Online massage booking        Find us on Facebook    Google+    twitter RSS

Frozen Shoulder and Massage

The term “Frozen Shoulder” refers to a painful symptom of the shoulder that can severely limit its range of motion and so giving the impression that the shoulder is “frozen”. The condition affects women more than men, and occurs most frequently in women aged from 45-65. Health-care practitioners prefer to use the term “adhesive capsulitis” as while the term “frozen shoulder” is common, it isn’t entirely accurate.

There are several problems in the shoulder that may be painful and limit the range of motion in ways similar to adhesive capsulitis. An important method of distinguishing adhesive capsulitis from other shoulder problems is to evaluate the way in which motion is restricted at the shoulder joint.

Shoulder MassageIn the glenohumeral joint, the capsular pattern for motion to be limited is first in external rotation, then in abduction and finally in medial rotation. Thus if a client has difficulty bringing the arm up in abduction but has no problems externally rotation the shoulder then it is unlikely that the client has adhesive capsulitis.

The glenohumeral joint has the greatest range of motion of any joint in the body. When the shoulder is in a neutral position (with the arm by the side), there is some slackening of the glenohumeral joint capsule on the underside which is necessary to allow full range of motion of the joint. When the arm/shoulder is moved to other positions, the underside of the capsule becomes taut.

Adhesive capsulitis develops when a portion of the joint capsule adheres to itself and prevents full movement of the joint. As the capsule is highly innervated, it is extremely painful when the adhesions pull on the tissues of the capsule.

Adhesive capsulitis is generally categorized into primary and secondary. In primary adhesive capsulitis there is no obvious cause for the condition – clearly frustrating for practitioners. There may be some correlation between a significant emotional trauma and the development of primary adhesive capsulitis.

Secondary adhesive capsulitis will often develop as the result of rotator-cuff tears, arthritis, shoulder trauma, surgery, bicipital tendinosis, etc. With these injuries, there appears to be a process of fibrosis that is initiated by these other conditions. As such, the individual is usually limiting motion in the shoulder at the same time the fibrosis is occurring and the fold on the underside of the joint capsule is never fully elongated. Thus begins a vicious cycle as the adhesion causes limitation to shoulder movement and pain, thus worsening the problem.

Subscapularis trigger points have also been suspected of causing secondary adhesive capsulitis. This may result from irritation of the attachment site of the subscapularis which is close to the capsule. Local inflammation at the attachment may then cause fibrous adhesion in the capsule.

Frozen shoulder is often divided into three stages:
Freezing. Onset is usually between 2 to 6 months and this period is characterized by a gradual decrease in range of motion and an increase in pain.

Frozen.This stage occurs for between 4 and 12 months after initial onset. Motion will remain extremely limited although there may be a gradual decrease in pain levels.

Thawing.In the thawing period, there is a gradual return of range of motion and decreased pain. This stage can vary from a few months to several years.

Treatment and Massage of Frozen Shoulder

Treatment should always be directed by a trained health-care practitioner who is suitably qualified to diagnose adhesive capsulitis. Most treatments begin with a relatively conservative approach aimed at increasing the range of motion of the glenohumeral joint. Simple movements such as letting the shoulder hang like a pendulum may encourage a gradual increase in range of motion. With adhesive capsulitis, if exercise is too vigorous then further damage and inflammation of the joint capsule may occur.

Massage techniques used to treat frozen shoulder should encourage relaxation of the muscles surrounding the shoulder. Simple effleurage and broad cross-fibre sweeping strokes are often used to assist in restoring proper movement to the joint. As discussed above myofascial trigger points in muscles such as subscapularis may also play a role in adhesive capsulitis. These may be treated with static compression or compression with active movement.

  
Another area that massage therapists may wish to consider is to encourage the elongation of the adhered capsular tissues. This is achieved by gentle stretching motions such as a passive stretch in lateral rotation where the client is taken to the point where discomfort begins and then held there. The client is encouraged to breathe deeply and relax the shoulder as much as possible. After holding the stretch for up to 30 seconds, the client is returned to the neutral position before repeating the procedure a few times.

If conservative treatment is not successful, a more aggressive stance may be taken of forced manipulation of the shoulder joint whilst the shoulder is anesthetized. Whilst this can produce dramatic improvements in the range of motion, it is extremely painful.

By Richard Lane

Sciatica and Massage

Many people claim to suffer from sciatica but what is sciatica?

