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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.

  

Pain Between Shoulders

Although there are any number of reasons that people call for remedial massage, probably one of the more common is for pain between the shoulder blades. This can be an isolated pain or it can be in conjunction with neck pain and stiffness or headaches. The pain can be persistent and chronic or it can appear acutely after a particular activity or movement.

Many people will believe that the root cause of the problem lies in the muscles between the shoulders blades, namely the rhomboids. If they book in for a massage then they will expect that the therapist pays particular attention to these muscles and the muscles around the area to reduce the tightness and tension.

MHowever, often the problem is not associated with tightness in the area but weakness. Tightness in other muscles is causing the muscles such as the rhomboids to become irritated because they are over-stretched not because they are overly tight. A massage therapist that tries to eliminate the tightness by stretching and adding length to the muscles may even be adding to the problem.

Often postural professionals will refer this condition with terms such as forward head posture or upper cross syndrome. The pain between the shoulders actually results from the complex interaction of the muscles around the shoulder girdle. It comes about from an increase in tightness in the muscles at the front of the neck and upper chest and weakness with the upper back and back of the neck (technically muscles such as the levator scapula, pectoralis major, suboccipitals, SCM and upper trapezius tend to be tight whereas the lower trapezius and rhomboid muscles tend to be weak).

Typically when you have your posture checked, a therapist would notice that the shoulder blades (the scapulae) are depressed lower than they should be and they are spread apart towards the sides of the body. When the shoulder blades are in this position, the traps and the rhomboids are stretched to their maximum and they struggle to hold the weight of the arms. The force of gravity leads to a constant pulling on the muscles and nerves in the area. The results is pain in and around the neck, between the shoulder blades and even down the arms.

Postural awareness is the first starting point for reducing the impact of upper crossed syndrome or forward head posture. Left untreated it can lead to degenerative changes in the upper back and result in constant neck pain, back pain and contributes to the formation of the Dowager’s Hump and be implicated in TMJ dysfunction.

  
Being mindful of when you are performing repeated tasks with you arms extended in front of you (such as typing on computers or driving) is a good starting point. However, restoring the balance between the muscles of the shoulder girdle is of prime importance and this can often be quite a challenge as normal movement patterns may have been compromised by persistant pain.

Massage can help to address some of the issues associated with these problems, in particular by releasing those muscles that are pulling the shoulders blades forward and down. Your therapist can also suggest stretching exercises for the upper chest and strengthening exercises for the upper back.

Learn Massage Online

If you think that you would like to learn about massage then there are a number of options available for you. This is particularly true if you are looking for more of an introduction to massage rather than formal training (eg being able to give your partner a relaxing yet effective massage).

You could buy a book (or loan one from your local library. You could buy DVDs on the types of massage that you think you might be interested in be it for sports, sensual massage for your partner or relaxation massage. There are formal courses available either at massage schools or there are local colleges that offer one day or weekend introductory courses to massage.

However, the internet has introduced a further options, namely that of learning massage online. Now whilst this can be a convenient option, studying Youtube massage videos should not be considered as a substitute for hands-on tuition. It is not possible to really understand the finer aspects of massage from a random video (that is not to say that there are not good Youtube massage videos by any stretch of the imagination – just that some are good and some are not so good and a novice may struggle to differentiate between the two).

There are a number of online massage courses and DVDs which are intended to assist people obtain an introduction into the world of massage. One of the more established online massage courses which could assist you improving your (and your partner’s) massage skills is:

If you choose to buy the massage course online and video workshop you’ll get

  • 15 Online massage lessons (video). This include the basic strokes and routines for parts of the body including back, neck, legs, arms, feet, head etc.
  • Basic anatomy relevant for massage.
  • Step-by-step massage instruction to attack critical hot spots of the body – key areas of tightness on most people that ‘demand’ to be released.
  • Tips on how to perform massage safely.
  • Hard copies of the full body massage sequence to make it easier for you to remember.
  • Member support and other helpful resources.

One of the beauties of massage is that the power of touch can be so strong that it is difficult to go too far wrong giving a massage even with minimal training. Rubbing your partner’s shoulders isn’t that challenging particularly as they will be instructing you on what feels good and what doesn’t.

