks also has a great side-lying bolstering system that eliminates pressure on the shoulder and hip that is being laid on. Ultimately, you are going to make your decision on what you will feel comfortable doing. I am very confident and comfortable with my side-lying routine and I know my clients leave very happy because they come back and they send their pregnant friends to me. I am comfortable with side-lying position and that is what I offer. I won’t spend my money on a body cushion system that will allow them to lay prone. I am ok with that. If I lose a client because of that, that is fine. There will be another to take her place.

I received massage throughout my two pregnancies and was side line. I went to the beach one summer and dug a hole in the sand to fit around my big belly so I could lay on my stomach. That was the best nap I’d had in a long time. There is no problem with lying on your stomach if you are supported correctly. Where I work we have a water table and so they start out on the left side to get the back and then face up for legs, arms, head and neck. The water table is wonderful.
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As I just had a baby and had several massages during my pregnancy as long as there is a sling in the belly cutout that is snug enough to not have the ligaments in a bind and there are breast recesses the prone massage wins HANDS DOWN!!! The sling in the belly recess gives enough support for an hour or 2 of massage. NOT recommended for long term use (to those of us pregnant that have a prenatal table) but I personally LOVE the prenatal table and prone massages (best naps EVER while big and pregnant!)
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As a LMT who specializes in prenatal work and had also been pregnant (3 times) before, most mama’s will lay on their belly until its uncomfortable. If their own body weight pressing on the belly is too much then it’s time for side lying. Knowing they are in early pregnancy you should not be pressing deeply on the low back area anyway so if mama is still able to lay prone this should not be an issue. I personally don’t use a cutout table, and I don’t see how one set non adaptable system can accommodate mama’s of all shapes and sizes….just my opinion though so please no negative comments. I prefer my side lying set up with a body pillow and other regular pillows to adjust the comfort of side lying or the incline when supine.
I set my table with pillows at the head and foot so my clients can lay supine in a reclining position. I am able to work on their entire body in this position. Then I will readjust the pillows for them to lie on their side to finish off on their back. My clients are very comfortable in this position
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No table with the hole. It puts strain on the lower back. Lying on the stomach, although super comfy, is not an ideal position for anyone. But for the ladies that love being prone, there is an special cushion set for them for our tables. I forgot the name though.
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I used to work in a spa that had pregnancy tables and the clients LOVED them. Especially women that normally sleep prone, for them to be able to lie prone again after months of not doing it is a real treat for them.
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There are pregnancy pillow set ups that allow pregnant women to lie on their stomach without putting undue stress on the back. Having had 2 children I would have LOVED this option!!! I have used one of the commercial body systems on a preg friend who loved being prone and didn’t feel any undue stress on her back muscles or ligaments (she is also an LMT).
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I’ve seen all the support cushions for pregnancy massage, and I too am curious to hear/see information about the benefits and contraindications. I have only been exposed to side-lying and reclining massage.
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I don’t do pregnancy massage, but we were taught in school they are not supposed to be prone at all and not to waste our money of a pregnancy table with the cut out that allows you to because it’s still a contraindication.
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In my practice I used a pregnancy pillow and my moms loved it. I had a handful of expectant mothers that were too small to be comfortable lying prone so we just adjusted to a side-lying position. Being able to lay in a comfortable prone position many of my clients were able to achieve a deeper state of relaxation. I myself have used it and I am not pregnant. The pillow reduced the tension in my back and allieveated pain due to two bulging disks.
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I have the Body Cushion system and have done a few pregnancy massages. Being able to lie prone was a relief to them. The cushions can be adjusted so there isn’t stress on the back. Just like any other client, though, you just have to adjust to each one, and each session as they get farther along. My policy is to ask for a new written Dr.’s release every thirty days, since the see the Dr. at least 1 x per month.

If you wish to receive a massage on a pregnancy massage table with holes cut-out then unfortunately we would not be able to help you but we certainly can provide a safe and effective pregnancy massage with you lying on your side.

By Richard Lane

Getting the Rancid Smell
from Massage Towels

Anyone who has been a professional massage therapist for any length of time knows that after a while their massage towels will begin to smell a little rancid. This is regardless of how fastidious and diligent they are with respect to washing their towels. They will try to wash them hot, try to wash them cold and use various proprietary products in an attempt to rid them of the all pervasive smell.