Put simply, sciatica is a pain, usually in the back of the leg caused by compression, irritation, or inflammation of the sciatic nerve. The sciatic nerves are the longest and largest nerves in the body, running down the back of each leg and are about the diameter of your thumb.

The sciatic nerve is actually composed of four or five smaller nerves that leave the spinal cord from the lower spinal column, join together and then travel down each leg. It then divides into numerous smaller nerves that travel to the thigh, knee, calf, ankle, foot and toes. When these nerves are irritated or affected by the inflammation of nearby soft tissues, then this is referred to as sciatica.

There are several reasons why the sciatic nerve could become compressed, entrapped, or irritated. In “true” sciatica, the nerve roots can be compressed by herniated, degenerated or displaced lumbar spinal disc(s). This can be exacerbated by tight muscles and soft tissues in the lower back, buttocks or leg.

sciaticaThere are also other conditions which can mimic sciatic symptoms such as Piriformis Syndrome where the sciatic nerve is entrapped by the piriformis muscle in the buttocks. Piriformis Syndrome is sometime referred to as “back pocket sciatica” as pressure on the piriformis muscle and sciatic nerve can be caused by sitting on a wallet in the back pocket of a person’s pants. Another problem that can imitate sciatic pain is trigger points in the Gluteus Minimus muscle. The trigger points in this muscle can refer pain sensations down the back of the leg along the path of the sciatic nerve and also on the outside of the leg.

People with sciatica suffer from a wide range of symptoms. The pain may come and go at different times, it may be a constant problem and then it may subside for hours or days for no apparent reason. Some people may feel only a dull ache travelling down the back into the upper leg. For others, it may be intense sharp shooting pains all the way down the leg into the foot and toes.

Many factors can influence the pain of sciatica. If the sufferer sits in one position for long periods of time then the pain can increase. Long distance drivers and computer operators are particularly susceptible. Exercising, or even simple things like walking, bending, twisting or standing up may be difficult and painful. For some, the pain may change from side to side or be present in both legs. For others, back pain may appear before the sciatica emerges. In some severe cases, sciatica can impair reflexes, or result in the wasting of the calf muscles.

Treatments for Sciatica
The medical approach to dealing with sciatica is to treat the symptoms. This may include using painkillers, muscle relaxers or anti-inflammatory drugs such as NSAIDs . Traction, physical therapy or injections directly into the nerve roots may also be used. In severe cases, Surgery (such as microdiscectomy or lumbar laminectomy) is used to help relieve both pressure and inflammation.

  
Massage Therapy
Massage Therapy and Bodywork can help Sciatica, Sciatic Nerve Pain, in particular the conditions which mimic sciatica such as Piriformis Sydrome. Massage therapy can relaxes muscles, releases trigger points and abnormal tissue adhesions, and improve posture to relieve the pressure on nerve roots and other sensitive structures.

Other Manual treatments (including physical therapy, osteopathic, or chiropractic treatments) can help relieve the pressure. Chiropractic and Osteopathic techniques are often used in conjunction with treatment by a Massage Therapist.

Use a Tennis Ball
The knots in the muscles of the hip and buttock can be effectively treated with a tennis ball. Simply lie on a tennis ball such that it presses on deep, sore points and just wait for the feeling to fade. However please be aware that the piriformis muscle is so unusually reactive and the use of a tennis ball to massage the piriformis needs to be gentle and conservative.

Jump in the Spa to Relax the Area with Heat
Whether the pain is caused by the crushed sciatic nerve itself, or just by tight muscles, the muscles need to relax. Hot tubs, with jets, are ideal for sciatica.

Check Your Posture
The types of sciatica that are related by excessive sitting may be influenced by the ergonomic design of work station and/or chair. It may be worth experimenting with your chair and the layout of your work station. A simple option is to use a timer to remind yourself to get our of your chair at regular intervals such as every fifteen-twenty minutes.

By Richard Lane

Massage Swaps

There are very few people who do not benefit from massages and massage therapists are no exception. In fact, given the physical nature of the work often with suboptimal postural position, massage therapists probably need more massage than some other professions.

There are often debates on social networks about the merits of fellow massage therapists trading massages.

Massage exchangeIt can be a great way for students to practise their strokes and receive constructive criticisms about their bodyworking style in a non-threatening environment. They can learn and discuss new techniques. They can ‘talk shop’ about the massage industry, their ideas and their business plans.

