Words can cut like a knife – leaving deep wounds and scars….

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At this past weekend’s Scar Tissue Release, class we were fortunate to have a Registered Nurse volunteer as the demonstration client. She was incredibly generous with her feedback on what she was experiencing during the treatment and answered questions for the students. Two of her scars were from 18 & 20 year old C-sections, respectively. As she told us the stories of the surgeries, the conversation turned to the trauma, both physical and emotional that the events caused.

Apparently, as the surgeons were preparing to cut her open, they were busy discussing their golf game. The surgerical nurse stopped the banter and gave them a what for. Just think how you would feel at that moment, laying on a cold operating table, about to have your abdomen sliced open in order to bring your child into the world, being denied the experience of natural birth. As she told her story, you could see that even after 18 years, she was still very emotional about it.

Since she is a cardiac recovery nurse, I took the opportunity to emphasize a few points I had made during the class lecture. Specifically how “donor” sites, areas where skin or veins are removed in order to repair another injured area of the body, are ignored once they have healed. When I asked her opinion on this matter, she agreed whole heartedly that no further thought is given to these areas; however, she referred to these areas as the “harvest” site.

Everyone in the room took a breath. I knew what they were all thinking as I looked at each of them. The Nurse looked around puzzled, and I explained to her that I refer to the area as a “donor” site. She thought about it for a minute and shook her head. “I never even thought of that, but you are totally right…how horrible.”

How we–doctors, therapists, trainers, family and friends–refer to someone, something, or situation sets the intent. This, in turn, dictates how we regard, and therefore treat or not treat. Most often when we think of harvesting an organ, we think of cadavers. So of course an area that was used for “harvest” does not need further care or concern.

The next day, one of my current clients was among the volunteers for the student practice session. He had burns over 2/3rds of his body from a car fire. He is one of the most balanced and centered people I know. He shared two very important points with the group. First, that he never even considered that there was any kind of restriction, much less a need for therapy, on the areas where they took skin for grafts and that he was blown away by the resulting treatment’s effects all of the areas, grafted and donor. Second, while still recovering in the hospital, a representative of a burn group came by to help him understand and deal with how his life was about to change. “How everyone was going to stare at him and treat him differently…” You can imagine the rest of the conversation. He could not believe this person was there to help him and fortunately he choose not to listen to her doom-and-gloom speech.

I had another client, a massage therapist, who, while filling out her intake form, said to me in regard to the question asking her to list all surgeries, “Well, I did have a C-Section, but I do not really consider that a surgery.” Unbelievably, she was not the first woman to make this statement to me either.

As health care providers we must take care of how we phrase our words, and just as or more importantly, we need pay attention to and assist in altering how our clients refer to themselves. The first step on the road to healing is understanding and awareness.

The children are our future…So how about we pay attention now!

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I received a call the other day from a fellow Massage Therapist. He was
referring one of his clients, a 15 year old male athlete ( lacrosse
goalie and football linebacker) with severe pain in his right knee. The boy’s coach told his mother he needed an MRI and that he most likely tore
something. My friend did not agree and wanted to see what I
thought and if Integrated Therapeutic Stretching would help. He had tryouts in two days and they were concerned about injury.

According to the client he only felt the pain when he was crouching in goalie position. I had him do it for me. He had all of his wait on the outside of his feet which were not wide enough apart to support his weight properly.

I ran him through some quick range of motion & muscle tests as he lay on the table with no resulting pain but revealed very limited ROM throughout the boy’s lower body. As we started to stretch it was quickly discovered that his left glutes were locked up. Hip rotators on both sides were in as bad a shape. IT Band and hamstrings were at 60% ROM and his quadriceps were down to 45%. This is 15 years old folks!

It is terrifying to see the physical shape of children today. Either they are overweight and under exercised or they are over worked, participating in multiple sports where proper strength and flexibility training is nonexistent.