Probably for most important people can learn from an online massage course is what doesn’t feel good and what are the most important massage contraindications. If you are interested in understanding more about massage then you would do worse than check out this course.

By Richard Lane

Massage Videos – Fun

There are many massage videos on Youtube, some provide good instruction, tips and advice. Others try to offer good instruction, tips and advice but fall short. Many are tacky and there are a few that are just good fun.

The videos below embedded below are a couple of my favourite humorous massage videos. If you have any suggestions for other ones to add to the list then please let us know.

How Not to Massage – “Massage from Hell”

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Tough Jobs: Massage Therapist to Models


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“Day in the life of a massage therapist”


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David Beckham massage prank

Disadvantages of being a mobile massage therapist

We recently wrote about the advantages of being a mobile massage therapist compared to working in a clinic or day spa. To balance that article, we are now discussing the corresponding disadvantages.

Traffic facing mobile massage therapist in SydneyNow many of the advantages could also be considered as disadvantages depending on your point of view. For example, I enjoy the flexibility and variety that comes from being a mobile therapist whereas others may perceive that the more irregular nature and the variable hours of the work are a disadvantage. The reality of mobile massage Sydney is that the majority of clients want their appointments in the evenings (often relatively late at night when kids have been put to bed) or at weekends when they have the time. Being out and about at night in locales that you might not be familiar with is not for everyone (and particularly female therapists need to mindful of their security).

Similarly it can be argued that calls for mobile massage need to be screened more effectively than clinics. If you are working at a clinic then it is likely that there will be people you can call on at short notice should ever the situation arise. When you are out and about on the road then, although you can always take security measures of making sure that someone knows where you are, ultimately you are on your own. This is particularly relevant if you take appointments at relatively short notice.

As a male massage therapist, though, this has never really been an issue for me and only occasionally have I arrived at a clients house with a sense of unease about the fear of the unknown. In virtually all cases when this has happened, my concerns have been unfounded and the clients have often gone on to book regular appointments.

The previous comments are relevant with respect to the disadvantages of doing mobile massage and should not be underestimated. However, for most therapists the number one disadvantage when compared with being in a Sydney massage clinic or day spa comes down to the logistics.
Traffic hold ups and delays can be stressful and add significantly to your total time for a given appointment.
Parking can be a challenge in some locations (such as when someone books in for a hotel massage in Sydney CBD). You may have to park a significant distance from the house/unit/hotel and have to lug your massage table, towels and equipment to the venue. Some clients don’t realise as well that if you have to park in a car park it can take a considerable time and effort to get to the room
Stairs. If you working in a block of units then if there is a lift you will be on the bottom floor, no lift top floor. Without fail.
Room layout and environment. You are working in someone else’s house. The space may well not be ideal for massage in that it is too small, too noisy or the wrong temperature. Unfortunately, whilst there may be steps you can take to improve your working space a little, ultimately you are governed by whatever the client provides. In a clinic, you can (normally) control the environment to ensure that it is conducive to the bodywork session you like to provide.
Limit to what you can carry. In a clinic you can make sure that there is all the equipment that you require eg bolster, pillows, blankets, heat pack etc. When you are working in someones home then there may be occasions when you simply do not have something that you could really do with. Whilst it may be possible to improvise, often once client is on the table you just have to accept that you may have to work in a sub-optimal way.

  
Ultimately if you consider yourself to be a mobile massage therapist, then it is just a case of accepting the disadvantages and working around them as best you can. If you only do outcall massages to occasional clients (and you would prefer not to do them) then many therapists will charge a premium to compensate themselves for the perceived hassles. However, effectively the clients make the ultimate decision, if the convenience of having a massage at home gives them a positive experience compared with the clinic then they will continue to rebook.

By Richard Lane

Celebrity Massages

celebrity massagesA recent ebook has been published which discusses various aspects of the massage industry (often salacious) – Touchy Subjects: Tales from the Massage Table by Steve Capellini. Included in the book is apparently detailed reference to a named celebrity that he massaged (I say apparently as I have not read the book and am only going on what people who have read the book have said). The report is that the story does not paint the celebrity in a good light.