However, professional therapists who trade massages in Sydney tend to be the exception rather than the rule.

In theory it should seem logical that therapists work on each other. However, in practice, even though most therapists try it at some stage in their career, most end up deciding that paying for massages works better for them.

There are a number of reasons for why professional do not tend to swap massages.

– They struggle to find someone that they want to receive regular bodywork from who also wishes to trade.
– They struggle to find suitable times that work for both parties.
– Very few therapists like to do a mutual swap within the same session. It is always very hard to get up from a massage table and then have to give your trade partner a massage straightaway.
– If they do find a massage swap partner who they do like, it is very rare that the bartering relationship is completely reciprocal. As often occurs in any relationship, one party tends to feel that they are investing more than the other. Eg one therapist may cancel or put paying clients ahead of their trade partner.

  
Most therapists tend to find swap partners when they are studying and it may well be that they only swap whilst they are learning new modalities or techniques. There are massage exchange websites where therapists can check out other massage practitioners who they may wish to consider swapping with. However, as a word of caution, many those with register with these sites may be after a sensual massage swap.

Even therapists who find that they are compatible with respect to swapping massages often drift away over time and what might start out as a weekly or fortnightly swap, ends up being just an occasional massage. In the end most experienced therapists end up preferring to become just another paying customer with therapists they enjoy receiving bodywork from.

By Richard Lane

Massage and Physiotherapy

Often when people ring to enquire about the nature of the Sydney remedial massage services that we offer there is some confusion and misunderstanding about what the differences between physiotherapists and remedial massage therapists. Some people believe that we offer similar services but this is not the case. Whilst there is a degree of overlap between the two professions, there is significantly more that is different.

Historically there are suggestions that the first chartered society of physiotherapists formed from remedial massages so there is a degree of commonality between them. However, since that time physiotherapists and physical therapists have moved away from this background and offer distinctly different treatments and therapies from remedial massage therapists who have largely stayed constant with their approach. Remedial massage therapists still rely on the same touch and palpation skills to provide the same benefits for their clients and there is no reason why the effectiveness of the application of these skills will have changed over the years.

Massage Therapy
physiotherapy and massageMassage therapists rely on touch to deliver remedial bodywork to their clients. There are many different massage modalities available such as deep tissue, sports, Swedish, Thai, trigger point therapy etc and they all work on the soft tissues of the body (mainly muscles but also tendons, ligaments and connective tissue/fascia). Massage therapists do not do any manipulation and, most importantly as a means of distinction from physiotherapists, they do not have sufficient training to be considered as diagnostic practitioners. If you are after a firm diagnosis of any condition you are faced with then you will need to see someone other than a massage therapist (although your masseur should be able to advise who to see for diagnosis).

People will most commonly see remedial massage therapists when they are suffering from muscular and soft tissue complaints. Sessions will typically last around an hour (or longer) and the therapist will use their hands, fingers, knuckles, elbows and forearms to provide the manipulation to the soft tissues. Although most remedial massage sessions have a direct therapeutic objective, for many people an added benefit is that, whilst the massage itself may be a little painful and intense, it will always provide a degree of relaxation for the massage recipient.

Physiotherapy
Physiotherapists will treat people who are suffering from injury or physical condition using a range of different techniques. Whilst hands on bodywork may be incorporated within this treatment, typically it is only a small component of any session. A typical physical therapy session will involve some assessment, some bodywork (if appropriate), application of ice, ultra-sound or tens machines and some corrective exercise therapy (which will normally involve exercises that the patient may do away from the clinic).

Typical injuries that may be treated by physiotherapists are both acute and chronic in nature. It is not uncommon for a physiotherapist to be seeing two or three patients simultaneously and so you may experience times during your session as the physiotherapists when you are not actually being formally treated by the therapist.

===============

If you are not sure who you should be seeing then it is always advisable to talk to any potential practitioner about your requirements prior to booking. You have the right to expect an honest answer regarding their suitability and appropriateness (although sometimes it can be a little tricky to make complete assessment over the phone). You should ask them about the nature of the treatment that you can expect.

As a rule of thumb, if you are suffering from an acute injury or require a firm diagnosis of your condition then it is probably preferable that your first port of call be a physiotherapist. It may be that after a few sessions then massage therapy may become more relevant for your treatment (generally in our view most people would sooner experience a massage assuming that their treatment goals are met).