Getting rid of rancid smell from massage towelsAny time they go for a massage with another therapist then they will be highly attuned to how their towels smell and will be immediately aware of any rancid smell.

If you go visit any massage forum and search for questions regarding the rancid smell in massage towels then there will be a plethora of potential solutions that you may be willing to try. Some of these may work; some may not be as effective.

Some of the solutions are based on changing the carrier oil you use for your massage and coconut oils are frequently suggested.

However, a simple method that I have found effective for my towels is to add some normal washing up liquid to hot water in the bath and soak the towels for an hour or so. Adding a few drops of tea-tree oil has been suggested to me. When the water has cooled a little then, with bare feet, stomp on the towels for a few minutes as though you are crushing grapes (can be quite therapeutic by itself or a job for the children).

  
Then just wash the towels normally (I would normally give them an extra rinse just to make sure that you maximised the chances of eliminating all the washing up liquid).

There is no need to do this again until such time as the towels show the first signs of starting to smell.

By Richard Lane

Massage and Nausea

Unfortunately an occasional side effect of massage is that you can occasionally feel a little nauseous after the massage. Whilst you will hopefully feel relaxed, looser with less muscle and joint pain, it is possible that you may just feel a little off colour for a while.

For most people, this side effect of massage only last for a relatively short period. Some people will need to have a lie down and sleep. Others will drink plenty of water to feel as though they are giving their system a flush. Regardless, in the vast majority of cases, the nausea is only a transient hindrance.

Dizziness and nausea post massage
There is much discussion regarding the cause of the nausea and dizziness after a massage and it may well be the case that there are a number of different causes. One theory which is discounted by most therapists is that the nausea is caused by toxins that are release by the massage. For a discussion of this fallacy then please check out www.innerwestmassage.com.au/massage-toxins.php.
A recent hypothesis is that “Post Massage Soreness and Malaise” is the result of a mild case of Rhabdomyolysis which occurs when muscle cells are damaged and it interferes with the blood chemistry.

Personally whilst there may be some evidence to support this theory, if you follow this theory then you would agree that the deeper the massage, then the more likely you would be affected. Although this is a personal viewpoint, it doesn’t tally with my experiences.

For me nausea is more likely if I haven’t had a massage for a while and I have never noticed any correlation between the pressure/intensity of the massage and the degree of nausea experienced. I tend to subscribe to the theory of Dr Keith Eric Grant who considers that massage is about returning the body towards homeostasis and that the nausea may be the result of giving the lymphatic system a bit of a kick-along. Other therapists may argue differently to this but regardless this type of nausea post massage is very normal and not a cause for concern.

However, if you start vomiting and feel extremely dizzy post massage then that is a different kettle of fish. This happen whilst I was massaging someone a while ago and we had to stop the massage after about 20 minutes as the client was unable to continue. Although massage had only been carried out to the back, just the act of lying prone was too much for the client. Although she recovered and started to feel better once she rose from the table, this was not a normal state of affairs and seeing her doctor was the next step.

Although uncommon, one possible explanation for the extreme nausea in this case is atlantoaxial instability.

Atlantoaxial instability can be considered as a loose upper spine and is the loss of the integrity of the joint between the top two vertebrae, the atlas and the axis. For some people who may have had a neck injury or trauma, then when they move their head or neck then a bone projection (the “dens”) from the axis may effectively make contact with their brain stem. The result of this can range from mildly unpleasant through to downright dangerous.

  
Whilst massage is not necessarily precluded for people who suffer from atlantoaxial instability, extreme caution would be required. The neck can be considered vulnerable and only relatively gentle strokes should be attempted with the approval of a suitably trained diagnostic therapist. Most doctors would strongly recommend that there be no manipulation such as a chiropractic adjustment.

Although there may not have been a formal diagnosis of the condition then a massage therapist should be alert to the possibility. A client may be particularly tight high in the neck or be very guarded and protective of the way they hold their head. If any alarm bells are rung for the therapist then they back off with the intensity of their work and use the adage “too little is better than too much”.