Sports injuries are on the rise in children and teenagers. Each year more than 3.5 million sports-related injuries requiring medical treatment occur in children under age 15. Today, as more and more children and adolescents participate in the same sport year-round, many young athletes are developing overuse injuries. In fact, overuse is responsible for about half of the sports injuries that happen to middle and high school aged students.

We worked together through each stretch, showing him how his body is supposed to move utilizing body proper form and mechanics. He was very eager to learn as was his mother. I assisted and guided him through the stretches focusing especially the ones which really opened his restrictions. Both he and his mother were surprised at how tight he was in the beginning and at speed with which he loosened up.

Now as we were working I observed a deep scar about 1inch in length on his left knee which he claimed was “no big deal” and said it was over a year old. His mother chimed in “the bad one was on his foot”. Three years prior he flayed his right foot open on a fence. There was a huge c shaped scar on the sole of his foot which upon palpation showed to have spread and attached into the arch.

I asked if he wanted to see something cool and then I proceeded to release the scar on his knee. When I asked him to bend his knee his eyes opened wide and said “That’s Sick!”. His knee flexion had increased by 20% . Next with his mother’s permission I went to work on his foot. When I was done I had him stand up. He laughed out loud and said “No Way! Thats Totally Sick! I can feel the bottom of my foot”. His mother , shocked at his reaction said ” I didn’t know you couldn’t feel your foot?!” “Neither did I” was his reply.

We followed this up with gait re-education and proper mechanics required for his respective sports positions (i.e. crouching and squatting). While he still had some minor pain he could see how adjusting his stance took the pressure off his knee. After having him go through the stretches once more I recommend to the mother that if the pain comes back or increases then she should indeed seek their doctor’s advice.

The mother was shocked at how much the scars were affecting her son. I explained to her that scars and adhesions are generally overlooked by health professionals because the extent of physiological affects they can have on the body have never really been acknowledged. The slightest restriction from falling off his bike at 4 could alter how he grows and have major repercussions from one end of his body to the other.

Four days later the duo returned, the tryouts went great and when asked about his knee he said “it still hurts every now and then but whenever I felt it start I shifted around until I felt right and the pain stopped.” I asked if had been stretching and he say before and after the games. (In the four days since I had seen him he had two lacrosse matches and two days of football tryouts). He was also very excited for more scar therapy “It was so weird but I could feel my foot moving better as I played!” His mother than asked if I had any extra time to look at her two scars that have been driving her crazy for years.

During the course of my career I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had. While not every scar presents a problem, very often they do. Doctors, along with basically everyone else, tend to ignore scar tissue from surgery and accidents especially in children.

Today children are playing more and more sports driven by the need of scholarships and future fame. It is time we start to pay attention to the adverse affects of training and playing so hard so young. We need to make sure that the fall off the bike or the cut from climbing over the fence does not lead to issues later on.

Mandatory Gratuities -Oxymoron

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images (18)I was settling up with a new client when she asked “And what is the recommended gratuity?” I explained that “while I appreciate the thought it was not necessary”. She was very surprised and commented that the last few places (both spa and private practice) she went to had a mandatory gratuity policy. This really drives me crazy.

The definition of mandatory is: containing or constituting a command: obligatory
The definition of a gratuity is: something given voluntarily or beyond obligation usually for some service; generally in the form of a tip.

A gratuity is just that. When a person is happy with a service that has been provided for them and wish to show their appreciation. So, would someone please explain to me how demanding a client be grateful for the service they have paid you to perform, whether or not they actually did appreciate it, acceptable? Especially to the point of requiring they give more money on top of the already established fee?

Now I am not saying one should not accept a gratuity. I believe it is a personal choice. It is up to the individual as to whether or not they wish offer a gratuity and to accept one. As I mentioned earlier I always tell my clients it is not necessary but if they insist I will accept because of what the offering means to them. I usually put the tip in a draw and then make a donation somewhere down the road with it, my way of paying it forward. But, again this is my choice there is nothing wrong if another therapist decided to keep the offering. The therapist performed a service to the best of his/her ability and were rewarded for the effort.

