When I was training as a physiotherapist I asked a supervisor what she thought was the most important advice she could give me. "Always remember," she said, "that what you do in the 40 minutes that you spend with a patient is of little significance. It is what you give them to do in the 23 hours and 20 minutes during which they are not seeing you that makes all the difference." Travelling to and from the training hospital each day I contemplated this statement. Whilst I thought that what I did during the 40 minute treatment sessions could certainly be significant, I more and more came to understand what the supervisor had meant concerning "non-contact" time. Whilst training in physiotherapy I was working as a massage therapist and after hearing this statement I naturally began to ponder in what ways I could make a difference to my private massage clients in addition to providing massage. After all, I saw my hospital patients every day but as a masseuse I usually only saw a client once a week. That meant that whilst I could be effective for around an hour or so with each massage client, that still left 23 hours and six days during which I was making little impact on them whatsoever. I knew that I was providing "TLC" and that my treatments gave them "time out" and that for some, seeing me was their weekly "reward" for a hard weeks work, but from a physiological (rather than psychological) point of view, was I being as effective as I possibly could be?
You will no doubt be aware that as massage therapists we are wonderfully effective at relaxing our clients, easing aches and pains in the short term, but a week later they are back, often with the same complaint. Whilst this is good for business, most of you reading this will have wondered at some time what else you could be doing for your clients (besides suggesting they drink more water) to alleviate their particular aches and pains. Perhaps it has been necessary to refer a client, perhaps you have considered training in advanced techniques (such as sports massage) to gain more understanding of musculoskeletal complaints, or to attend a workshop that enhances your existing skills. In addition to these possibilities we should consider that one of the simplest and most effective treatments we can provide is stretching. Most mammals stretch after a period of inactivity as it is essential to proper joint and muscle functioning. It is something we need to encourage our clients to do not just once a week at a fitness class but regularly, every day, throughout the day. We can provide it as part of our treatment, integrating it into a Swedish/holistic treatment or provide simple and comprehensive stretching advice as part of our after care. And what is fantastic about stretching is that it is so easy to learn, simple to do, there are a huge variety of techniques to experiment with and almost all of them can be modified to suit the needs of your clients.
For example, you could provide a set of three simple active neck back and shoulder stretches that you advise your client to perform at regular intervals during the day when they take a break from using their computer. If they suffer from low back pain you might want to give them half a dozen specific stretches for the low back that they do at the end of each day or when they are in particular discomfort. Alternatively, you could demonstrate a few appropriate passive stretches to them and their partner that they perform together. (Passive stretches are those carried out by another person on the client whilst the client relaxes.)
A third alternative is to provide sport specific stretches. Proprioceptive Neuromuscular Facilitation (PNF) is a gentle form of passive stretching that works well for active clients. You might suggest that your client comes to your for 30 minutes of stretching after an event plus 30 minutes of massage, for example. A 30 minute stretching routine is easy to devise and administer, adds to your skills and demonstrates your commitment to client care.
A fourth useful type of stretching is Soft Tissue Release. As the name implies, this involves gently stretching the soft tissues of the body by "fixing" part of the muscle before applying a stretch. This technique is particularly useful at targeting localized areas of tightness and may be used all over the body. It may be used through clothing or a towel, and is easily integrated as part of an oil massage in both prone and supine to the upper limbs, lower limbs and trunk.
There are of course many variations on these simple techniques and what's great about them all is that they are fun to learn and easy to apply. There are as great many books available on stretching and a lot of fun one-day courses so we have plenty of opportunities to experiment with the sorts of stretches that we all feel comfortable with administering. As massage therapists we are already experts in facilitating relaxation. Lets become experts in aftercare. Lets increase our effectiveness as therapists both during the treatment session and during those 6 days and 23 hours when the clients are not with us!
Feel free to be in touch if you have any questions.
By Jane Johnson Chartered Physiotherapist MCSP, MSc, BSc, BA (Hons)
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