By Richard Lane

Deep Tissue Massage Sydney

If you check out any website of a massage clinic or service that offers therapeutic massage then the chances are that they have listed “Deep Tissue Massage” as one of the services that they offer. It may be listed separately or in conjunction with other massage modalities such as sport or remedial massage.

It is not unusual that the price for a Sydney deep tissue massage is quoted higher than for a relaxation or Swedish massage (or even remedial massage).

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deep tissue massageThe use of the term deep tissue massage causes much discussion in the massage fraternity and there are therapists who believe that deep tissue massage = deep pressure massage and this is simply not the case. Whilst most therapists would concur that it refers to the massaging of the deep layers of the muscles, the massage strokes and techniques used in a deep tissue massage will vary depending on the training and preferences of the therapist.

This is purely my opinion but those who have received specific recognised training in deep tissue massage will work slowly and with intent. They will use a wide range of massage tools to work through the superficial layers of the body to reach the deeper muscles and soft tissues. Although the massage can be a little intense at time they are not necessarily using a great deal pressure as by working slowly then it is

Those who have not received specific training may not have the same level of understanding and believe that deep tissue massage means using a lot of pressure. Indeed many clients believe that a deep tissue massage is by definition a strong massage. As such these therapists often use more body force and energy to achieve their goals and this may be the reason why they charge a greater price for their services if they believe that they cannot do as many deep tissue massages in a day compared with relaxation.

Recently this issue was discussed on Facebook and below are some of the quotes from therapists regarding the a discussion about charging differential prices for deep tissue massage. There are certainly some differences of opinion!