  
If your condition is more general and chronic in nature, such as stiff neck or ongoing sore shoulder then massage therapy may be appropriate. This is particularly the case if you wish to have a more general approach with the therapist devoting their time solely to your body rather than a session that is totally dedicated to dealing with the soreness in your left forearm, for example.

Regardless of the therapy you receive, then it is suggested that you talk to your therapist about goals and milestones with the treatment program. If you do not feel you are progressing at the rate you would like then it may be an idea to consider alternative treatments (although it is also recommended that you give a therapist a fair opportunity to make progress and not just chop and change after one or two sessions).

The Benefits of Abdominal Massage

Many massage therapists will spend the vast majority of session working on the back of the client. They will give great bodywork to the back, shoulders, neck and the back of the legs but then only give cursory attention to the front of the body. Now it is true that most of us have significant issues with the back of our bodies but to neglect the muscles and soft tissues at the front of the body is to provide an incomplete session. Only a few therapists would routinely incorporate an abdominal massage within a full body massage, yet there is little doubt that bodywork through the stomach area can offer many health benefits.

Abdominal massageMost people who do request an abdominal massage would likely do so because of digestive issues although there is also significant musculature in the area that may require release to assist with physical problems. For example, a tight and contracted rectus abdominis muscle will impact on the stability and movement of the lower part of the body or lead to us slouching forward setting up postural imperfection through the lower back.

In total there are at least four layers of muscles in the abdomen and these can impact on your core strength (both your physical and emotional core). Trigger points are not uncommon in the abdominal muscles and the pain referral patterns can include the lower back. Simons and Travell (1) observed that

An active trigger point high in the rectus abdominis muscle on either side can refer to the mid-back bilaterally, which is described by the patient as running horizontally across the back on both sides at the thoracolumbar level … In the lowest part of the rectus abdominis, trigger points may refer pain bilaterally to the sacroiliac and low back regions.

Regardless of the requirement for remedial massage and trigger point techniques for hypertonic muscles in the abdomen, the vast majority of abdominal massage will be for digestive issues. Most therapists consider that massage to the stomach areas will improve the capability of the digestive system and will potentially benefit some of the organs that are contained within the abdominal cavity (such as liver, pancreas, gall bladder, small intestine and colon). A recent review of research has confirmed that there are likely to be benefits for performing abdominal massage to treat chronic constipation. Sinclair (2) concluded “studies have demonstrated that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it. There is also good evidence that massage can stimulate peristalsis in patients with post-surgical ileus.”

Routine for Abdominal Massage
In order to give an abdominal massage then the stomach needs to be exposed and it is usually recommended that there be some bolstering under the knees to slightly relax the abdominal region. Normal massage lubricatants are fine to use.

– Place your hands gently on the stomach and palpate. The stomach should feel soft and relaxed

– Always be aware of the breathing of the client and work with the breathe, not against it.

– Sink in through the diaphragm region with the breathe of the client

– Lightly work along the lower border of the rib-cage with fingers and thumbs.

– Gently effleurage the area with light circular strokes. Always work in the direction of the digestive system which means working clockwise around the stomach.

– Place your hands over the rectus abdominis and gently palpate for areas of tenderness and restriction. Work the edges of the muscles with static compression (asking the client to tense the muscle by have them start to sit up) with sufficient pressure to be therapeutic but not too much that it causes pain. Release attachments at the xyphoid process (obviously without ever putting direct pressure on the vulnerable process itself). Release the attachments at the upper border of the pubic bone (mindful of the sensitive nature of this area – if client has any concerns then you can get them to use their own hand to achieve this release or alternatively work through a drape).

– Work deeper under the ribcage on both sides of the body (be aware of working too deeply directly into the liver which is on the right side of the body). Cross friction at any tender points.

– Pull through the sides of the body with relaxed hands, reaching around the body as far as possible, working and stretching the fascia.

– Work the ascending colon (right side) and descending colon (left). Make sure you connect with sufficient pressure through colon although not too much so that it causes pain. Some therapists recommended clearing the descending colon first too “make room”.

– Finish with a calming connective touch to the abdomen.

  
Normal massage contraindications would apply for abdominal bodywork and if the massage is to be performed for a specific health objective then it is recommended that it be discussed with suitable doctor prior to treatment. Also be aware that many people may have emotional sensitivity and instinctively be highly protective of this so any bodywork needs to be mindful and respectful

1. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body, 2nd Edition. Lippincott, Williams and Wilkins, 1999:943.
2. Sinclair M. The use of abdominal massage to treat chronic constipation. J Bodyw Mov Ther 2011; 15:436-445.