An online discussion followed about the merits of discussing celebrity clients. There was fairly clear consensus that just because you have massaged someone who is in the public eye, it does not give you the right to discuss this or use the fact that you have massaged so-and-so to promote your business (unless you have their specific permission). Just normal basic privacy considerations should apply, regardless of who you have had on your massage table.

Yet there are massage businesses and therapists both in Sydney and in other cities who do use the fact that they have massaged identities to give their business a sense of elitism. Whether they do or do not have the individuals permission, I have no idea. They use phrases such as “the rock star massage therapist” or “massage therapists to the stars”. Whether they are trying to use such phrases to attract other ‘stars’ or to attract people who will be impressed by the fact that they have massaged celebs I don’t know.

The validity of this approach is very much a personal opinion.

  
Over the years that we have been operating, we have not divulged who we have massaged nor asked for ‘celebrity endorsements’.

It just doesn’t sit well with us. Most of our clients are ‘real’ people with ‘real’ issues from their everyday ‘real’ work and life.

Once you are on our table, it doesn’t matter to us who you are, where you live or what you do. All that matters is your body on our massage table and how we can best give you the bodywork experience that you are after.

By Richard Lane

You should always Massage Distal to Proximal. Is this yet another Massage Myth?

Recently there has been significant discussion about the massage myths that are frequently perpetuated by therapists (and sometimes even taught in massage schools). For example, pregnancy massage being contraindicated during the first trimester and massage releasing toxins are myths that are in the process of being eliminated.

distal to proximal massage
Massage therapists are always taught that they must massage distal to proximal, from the extremities towards heart. The argument is that the bodywork can increase the back pressure in the veins and potentially damage the vein’s valves through undue pressure.

Although it may appear to be logical rationale, is there any evidence that massaging proximal to distal does cause damage?

If you can imagine a fluid filled balloon inside a second fluid balloon and apply a local pressure to the external balloon, then (without claiming to be a scientist), it is hard to imagine that there will be a significant increase in the local pressure of the internal balloon. Isn’t this the situation in say the hamstrings, the calves or the quads? Would applying a distal force in one of these muscle groups really cause an increase in pressure significant enough to cause damage to a valve in a vein, even if the therapist was performing a strong deep tissue massage?

Please note, I am not advocating that therapists throw out the mantra that you must always work towards the heart. It is always understandable that there should be caution with working distally with anyone who has varicose veins, risk factors for deep vein thrombosis, potentially weaker veins (ie the elderly), during pregnancy, etc. However, let’s say for reasonable fit and healthy clients, is it true that we can really damage their veins?

I’m struggling to find any evidence that it can and has happened.

There are those who argue that working in a distal direction can be effective in achieving your massage goals, particularly if you are performing structural bodywork or the like. If you are massaging with correct intentions and are in tune with the requirements of the client’s, then you should work in the directions that will get the best results for the client.

According to Art Riggs(1) there are significant advantages of working distally:

• Since most muscles attach proximally in order to exert force proximally, working distally lengthens short muscle fibers and fascia for lasting relief from contraction which limits joint function and causes discomfort.
• It frees and lengthens nerves that have shortened along with the muscles.
• It decompresses joints and releases tight ligaments for better osseous function.
• Possibly the most important benefit is that working distally helps train our clients to override protective holding and reprograms movement patterns as they release in the direction of lengthening and relaxation.

  
If you have never tried releasing soft tissues by working proximal to distal then maybe it’s time to consider introducing it to your range of massage strokes and techniques. Just be mindful of normal massage contraindications, what you are doing, why you are doing it and who you are doing it on.

(1) “Distal vs Proximal Work”. Art Riggs. http://www.abmp.com/textonlymags/article.php?article=91

By Richard Lane

Sydney Mobile Massage Etiquette and Suggestions

If you search the internet for articles about massage etiquette then there are plenty to choose from. Many of these talk about how to prepare, what to expect, how to behave during massage, tipping etc. I thought that it would be appropriate to discuss massage etiquette for mobile massage and have a think about whether there are any differences in the etiquette for massage in home and massage at a Sydney clinic or day spa.

