The new year is just around the corner, which means it's time to take stock of the current year and make goals for the next one. I don't make resolutions very often, but I respect those who do. While personal growth should be a constant factor in life, it's good to have a culturally sanctioned time to get properly motivated.

Not that it always works. The biggest cliche of resolutions is the one where you buy a gym membership, work out every day for the first few weeks, and completely forget about it by the end of January. It was a great goal in theory, but in reality there was nothing to sustain it.

But that doesn't mean you should scrap goal-making completely; just make reasonable ones. Change doesn't happen all at once, so you need to think and plan for the long-term.

How do you make a goal more than just a one-sentence declaration? Education. Read articles about the topic. Watch documentaries or news reports, if applicable. Talk to other people who have done the same thing. The more background knowledge you have, the more likely you'll be to follow through.

Understand your goals. If you want to lose weight, figure out why. Is it so you can fit into your old jeans? That's a pretty narrow goal. Is it so you can feel good about yourself? That's easier to tackle. Learn about the importance of healthy eating. Go to the gym to improve your cardiovascular strength, increase your stamina, improve your sleep, and maybe, eventually, drop a few pounds.

As a personal example, my goal for this year is to practice meditation. I know I want to do it - and, more importantly, I know why I want to do it. I'm motivated enough to read about meditation, but I'm not quite ready to add it to my life. Small steps. Ideally, though, I'll get there by springtime.

And whether or not you're making goals, have a healthy and happy new year!

I'm one of those strange people who actually doesn't care for foot massages. It's probably due to the fact that my feet are absurdly ticklish. Still, I know that the majority of people absolutely love getting their feet rubbed. And there are plenty of times - after a long walk or too much time in uncomfortable shoes, for example - when my feet hurt, and I need to make them feel better. But how?

If the thought of someone else touching your feet makes you cringe, or if your spouse/partner/close friend isn't around to help, use a tennis ball!


I know, I know - I didn't really need a diagram.

There isn't much to explain. Stand on a tennis ball; roll it around under your arch. Vary pressure as needed by shifting your weight from one foot to the other. If you find a painful spot, hold for 20 or 30 seconds before moving on. This is great to do regularly or just after a particularly tiring day. Your feet will thank you!

I just got credentialed with a bunch of new insurance providers! New on the list are: Optum Health, Great West, Health Allies, Access One, Medical Resource, PacifiCare, United and Premera Blue Cross. Do you have a plan with one of these providers? Call to see if you're covered for massage!

Check out the full list of covered providers here.

I had planned on writing about this topic for a while now, but with recent events it seems even more necessary. Elizabeth Edwards passed away last week after a long struggle against breast cancer. Click here to learn more about her.

It seems like there are breakthroughs every day when it comes to cancer research. Statistics show overwhelming progress with how we're treating and managing the disease. Cancer is becoming more just something to live with instead of something to die from.

Still, it happens. The cancer might be discovered too late, or it might spread too fast. Further treatment would only cause more pain and prolong the suffering. Instead of dying in the confines of a hospital, though, many people are choosing the compassionate care of a hospice.

In America, we (yes, I'm generalizing here) don't like thinking or talking about death. Death is a frightening concept, seen essentially as the end to all things one knows. And so discussions about death are systematically avoided; interacting with the dying is done with uneasiness behind closed doors.

While this mindset has plenty wrong with it in a general sense – that is, living in constant fear of an unavoidable fact – imagine what harm it does to a terminally ill patient. The loved one becomes a taboo, representing what people fear most. Interactions are suddenly colored with pity and sympathy; conversations are marked with hesitations so that feelings get spared and no one confronts the obvious.

But by its very nature, the hospice is a different world. Death is no longer something to fear – it happens, sure, but the doctors, nurses, and others are there to make the transition as agreeable as possible.

What can massage do for the dying client? It can provide the client with a safe space, where he or she can relax, find calm, and escape reality for a moment. Massage, as with everything else offered at a hospice, helps to remind the client that he or she is loved and cared for.

Touch is often used as a tool of comfort – holding a fearful child's hand or giving a hug to an upset friend – effective when words are not. And just like at the beginning of life, touch can be the most important way to communicate at the end of life. Massage therapists are good at touching; that's our profession. But we can also be teachers. Instructing the family or caregiver in basic massage techniques is a wonderful way for them to connect with their loved one during such an important time. Light strokes to apply lotion or just basic hand and foot holds are very easy for non-professionals to learn.