============
Update – a 2011 review of the effect of abdominal massage in chronic constipation found that abdominal massage can stimulate peristalsis, decrease colonic transit time, increase the frequency of bowel movements in constipated patients, and decrease the feelings of discomfort and pain that accompany it.

“The use of abdominal massage to treat chronic constipation.” Sinclair M.
J Bodyw Mov Ther. 2011 Oct;15(4):436-45. doi: 10.1016/j.jbmt.2010.07.007. Epub 2010 Aug 25.
============

By Richard Lane

Therapeutic Breast Massage

Breast massage can be a contentious issue amongst therapists. Some promote that there potential health benefits through lymphatic drainage; others are less enthusiastic about any advantages of performing breast massage. Some are concerned about the personal nature of any Sydney massage that involves touching of breast tissue; others are more relaxed.

However, it must be mentioned that professional associations have policies regarding breast massage. For example, the Australian Association of Massage Therapists offers a policy development document on this issue at http://membership.aamt.com.au/lib/Journals/Summer06/AAMTbreast.pdf.
Within this document they state:

Massage therapists must recognise, accept and respect the right of every individual client to choose whether they wish to decline breast massage …..
Even when agreement with the client for the breasts to be included in a treatment is granted, it is entirely inappropriate and completely unnecessary to provide disproportionately prolonged massage to the area and that that the client is free to revoke that consent during the massage.

AAMT suggest that massage of the breast tissue is currently practiced in modalities of Manual Lymph Drainage, Lymphodema, Lomi Lomi and post surgical breast augmentation and when specifically prescribed by a Medical Practitioner. During a standard remedial or relaxation massage then there is no reason for the breasts to be massaged and the ATMS policy is that mammary glands should not be massaged and only professional techniques should be applied to surrounding tissues.

This last point can cause a little confusion from massage recipients though. For example, the pectoral muscle groups are often indicated when people have tension in their neck and shoulders. Tightness in the upper back muscles is often the result of excessively hypertonic pectoral muscles bringing the shoulders forward. Therapists may often feel that lengthening these muscles of the upper chest is important for improved posture yet to access these muscles then the therapist needs to work close to breast tissue.

Massage for the pectoral musclesThe picture to the right on this page of this page demonstrates a therapist performing a remedial massage technique on the pectoral region. It is easy to image that, on women with a larger bust, performing such a stroke for the pectoralis major and pectoralis minor muscles would be extremely difficult without touching breast tissue.

But this stroke would not be applying massage to the breast itself.

  
Therapists do need to be mindful of such strokes, explaining why they need to work in this area and soliciting permission from the client before commencing. The client also has the right to request the therapist stop should they ever become uncomfortable about the nature of the touch. Some therapists may ask the client to hold their breast to provide a physical barrier between the therapist’s hand and the breast.

As mentioned above breast massage in Sydney is not permitted within a remedial or relaxation massage. I have included the technique (with client permission) during Lomi Lomi massage. Within a traditional Lomi Lomi massage then including massage to the breasts is considered to be a normal part of the routine and whilst there is obviously no muscles within breast tissue, there are claims that it can reduce pain and stress in the chest.

Free Massages – How Not to Give Them

When you are a student massage therapist then providing a free massage for Sydney family members and friends is considered part of the training. In return for you giving them a massage then you get the chance to practice strokes and techniques that you may have learnt in class. In addition, you can solicit feedback from the recipient of the free massage.

It is a win-win situation.

However, once you have qualified and start working as a massage therapist then this synergistic situation changes. You are confident of your skills and how your bodywork is received by clients and client feedback is less important for you.

If you have been working hard at a clinic, doing mobile massage or at a spa then the last thing you want to be doing when you get home is to give away a freebie.

free massage in SydneyUnfortunately from the therapists point of view though friends and family don’t necessarily see it this way and many therapists are frequently asked to give them a few minutes of time to massage their stiff neck or sore shoulder.

A question that is often posed is how can I, as a therapist, politely decline to work on them?

On a recent Facebook posting, therapists gave suggestions on how to deal with this issue. The most common response was along the lines of handing the person your business card and asking them to call to make a booking.

Here of some of the other answers.