We don’t, but I have considered it. When you are massaging a Lions football player, it’s hard work no matter how good your mechanics are!
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I certainly come out sweating a lot more doing deep tissue than just a traditional relaxation swedish massage… especially if I am working on an athlete!
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I’m going to go ahead an entertain this subject. Each individual has a RIGHT/PREFERENCE to charge however & whatever rate they choose. It baffles me that MTs want a justification for what others do in their own private practice or Spa. But to tickle your fancy…..rather seeing as charging a client a higher rate for Deep Tissue, I see it as offering a discount to a modality that is less cumbersome. Some may see it as charging a higher rate as being ‘unfair’. Well, my deep tissue is $80 per hour. Sure I can charge one flat rate. But I would much rather charge $60 for Swedish given the fact that is IS less taxing for me and my team. So you see, where others may see it as charging a higher rate for Deep Tissue, I consider it as offering a discount for Swedish. In summary, ‘I don’t charge MORE for Deep Tissue, I charge LESS for Swedish & other modalities.’ 😉
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I charge $5.00 extra for deep tissue. It’s more straining on my hands and requires more effort which intern I take fewer appointments. I’ve never had a client complain about the increased price either. So for my practice it works.
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I work on a body builder with layers and layers of muscle….that’s justifiable for the rate increase on deep tissue. He’s a regular client, if my body mechanics were off, I would be a mess and I wouldn’t be able to get through those layers of muscle that are “deep” requiring me to work deeper.
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Exactly. I have great body mechanics (although could always use improvement in some areas), but saying a deep tissue is as easy as a swedish is minimizing the work of the therapist, IMO. I actually find it a bit offensive. I find Swedish massage quite easy on the body, but deep tissue takes more work. Especially sports massage on a huge, solid, muscular man. We must all be doing it wrong, then?
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For clients to continue valuing massage at a healthy level, I agree with charging more for deep tissue styles of bodywork. There is greater usage of the therapists’ body and more detailed knowledge of anatomy is needed as well. Swedish massage is primarily meant for relaxation, any therapeutic massage beyond this demands more effort whether for realigning the body or clinically oriented bodywork.
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good body mechanics can not alone compensate for the overall wear and tear on your body, I’m not sure how your neuro clients are but I have very large men, ex NFL and some MMA, plus I customize product usage for the massage style, swedish gets just biotone bought in bulk and some essential oils, neuro gets joint and muscle cream and usually sombra at minimum plus for deep tissue I almost always use aids like hot rocks, bamboo or other to help my get get started, that adds cleaning cost and product wear, my neuros are more in depth plus I utilize additional education and incorporate some gentle tai yoga stretches to further the effect. So I have listed 3 of my main reasons for charging for and 2 of them are not wear and tear on my body, although for me that is #1.
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i don’t charge more for DT, but I do offer a seniors’ discount. I do, however, charge more for Hot Stone massage because it takes 15-30min of my time to clean them afterwards, and I charge more for spa treatments that use product, so that I don’t lose money on the deal.
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In my practice I charge more for deep tissue/clinical work. Swedish massage doesn’t require the brain power that assessment and clinical approach requires, as well as the physical effort if you are moving limbs, checking ROM, doing PNF stretches, and the like. Swedish is generally the first thing taught in massage school as far as hands on work. Myofascial, Trigger Point work and more advanced modalities do cost a lot to learn. If you took classes for prenatal and wanted to charge more for those sessions, that is your right as a practitioner. People will pay you what you are worth! If you have expertise in other modalities, price them how you feel is worth that expertise. Don’t under sell yourself. You know the benefits which you provide!
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I charge for my time and don’t have different charges for different treatments, but that’s just how I like to run my business. If another therapist wants to charge more or less for different treatments that’s their call.
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One of the toughest clients I’ve worked on recently is a challenge. Though I’m well trained in deep tissue body mechanics this client has the toughest fascia I’ve come accross. After doing 2 hours of deep tissue, the nxt day I’m sore but I still don’t break a sweat unlike some of my coworkers lol. If someone wants to charge more for deep tissue that’s their choice so we shouldn’t judge or think of ourselves more highly. We are all different.
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I really like therapeutic body work so feel free to send all those tuff ones to me. its all in the mechanics folks. I will send all my Swedish clients
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I do charge more for both deep tissue and for pregnancy massage as I had to acquire additional specialized training for my prenatal certification as it involved more extensive/ different studying and training of anatomy, trigger points, contraindications, etc. Taking into account the different positioning, consort considerations for the client in the later stages, much like deep tissue there is a different use and exertion of my skills level of work and body mechanics used. Unfortunately many people treat prenatal as just Swedish in a side-lying position and many who perform prenatal in spas are NOT properly trained or certified to do so IMO watching a 30 min home video does not a certification make, And I also agree w/ Jennica, how are we ever going to be expected to be taken seriously if we’re always discounting all over the place – I feel this is one of the primary reasons a lot of people have difficulty seeing our service as a necessity or compliment to their health and wellness and continue to view it as a ‘treat’ or ‘luxury’. It may be hard to admit but there is a certain expectation of quality and competence that comes along with competitive pricing. When your pricing is always cheap or discounted – that’s how your work is viewed as cheap.
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I sometimes wonder if the LMT’s are doing deep tissue or deep pressure when they talk about being worn out after doing it. i find that the deeper tissue that i work on the lighter pressure i’m actually doing (sometimes confusing to my clients which is the perfect chance for me to educate them on the difference). i have had many / most of my clients tell me they’ve never had a massage like i do – i combine many “techniques” — swedish / rom / pnf / trigger point / deep tissue – basically what ever they’re body is telling me it needs. i’ll work on all the “tough” clients that you want to charge extra for and i’ll send you all my “swedish” clients – i almost want to charge extra for that since it stresses me out to do only swedish – if i find a knot or something – i want to work it out to benefit my client!
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In my area I have seen them charge more for prenatal than deep tissue!
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deep tissue is more specialised and carries with it more “risk”, more on costs and more effort (both mental and physical). I charge less for Swedish because it’s simple and easy to do – to me, it’s like meditation. Remedial is a worthy challenge. And those of you who swear “it’s all body mechanics”, get over yourselves and get some experience with professional athletes (esp footballers) before you make your judgements.
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Here’s another thing I wonder about as well….in spa’s well, in most spas – they almost always upcharge for evvvvery little ‘extra’ thing, most of which we use anyway – paraffin, aromatherapy, bio-freeze, wrapping/ taping, etc. Why are those charges NEVER questioned in fact most people are happy to pay the difference w/o giving it a second thought, but as individual practitioners, we are nickeled and dimed to death about why we charge this and why we charge that – I promsie you I believe its a direct effect of the group-on syndrome – why pay full price and actually COMPENSATE the therapist for his/her time/effort/energy/skill, when you can just wait for the next dirt cheap discount!
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I’ve been doing “deep tissue” for 20 years. I charge more because if you need deeper work, my education and experience is worth paying for. Deep work can be anything from deep muscle therapy, fascial work or craniosacral work. When the person’s body is ready for Swedish maintenance work the fee is adjusted to the lower price. I have also worked on my body mechanics constantly over he years so I can continue to give people massage therapy, no matter what type of bodywork they need. I do have to say, when I have somebody on the table who needs pure physical strength to get what they need, I am very happy that I am making more money.
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Seems difficult to charge more for a service if it’s based on the reasoning of extra effort…that would mean we have to charge more for an OBESE client and bulky athletes, and LESS for skinny minny and the cyclists/runners who are thin (but still athletes).