Now, there are probably not many differences in reality between a mobile massage and a clinic but given the massage is in your home there are slight differences.

mobile massage etiquetteFrom the therapists point of view, it is respectful that you are ready at the appointed time for the session and that you have prepared a suitable space in which the therapist can work in. If you prefer to have a shower prior to your massage then please do not wait until the therapist arrives as your therapist may be on a schedule that requires them to finish on time.

As an aside we feel that it is a courtesy for you to have showered prior to your massage. However, please do not feel self concious about your body, for example the fact that you haven’t had time to shave your legs is simply not an issue for us. What you wear or don’t wear has been covered in a previous post.

If you know you that you may be running late then give your therapist as much warning as possible so that if there is the opportunity for them to juggle their schedule a little to accommodate you then they have the maximum chance to do so.

Try to have the massage in a part of the house that provides the therapist a reasonable space in which they can set up their table and that is in a relatively quiet part of the house. However, if space is at a premium or the massage needs to be in a high traffic area then so be it – the therapist will be able to work (but it’s just preferable to have space/quiet). If the massage is to be in winter or the cooler months then try to ensure that the room is heated as you will cool down when you are on the table.

As with any massage, remember that it is your massage. You are paying so you are the one in control. If you want to talk or not to talk then an experienced therapist will pick up on your vibes and should behave accordingly. If you want more or less pressure during the massage then let the therapist know. Also if you feel that your therapist is spending too long or too little on one body area then talk to them – communicating how to the therapist how their bodywork is being received will provide you with a better experience and a better outcome in the form of greater muscle/soft tissue release or stress release.

We prefer you to have your phones and the television turned off but again, it is your massage so if that is what you want then that is up to you. It is just our suggestion that you will be able to relax more if there is gentle music or silence rather than a TV blasting.

Pets can occasionally interrupt a session so if you know that your dog or cat is likely to jump up on the table when you are just about to float away in a blissful haze, then try to ensure that that won’t happen before the massage begins.

The usual stuff regarding massage boundaries and draping applies to having a mobile massage as opposed to clinic or spa. Please do not expect that because the therapist is in your home or hotel room that they would behave any differently to if they were in therapeutic massage clinic.

  
If you have any concerns or questions about having a massage at home then please raise them when you call to make a booking. As well talk to the therapist before the session begins about what you specifically want from the massage (and also what you don’t want eg if you don’t like having your feet touched then let them know).

Hopefully these comments and suggestions will mean that when you book your next massage with us, you will be able to realise the great benefits that having a mobile massage in Sydney brings.

By Richard Lane

Massage and Cancellation Policies

Probably the 2nd most popular topic amongst massage therapists on internet forum and discussion sites is the issue of cancellation policies. Go to any forum and there will be countless posts from therapists asking what is the best cancellation policy and what is the best way to enforce it.

Cancellation policy for massageThe breakdown of responses tends to be split into two:
(1) I have a strict cancellation policy and I will enforce it without fail.
(2) I have a cancellation policy but will take each cancellation on a case-by-case basis.

Most cancellation policies will only come in force either for same-day cancellations or with less than 24 hours notice. Some will charge the full amount, others a proportion of the fee.

Those who go for option (1) above will often respond by saying that it is essential for the professionalism of the massage industry that therapist stick to their guns and be firm.

So long as the client is fully aware of this when making a booking then this is a perfectly fair and reasonable approach. We are professionals so why should we lose out if the client has to cancel for whatever reason. If the therapist is working in a clinic or day spa then there is rent to pay. If they are unable to fill the slot then they will be out of pocket for the cancellation or no-show.

I personally adopt option (2) and prefer to be a little more flexible with cancellation policies. Sometimes circumstances are simply beyond the clients control and as a business decision then it may be better to waive charges. If, for example, someone wakes up in the morning feeling feverish, then effectively forcing them to have a massage otherwise they would be charged a full cancellation fee, could be considered as borderline unprofessional.

Formally our cancellation policy is:

We understand that life is unpredictable and personal circumstances can change at short notice. We prefer not to charge a cancellation fee if there is no impact on the time/scheduling of the therapist. However, we are professional therapists and this is how we earn our living. We reserve the right to charge up to 100% of the fee based on the amount of cancellation notice given and the impact on the therapist(s) involved (for example, travel time/ travel costs/other bookings that have been knocked back)

which is probably too woolly for the strict ‘cancellation policies must be enforced’ brigade.