I say in a funny sarcastic yet friendly way, “I have all my free massages when I was in school for two years. I have to pay off my student loans before giving anymore free massages.”

I’m just honest. I tell them that I don’t have the stamina on my days off and they always understand. If I can tell someone is just trying to get a freebie, I tell them they can have a business card. They laugh and say, “Smart answer”.

Tell them you’ll trade if they work on you first

When family and friends come crying to me about what is hurting on them (hinting about wanting me to work on them) I always reply by telling them what is hurting on me. They usually get the hint

It seems that people think that because we are MT’s, that we never hurt. Typically don’t like it when I say… Yeah, my neck and back are killing me too!

Sometimes if my friends say “Oh, my back hurts so badly!” I answer with, “I’m sorry, I wish I knew someone who could help”

Make an appointment, today’s my day off.

“Sure! I’ll trade you. I can always use a massage! 5 minutes for 5 minutes?” “Uhh.. uhh… uhh… “

  
But probably my favourite is

If you know someone who is a mechanic, and says “My back hurts, can you help me?” answer: My car needs brakes, can you help me later tonight?
If you know someone who does daycare and they ask for free massage, ask them in turn to babysit your kids for free when they get off work.
You get the point. If they wouldn’t work for free, why should you?

By Richard Lane

Massage Client Behaviour
– What Bugs Us

Although massage therapists always try to give the best experience they can to all clients, they are only human. Some client behaviour can impact on the mood and general psyche of the therapist and you may be surprised at some of the things that may annoy your therapist. Most of these apply whether you are visiting a massage clinic or having a Sydney mobile massage.

Recently an online massage discussion talked about client behaviour that winds up therapists.

Open Eyes
Lying on your back with your eyes open is kind of freaky for us. It gives the impression that you are not relaxing and/or enjoying the massage. Some therapists commented that they were a little unnerved and felt like they were being watched.

“Helping Us”
When we move a particular part of your body such as a limb or leg, then we like to have the muscles relaxed and loose. If you are helping us by holding your arm or your head up then muscles will be contracting which we don’t want contracted.
However, some people can be too loose. To quote from one therapist:

what I refer to as “bobble heads”, there is a difference between relaxing your neck for me to work on it and letting it go completely limp so every time I touch it, you just bobble around.

Try to relax and switch off. Let the therapist do the work – that’s what your paying them for.

massage behaviourCutting it fine
Some people will arrive right on the designated appointment time (or a few minutes late) but then trundle off to the loo and spend 5-10 minutes there whilst the therapist paces up and down waiting for them. Massage therapy is a business so time is money and many therapists operate a tight schedule and cannot afford to run behind time.

However, there is one thing worse than going to the loo when you should be on the massage table and that is
….not going to the loo.

Some therapists describe situations when the client left it too late before using the bathroom……….

Not talking to us
If you are lying on the massage table and not enjoying aspects of the massage then talk to us and let us know. If you want more or less pressure, if you don’t particularly enjoy a stroke or technique, if the room is too warm or cold, if the music is bugging you then please tell us. Whilst some things may be outside of our control, we will endeavour to change what we can so that your massage can be as enjoyable and effective as possible for you.

Talking to us
This can vary from therapist to therapist but some therapists find it distracting if you are constantly talking. It can give the impression that you are not relaxing and not overly enjoying the bodywork.
However, it may be the case that you use your time on the table to wind down and you do this by talking and unloading.
If you want to talk and your therapist doesn’t then maybe it might be time for you to find a therapist who is more open to chatting and conversation during the massage.

Unreasonable expectations
A common theme amongst the discussion was that sometimes clients have unrealistic expectations about what we can do within the one session. If you expect me to release your calf muscles, increase your hamstring flexibility, cure your tennis elbow, address that nagging pain in your lower back, free up your shoulders, loosen a tight neck and get rid of the thumping headache you are suffering from, in one 60 minute session then, sorry, but you will be disappointed.
I’ll do what I can but if you require remedial or medical massages, I can generally only work on a couple of areas effectively with one hour.

Not letting us know what is happening with your health
If anything has happened with your health since we saw you last, please let us know. To quote from one response:

Another time an elderly lady said, while on the table and after saying, “no, no changes this week”, “oh yeah, I had a small stroke the other day”. Yeah…….the MT about had a small stroke…..