And while massaging clients in hospice care can be extremely welcoming and beneficial, there's yet another way to be useful in these situations - massaging the caregivers. The logic behind it is hard to refute: in order to take care of someone else in the most complete and effective way possible, you need to start by taking care of yourself. Unfortunately, most caregivers find themselves too busy taking care of their loved ones to find a spare moment for relaxation.

But they do need it. Studies show that spouses who act as caregivers report as much (or more) anxiety as the person in care [source]. It's easy to imagine how caregivers can become so overwhelmed and exhausted. And exhaustion will just breed more exhaustion, more stress and anxiety, with nothing to break the cycle.

Luckily, massage is there to help. The sessions don't need to be long or elaborate; just a quick, seated massage when they have a small break. Short, 20-30 minute massage sessions have shown to significantly decrease anxiety, depression and fatigue in caregivers [source]. The best thing about having massage therapists available in hospice settings is that they can work freely with both populations. The caregivers don't need to leave the hospice or even set aside much time in their already overburdened schedule.

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The best part about massage is its flexibility. A ten minute foot rub to lower anxiety before a radiation treatment; an hour-long session working to regain full shoulder motion after a mastectomy; a light massage in a hospice bed whose purpose is more emotional than physical. It would be impossible for me list all of the times and places in which massage can help, just as I could never emphasize enough how beneficial a caring touch can be. Oncology massage isn't unique because the techniques are vastly different from the norm; it's unique because of how integral massage can be in treatment and recovery.

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Part One: Introduction
Part Two: Benefits
Part Three: Adjustments
Part Four: Hospice

This is what it all comes down to: the adjustments needed to make massage possible (and comfortable, safe, and effective) for cancer patients and survivors. But let's back up for a second and take a look at the larger picture. What are these adjustments for, exactly?

To state the obvious, cancer treatment puts the body through a lot of stress. The lymph system spends extra energy filtering out dead cells and cellular debris left over from chemotherapy and radiation. Drugs and medication can increase pain and nausea. Surgery leaves painful scars; radiation can leave the skin raw and tender. Lots of treatments, little time to recover in between. The body is overwhelmed from invasive procedures and needs to heal as best it can.

It's easy to see how an overeager massage might add to the troubles. If the therapist enters the massage session with the mindset that she will be fixing the client, she may wind up introducing new stressors to the client's already overtaxed body. Instead of healing itself from the cancer treatment, the body will need to spend extra time and effort repairing the tissue damage brought on by a deep massage.

In this setting, the therapist needs to have a new goal: not to heal, but to help. I've already talked about the benefits of massage, the ways that a massage session can truly help the oncology client - less pain and nausea, increased relaxation and a better sense of wellness. Some of these goals are a little vague, but perhaps that's the point. The massage is creating an environment in which the patient's body can properly heal itself.

There are a lot of potential adjustments, but most of them fall under just a few categories. Site adjustments: where on the body you'll be massaging. Avoid scars from recent surgery and don't massage near medical devices (e.g. chemo ports). Positioning adjustments: Does the client have trouble breathing when laying down? You can easily prop him up with some pillows. If the client is most comfortable when sitting, a chair massage might be the best option.

Pressure adjustments: As I explained above, a massage that's too strong could interfere with healing when someone's body is already under a lot of stress. Of course, different bodies have different thresholds, so what's too much pressure for one client might be perfect for another. Pressure adjustment is often a source of contention: The client might feel that he or she can tolerate a deep, strong massage, but the therapist may not be comfortable working at that level. The best option is to start with soft, light pressure and build up over several sessions. This way, the client can see how his or her body responds to the increase. As long as both the client and therapist remain in communication, they should be able to find the appropriate balance.

The final adjustment category is the level of demand. Beyond just pressure level, there are a wide number of factors that determine the intensity of the massage. What parts of the body will the massage focus on? A full-body massage has a higher level of demand than a hands-and-feet massage. Will the client remain clothed or be draped? Clients undergoing invasive treatment might be extra protective of their body and not be comfortable with having certain areas touched or exposed. How long will the massage session be? It hardly needs to be said that an hour-long session has a different level of demand than a 10 minute one.

While some of the goals of massage in this setting are pretty general, it's still possible for the client and therapist to develop a set of goals specific to the client's needs. This is especially true when working with cancer survivors. For example, let's say a client wants to regain range of motion in her shoulder after a mastectomy and subsequent reconstruction. It's a very common goal, but the steps taken to reach it are different depending on the client's history. How long ago was the mastectomy? Did the client have lymph nodes removed in that area? How active is the client in her daily life? All of these details will determine the details of the massage session.