I know that there are a few points of view out there in regard to the Massage Profession. The first is we are a service industry and that there is no reason why we should not accept tips. The second is that we are healthcare providers, the same as doctors and physical therapists, and it is unprofessional to accept tips. We are all in service in one way or another from the doctor to therapist to contractors to the waitress at the local dinner. It is always uplifting when one is complimented or thanked for a job well done. Where the distinction falls as to who should or should not receive a gratuity it is commonly left up to proper social etiquette. What most fail to see is that if we follow proper etiquette everyone receives a tip. – hospitals are giving grants, doctors receive the fruit basket or bottle of wine at the holidays. We leave holiday bonuses for the mailman and the garbage collectors. We leave the tip on the table at the end of the meal for the waitress. How much we give, if at all, is a personal choice. While society likes to comment on the end results it is no one else’s business and it is certainly no one else right to demand that their way of doing something be adhered to.

There is also the unwarranted distinction of whether or not the therapist is working for themselves or on staff at a spa. In other words, it is required to tip the therapist at a spa because the house is taking a cut and the therapist makes less. First off the therapist chooses to work for the spa and that alone does not make them worthy of a gratuity. If the client is really pleased with the service then by all means have at it, however, the client should not be required to do so. It is a bad habit of some spas to make gratuities mandatory to make up for the low wages they pay the therapist. So in other words, the Spa is demanding the client not only pay them for the service but also share the cost of paying the salary of the therapist as well. If a spa wants quality staff then pay a decent wage.

A client once told me how she went to a spa where the staff was rude, she waited 20 minutes past her appointment time and the massage was just o.k. In spite of all of this when she paid for her treatment, she included a tip as etiquette required and she was promptly informed out loud “that is not how we do it here your tip is not enough”. She felt so embarrassed she gave them more money and fled. Granted this is not the norm but what is the incentive, for those who need one, to do a good job if they are already guaranteed a bonus no matter how they perform?

As far as not tipping a therapist in private practice because all of the money goes to them- well please, the therapist is paying their own overhead and has bills like everyone else. Either way if the client is pleased with the massage there is no reason not to express their appreciation and it is up to the therapist to choose to accept it. That’s all I am saying.

Wide Band Narrow View

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A_HAD_1p_P36Should we stretch? Does it help or does it cause harm? This is a very popular debate. One that usually ends in “Well… there is no evidence that proves it is good… but everyone does feels better afterwards.” or “It is a waste of time that can only lead to loss of strength.”

When we think about stretching we tend to think only about the muscles and static holds. These narrow views are what gives stretching a bad reputation and where all of the misunderstandings occur. We should be stretching the whole body, which is primarily made of fascia, in line with the way it was designed to move, dynamically.

For example let’s look at the knee. Usually when there is an knee issue most look to stretching the Quadriceps or Hamstrings muscles. body_worlds_knee When the IT Band comes to the knee joint it binds into a large network of connective tissue or Fascia. This fascial network comes across the front of the knee depending on the direction of force and it connects down into the shins. The IT Band fascially connects into the Peronals & Tibialis Anterior. The knee cap is embedded in fascia. When we have Knee injuries such as patella tracking, meniscus tears, ACL we often focus our view on the Hamstrings and Quadriceps addressing only half the possibilities of causation. Perhaps the fasica is inflamed. A common complaints of knee pain is a sweeping type of pain across the knee and under the knee cap. For it to be sweeping across it must be the fibrous attachments across the knee. This is not the type of pain a Quadricep or Hamstring would be causing.

So by opening up our point of view to encompass all of tissues involved, while recognizing the patterns in which it is connected and functions leads to a productive pain reducing, fascial lengthening, muscle educating and recovering stretching session.