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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.

Breathing and Neck Pain

Have been seeing a few clients lately with neck pain with trigger points present in their scalenes muscles. These muscles are side of the neck (more towards the front than the back) and they are used to tilt the neck and also stabilise the ribs when breathing.

Typically this arises when the person is what is known as paradoxically breathing or thoracic breathing when we should be diaphramatically breathing.

Some people can diaphragmatically breathe in one position but not in another. For example, many of us fail when we are sitting typing on a computer. Yet, We should be able to breathe correctly whether standing, sitting or lying.

One technique that is often used to train our breathing patterns is to put your right hand on your chest and left hand on your stomach. With your eyes closed then breathe in through the nose to a count of around 4 and then exhale via the mouth. This exhalation is also performed to the count of four. Whilst this exhalation is taking place then the abdomen should be returning to the original position.

This exercise should be practiced for around 60 seconds at any one time and should be repeat during the day whilst standing, sitting and lying down.

A demonstration of breathing exercises is shown in the video below.

  

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.

      

    Mobile Massage Sydney

    Benefits of mobile massageLuckily for massage aficionados there are many different options for getting massaged in Sydney. There are remedial massage clinics, day spas, Thai massage spas, 10 minute neck and shoulder rubs in Westfields, student massage clinics and various other tyyes of establishments with varying ranges of legitimacy.

    Assuming that you are after professional massage from a trained therapist then it is worthwhile considering some of the advantages of the different options when you are looking to book your next Sydney massage. Not all massage settings are the same.

    Why book in for a Mobile Massage?
    Convenience
    You choose a time for the massage that suits you. If you find it hard to get to see a therapist at a clinic during their business hours then it can limit how frequently you can receive bodywork (particularly if you could really do with seeing someone at relatively short notice).

       
    The convenience also extends to saving time – having the therapist come to you saves you the time of travelling to and from the clinic which can be considerable depending on where you prefer to go. There are also no hassles about parking or feeling rushed if you are running late because of circumstances outside of your control.

    Save Money
    There is a perception that mobile massages are more of a luxury and as such, are typically priced significantly higher than an equivalent massage would cost you at a clinic. This view is not uncommon by those therapists who prefer not to do mobile work. They feel that mobile therapists should charge a premium for travel, set up time and the inconvenience of carrying their gear around.
    Now whilst mobile therapists will effectively include a component for travel and set up time within their fee, they do not need to include any fixed costs for renting space.
    Charging a fee for carrying equipment is really only relevant for therapists who do not really want to do mobile work. Therapists who consider that mobile massage is an important part of their business, would accept that carrying massage table and towels is just part of what they need to do to be a mobile therapist.

    Effectiveness
    Imagine that you are climbing off the massage table and having had a great massage The therapist has loosened your tight muscles, freed up your stiff neck and eliminated the nagging headache that has been bothering you for the last few days.
    Where would you rather be, at a clinic with the prospect of your drive home or in your home?
    Seems to be a no-brainer that receiving great bodywork in your home will have more of an impact on your physiological wellbeing and reducing stress levels than having to drive immediately after a massage. This can be even more relevant if you are pregnant, for example, or wanting to be able to go straight to bed after a massage because of sleeping problems.

    ================
    It is acknowledged though that each persons personal circumstances so that some of the advantages listed above may not apply to you or there may be specific reasons why having a Sydney home massage is not right for you (such as lack of space or privacy).

    However, if you do live where it is suitable for you to have a therapist come to you then please consider it the next time you want to have a massage. Hopefully you will realise many of the advantages listed here.

    To find out more about the services offered by Inner West Mobile Massage Sydney then please check out the main website at www.innerwestmassage.com.au where you will find information re prices, therapists, availability, FAQs etc.

    By Richard Lane

    Massage Sydney – What Areas We Cover

    We provide therapeutic remedial, sports, pregnancy and deep tissue massage to the Inner West of Sydney. However, different people have different ideas about what constitutes the Inner West.

    Now, the areas we visit are shown in the map below. The colour code used in the map is:

    • the green area is the area that we formally promote that we provide mobile massage to
    • the red area is effective the Sydney CBD and inner city suburbs which some therapists are happy to visit. However, given that it takes longer to travel to the city we do charge a higher rate and also require any parking fees to be added.
    • the blue area is what we consider to be the fringe of the area we cover. Some therapists may go there at particular times. However, this is subject to the location and the particular circumstances of the individual therapists.
    • If you have any doubt about if any therapists may be available for your suburb then we do suggest that you ring 0421 410057 and we can discuss your individual circumstances. Unfortunately we do have to limit the suburbs around peak hour when travel times can become excessive and unpredictable.

        Travel Surcharges

      Occasionally we are asked to go to a fringe area or an area that we would not normally consider going to. The enquirer will say something along the lines of

      Well you go to the neighbouring suburb – we are only 5 minutes from them. Why won’t you visit me? I’ll even pay an extra couple of bucks for the travel.

        
      Unfortunately it is not as straightforward as that. Effectively we average our travel costs/time over the (green) area we cover. Sometimes the true cost for a job for a therapist will be less than this average, sometimes more, depending on the particular suburb and the location of the therapist. Typically the suburbs at the edge of our service area will take longer to get to and the cost of going to these suburbs can be say $20 more than our average.

      Now it is not practical to have a price per suburb even though the true cost to the therapists does vary depending on when you live.

      But the situation does change when we go out of area. We are now going outside of the area we use to average our travel cost component and as such to go to the clients suburb then we would need to charge the true travel cost.

      And so although we may go to a suburb that directly borders yours, unfortunately were we to visit you then we would need to add a travel surcharge which may be of the order of $25 which can appear excessive and bizarre to travel an extra few minutes. As we do not feel comfortable quoting such high figures as a travel surcharge it tends to be the exception rather than the rule that we will quote to visits areas outside of what we consider to be the Inner West.

      Whilst it would be nice to be a Sydney-wide mobile massage companies, the logistics count against such a service. By constraining the area we cover then we can keep our rates both reasonable and competitive.

      By Richard Lane

    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


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