  
Other (irritating) behaviours described included:

  • Leaving phones on and talking during a session.
    Cracking knuckles during an entire session.
    Playing games on a phone.
  • ==========

    Please be aware that these are personal comments from individual therapists and ultimately you are the paying customer. However, it might be worthwhile to have an appreciation of the massage from the therapists point of view.

    Want Great Massage
    – Then Speak Up!

    If you regularly experience massage then you know the type of touch you like. Some people like point pressure, some people like flowing strokes. Some people like strong pressure (which they may refer to as deep tissue massage), others like a more gentle nurturing approach. Some people like different techniques and pressures for different muscle groups. Some people like different massages at different times depending on their mood and how their body is feeling on a particular day. Some people like a full body massage including massage to the glutes, abdomen and pecs, others prefer the session to concentrate on specific problem areas such as the neck, shoulders or back for example.

    massageNow whilst many massage therapists may consider that they have a degree of intuition and may modify a particular session based on what they are feeling both physically and intuitively, unfortunately none of us are mind readers. We are only guessing how the massage feels for you.

    To optimise the benefit you receive from your massage then there is an onus on you to communicate your requirements and preferences.

    If there are techniques, strokes and styles that you particularly enjoy (or particularly dislike) then let your therapist know before the session. If there are parts of your body that you want included in the massage then please communicate that to your therapist (similarly if you don’t want particular areas included).

       
    For me personally, I dislike being jabbed or prodded with point pressure with a sudden motion. It does nothing for me (and to be honest I cannot understand how it is supposed to improve the function of the soft tissue). But it is up to me to tell is to the therapist.

    Once the session begins again if there is anything that is bugging you with the way the therapist is working, don’t just lie there but speak up. Tell your therapist that you want more or less pressure. Let them know that you would prefer more gliding/stretching strokes rather than acupressure style or whatever the case may be.

    Although you may not wish to talk too much during your treatment, just a couple of comments to direct the therapist will go a long way to providing you with the bodywork you are after.

    By Richard Lane

    Subscapularis Massage

    I recently posed an online question to other therapists about what muscles they believe do not receive sufficient attention from bodyworkers. My suggestions was the SCM (sternocleidomastoid) muscle at the front of the neck. Other suggestions included the gluteal muscles, the pecs and abs which didn’t surprise me too much. However, a few therapists included the subscapularis muscle in their lists which I have to admit, is not a muscle I would normally spend a great deal of time on.

    Their comments inspired me to have a look at subscapularis, what it does and why it may be important for some shoulder conditions.

    Now the subscapularis muscle is part of the rotator cuff group, along with the teres minor, infraspinatus and supraspinatus muscles. These muscles work together to stabilise the humerus in the glenoid fossa of the shoulder. From a massage therapists terminology it attaches to the anterior surface of the scapula at the subscapular fossa and the lesser tubercle of the humerus. It’s action is to internally rotating and adducting the humerus (along with it’s stabilisation role).

    Pain and dysfunction in the subscapularis muscle often manifests as an inability to lift the arm above the shoulder (although it should be mentioned that not being able to lift the arm above the shoulder does not necessarily indicate that there is an injury to the muscle as there are other conditions which have the same impact on lack of shoulder mobility). It is often the case that someone who spends a lot of time in front of a computer may very well have some dysfunction of the subscapularis, such as trigger points (this applies to anyone who works with their arms out in front of them including massage therapists!).

    Pain that is due to dysfunction of the subscapularis can manifest in a number of different ways, it can be sharp and located in the shoulder, deeper or at the top of the shoulder. It can refer down the arm. There can be impingement of the brachial nerve which can lead to numblike sensations or tingling down the arm. The pain can gradually appear over time or, in the case of an acute incident, it can happen at an instant (throwing or pitching a ball is commonly cited as a major contributer to subscapularis injuries). Subscapularis therapy is often indicated when a client is recovering from frozen shoulder.

    Massage for the Subscapularis
    Access to the subscapularis is limited particularly when a client is lying prone and most therapists prefer to do their subscapularis bodywork with the client either supine or in a side-lying position. Examples of supine and sidelying subscapularis massages are shown in the videos below.

    Supine Massage

    Sidelying Massage

    Dr Ben Benjamin advocates using friction treatments to address subscapularis tendon injuries and claims that it can be a remarkably effective treatment for most muscle, tendon and ligament injuries. Friction massage for the subscapularis can be mildly unpleasant and should be performed from 5 to 15 minutes and is demonstrated on the video below.

      


    Tweet