For me, the overriding factor is whether the client respects my professionalism if and when they cancel within the timelines of our cancellation policy. Respect that my time is of value and this is how I make my living and I will respect that you are cancelling because you have to not because you want to.

However, one of the reasons for cancelling at short notice is that you have to stay back at work or you have been called into work unexpectedly. Whilst this is a part of life that may be unavoidable, I do have to say that it is not a reason for us not to charge you.

Very occasionally a client may say that ‘well you aren’t paying rent so if I cancel then there’s no impact to you’. However, this fails to respect that we have planned our day around seeing them at a given time and we suddenly have a huge hole in our day (appointment time + travel time). Being out on the road it is not always the case that we go to our home base or use the time effectively. Also we may have had to knock back other clients so we have also lost earning potential or had to make personal arrangements to take the booking (ie some therapists need to arrange childcare or the like).

  
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By the way, I don’t want this post to sound like a whinge. Cancellations for our mobile massage businesses are significantly rarer than clinics and it is highly unusual for us to charge a fee. The upshot is that we don’t like charging a cancellation fee as it is never a satisfactory outcome for anybody but we will do so when circumstances dictate that it the right thing to do with respect to our business.

By Richard Lane

What (not) to wear for a massage

If you are visiting a Sydney massage clinic (or having a mobile massage for the first time) as the therapist leaves the room to allow you to undress in private, they will invariably utter the phrase:

take off whatever you are comfortable with.

Those who have had many massages will follow this instruction without a second thought and either take everything off or leave their undies on, depending on their preference and level of comfort with the therapist.

Massage where client prefers not to take everything offFor the less massage savvy though this request does not illict an automatic response and can bring about a sense of unease. If I leave my underwear on does that mean that the therapist will think I’m a prude and not entirely comfortable in their presence? If I take everything off, will the therapist misconstrue my reasons for getting a massage?

The direct answer to these questions are a very simple “NO”. Put bluntly, your therapist simply does not care what you leave on and what you take off. They will make no judgements based on your decision. All they want is for you to be comfortable with your decision and to be able to relax and enjoy the massage.

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Just a couple of asides on this topic though.

Whilst massage strokes are (marginally) easier to perform if the client is not wearing anything, this is of secondary importance to your level of comfort. If you would not be relaxed if you were naked during the massage, then don’t be.

If you prefer to wear bra and knickers during a massage then your therapist will be able to modify their strokes and still provide an effective and relaxing massage. The outcome of the session will be the similar regardless of your decision and preference, so long as you make a decision that you are relaxed with. Never be pressured by a therapist to take off more than you want to (nor accept draping that exposes more of you than you would expect your therapist to see).

If you prefer to wear underwear then inexpensive and basic is best from the therapists point of view.
Ladies, if you are massaged wearing expensive knickers then there is a chance that they may get oil on them. Also, skimpy, lacy and tight undies are hard for the therapist to manoeuvre if they want to massage glutes or hips.
Guys, if you want your quads or hamstrings massaged then wearing boxers that extend three quarters of the way to the knee are a challenge.

Whilst the therapist needs to respect your boundaries, you also need to be mindful of your therapist’s boundaries. Whilst most therapists are comfortable and used to seeing with peoples bodies, a significant proportion prefer that you wear underwear (and will tell to leave your underwear on). As one of my therapists recently put it

My Table. My Rules!

This is their right. Therapists need to be careful, particularly when massaging people of the opposite gender such as male massage for females. The wearing of underwear at least affords some level of protection to the therapist that their massage intentions are not misintrepreted when working around the hips, glutes, quads and adductors.

  
I have noticed that there is a difference between the massaging in a clinic and providing mobile massage to Sydney homes. When I was working in a clinic, the vast majority of clients would choose to keep their underwear. However, in the home environment a greater proportion take everything off (or probably more accurately, choose not to put anything on if they have a shower prior to the therapist arriving).

Ultimately though whatever decision you make is really neither here or there for the therapist. Be comfortable with your decision and you will be comfortable during the massage.

By Richard Lane


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