As for training, all clients benefit from training, not just what ever style chosen for the session.

Products? Absolutely charge extra. They cost extra. Aromatherapy oils are expensive!
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The salon I work at charges more for deep tissue than Swedish (the former receptionist set the prices. She was not an MT, but shes had massages in the past making her an expert {I hate people like that}). Most people I see there want relaxing with deep pressure. If they really want deep tissue, I will do it at the regular price of the Swedish (it doesn’t matter to me). In my out call business, I charge different for relaxation and therapeutic. Relaxation is easy to me, and some people just want to relax, which is fine. I charge more for therapeutic because it does take greater knowledge and training. I have never had anyone complain.
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I myself do an integrated style of massage, using many different techniques in a single session. As others have stated , deep tissue is harder- but using leverage, and for Pete’s sake, slowing down makes a world of difference in how much pressure you have to use, how uncomfortable it is for you and the client, and how sore they might be later. There are a lot of good arguments here, and I think all of them are valid. I charge for my time. Deep tissue takes longer, or else it will only be a targeted session, not a full body. So for me, it all equals out. Each therapist has to decide what is ethical and appropriate for them. There just isn’t one right answer to this question. For instance, I do quite a bit of deep tissue, and some of it isn’t about pressure. But, I don’t have any football players or body builders. Everyone’s clientele is different, and you have to look at that….

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I charge exactly the same for all my work. I charge by the time, with different rates for half hour, hour or 90 minute massage. I don’t feel that the patient can know in advance what kind of treatment they will need – we make that decision after I have done the intake and assessment. I treat based on what I find and what their needs and goals are. I do whatever techniques are most suited to helping the patient — I don’t do more or less based on what they are able to pay.
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I charge by time & modality and I have never had a client be upset or argue with me about my rates once I explain that the more specific the massage, the more detail is involved. I charge a higher rate for PreNatal than Deep Tissue or Sports. Everyone’s rates are their own choice. I have chosen to value my services & professional liability accordingly.
Any therapist who is practicing should have liability insurance at the least even if they are in unregulated territory. Having said insurance and/or credentials is an automatic need for CE to maintain these. Some therapists will spend more on CE while others will spend less. If you are one to spend more, then charge more for your sessions across the board. Deep tissue techniques are not hard on the body if you are truly applying proper technique and body mechanics. Please send me the “toughies”….deep tissue rocks!
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i work deep tissue in preventive injury and injury treatment, i work with professional mma fighters, pro lacrosse players and at boeing on the factory workers who build the planes, many of these people dwarf me in size and their strength as athletes which demands a intense amount of work in a short amount of time. i work with people who out weigh me by 150 and up. and the most time i have is a half hour to be effective and 15 at the shortest. it is very different than Swedish even with proper mech. this has been my experience.
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It is just a business and marketing tactic. You can do whatever you want really. You could charge more for pregnancy massage or different rates for any type of massage really. why not?
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Personally I can’t be bothered trying to charge for different services when it comes to massage. I charge for my time and skill. If you want spa services they are charged accordingly.
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I think it is a personal choice on what therapists want to charge. I myself mix my techniques…if I do massage at my house for friends that come over I just charge one price. Also at the Chiropractors we charge one price..I just find that its easier to just stick with one price.. and tell them I do my consult and then from there create my massage based on what I think is best for them..esp. depending on what they do for work. I don’t think you can compare Swedish to deep tissue.Swedish is long flowy strokes and I feel lazy doing them lol and just feel like I’m rubbing in lotion. I do deeper lunges and I feel like cross fiber work does make me sweat. Especially when I do a lot of my forearm and elbow work.. I am def using more of my body and more effort. But sometimes I believe it all falls on the therapist.. I’ve gotten many massages.. and sometime’s I find myself thinking.. that felt lazy.. or wow.. now that he/she has moved on to my right side of my back I can feel the difference on the other side already! Some people just put more effort into their work.. and I believe they deserve to charge a higher rate! 🙂
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I charge a bit more for specialties, such as prenatal, hotstone, lymph drainage, ashiatsu etc – modalities that require special training and/or extra equipment. I charge the same price for THERAPEUTIC massage, be it swedish, deep tissue, trigger point work, or a combination of all. Massage Nerd is correct. We should all know how to give proper pressure to each body using proper mechanics and not feel we need to charge more for clients who may or may not feel what you felt.

  
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imho, if a therapist has invested time and money to learn advanced modalities then it is justified to adjust the fee accordingly.
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Deep tissue requires more work for the MT, physically and thought process as well as training. And yes, it can be taxing despite proper body mechanics. I don’t book as many DT clients in the same day as I would swedish. I think blaming the ability or lack of on just body mechanics is very inaccurate. For the record I charge a flat fee regardless of the tyoe of massage.
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Sydney Massage Deals

As a consumer, I am a supporter of the plethora of websites offering deals on products and services. Spreets, Living Social, Cudo, Ouffer, etc provide a range of different new offers on a daily basis for virtually anything you can think of.
Whilst I am not a regular subscriber to these services, I have used them occasionally and my experiences is that some of the offers have been more trouble than they are worth but, on balance, I am probably ahead with the ones that I have purchased.
Massage Deals in SydneyHowever, like many massage therapists I am not particularly in favour of these sites for a number of reasons. The main reason is that there is a perception from massage therapists that it devalues the services that we offer and people may struggle to understand why there is a price difference between what is the normal fee for a clinic or mobile massage and what is available to them through the offer sites.
Typically the way that these deals operate is that the normal fee charged by the therapist, clinic or day spa is split roughly 50-50 between the massage provider and the offer company. So if the offer is for a $60 massage then the therapist may be receiving around $30 for their time.
Now I am not criticising massage businesses for listing their services on the offer websites. It is a business decision that should be made on a case-by-case basis. Personally though I could understand why a business would do it only in a couple of instances.

   
Firstly, they are setting up a new business and they want to spread word out to people in their area about their new clinic or spa.
Secondly, a clinic or spa has excess capacity at specific times so that they would tailor the massage offer to only be available for say, between 10am and 2pm.

I have heard that often these offers are used by therapists/clinics whose businesses are struggling and it is almost a last throw of the dice.

I can say categorically, that our Sydney mobile massage business will never offer our services via these websites.

  • We believe that we are offering our services at a fair price (and back that up with an unconditional guarantee of our massage services).
  • We are different to clinics in that we do not have overheads as such but have travel costs instead. If we were to only be receiving $30 per massage then this may not offset travel costs and as such we would be working for nothing.

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I’d be interested in hearing from anyone who has used these offers to have discounted massages. Feel free to comment below. If you are using them to find a permanent therapist then all well and good. However, the perception in the industry is that most people who buy offers are rarely prepared to pay full price, regardless of how good an experience they receive.

From those I have spoken to I had mixed feedback. Some people have been satisfied with the massages they have received whereas others have felt that the therapists have just been going through the motions with limited enthusiasm and commitment to the bodywork they are providing.
eg from a Google review of a place that offered discounted massage

Terrible! I got a deal through Cudo and the experience so beware. The experience was non-existent. My ‘therapist’ was having lunch as she was giving me a massage (!!) and the place feels old and dirty, held together by a safety pin and nothing more

  
I have only ever seen one mobile therapist using an offer site and she received a lot of negative feedback not because of her massaging but because people could not book with her when they wanted to.

Obviously my attitude is biased and I probably could have found positive reviews from recipients of discounted offers. But my perception is that for every good experience there is just as likely to be a poor experience so it is a case of buyer beware. As someone on Facebook the other day commented

Buy cheap – get cheap!

By Richard Lane


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