Massage is always possible in an oncology setting; it might just take a little refining. The best thing is to be flexible, and to view the massage as a learning opportunity. The client and therapist have to forget what they know about "normal" massages and open themselves up to new techniques and approaches. Working together, they can tailor the session to meet the client's needs and easily create the best possible massage.

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Part One: Introduction
Part Two: Benefits
Part Three: Adjustments
Part Four: Hospice

Massage, acupuncture, naturopathy, hypnotherapy. These therapies (and more) are often classified under the heading of "alternative medicine", as if cancer patients should be forced to choose between medical science and other treatments. But rather than viewing these treatments as alternatives to anything, it's better to think of them as complementary to normal medical treatments. Doctors are really good at treating the cancer, but massage therapy (and others) are great at working with the bigger picture - the whole person. Used in combination, these treatments work towards freeing the patient from cancer while minimizing or controlling the side-effects.

More and more people are starting to realize that patients need more than just radiation and chemo to get through their cancer in one piece. In a 1999 publication, NCI found that about half of their cancer centers offered massage as a complementary therapy to cancer treatment [source]. A 2005 study found that 2/3 of their doctors recommend some form of CAM (Complementary and Alternative Medicine) to their patients, and 57% felt that massage can be an effective treatment.

So massage can help during cancer treatment; many people, including doctors, know this. But how does it help? And how do we know?

We know by two methods: scientific research and personal anecdotes. Each of these has their advantages; they also have their flaws. Scientific research is just that: scientific. Controlled settings, solid results that are taken seriously by other professions. But these benefits can also serve as drawbacks: the findings in a scientific study are sometimes very narrow and too heavily controlled to be applicable in the real world. Massage is both a science and an art form - art can't be expected to heed the rules of research.

Anecdotes, however, are slippery in another way. Descriptions of single instances in which massage has incredible results are powerful - much more powerful than research statistics. But for every success story, there are at least 20 non-eventful massages, where nothing out of the ordinary happened, no big breakthroughs. These are more common, sure, but also less interesting. They get pushed aside and forgotten in order to make room for the exciting (but rare) cases.

Anecdotes, by their very nature, will help to prove the point they're trying to make. They make great stories, but they don't show the whole picture.

So let's talk research. There haven't been a great number of studies on massage in an oncology setting, but what has been done has shown some promising results. First of all, massage is clearly beneficial when it comes to decreasing pain and anxiety in cancer patients. These results shouldn't be too surprising, though, since they're also some of the strongest findings in the non-cancer population.

The rest of the factors: fatigue, nausea, medicine use, etc - either have mixed results or just don't have enough research to back up a claim in either direction. One factor in particular - how massage affects a patient's length of time in the hospital - ought to have more studies soon. Besides being a benefit to the patient, if researchers found that massage did indeed reduce hospital stay, it would be good for the hospital's bottom line. All research requires funding, and a hospital looking to cut costs might benefit from this type of study.

While pain and anxiety are only two factors on a big list of variables, the implications are still huge. Say it out loud: Massage therapy has been proven to reduce pain and anxiety in cancer patients. It's a great statement.

In the vast space between quantitative studies and personal anecdotes lies another type of research: qualitative. This type of research is literally measuring quality of life, that is, how the patient feels after receiving a massage. And in a way, isn't that just as important as a number on a chart? Overall, massage has shown quite positive results in qualitative studies. In one study, patients reported a number of common themes after receiving massages: feeling special, feeling as though they had greater strength, and feeling that massage provided meaningful relief from their suffering [source].

In a study working with breast cancer patients who had undergone a mastectomy, massage therapy helped to lessen the patients' emotional trauma and cope with their changing self-image [source]. If nothing else, massage helps to give cancer patients a positive outlook on their situation. And a positive outlook like that is beneficial on so many layers.

Massage therapy can't solve all the problems, and it would be wrong of me (or anyone) to suggest that it could. But what massage can accomplish shouldn't be overlooked. Less pain and anxiety, and feeling better about oneself in a number of ways. To put it broadly, research has shown that massage for cancer patients is a very good thing.

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Part One: Introduction
Part Two: Benefits
Part Three: Adjustments
Part Four: Hospice

Let's start with the obvious question: Why is massage different for cancer patients (or survivors)?

A simple question, but a tricky answer. There isn't a specific type of massage that's used only for the oncology population. In fact, any technique I use with my cancer clients I can (and do) use with my other clients. The unique part about cancer massage is an increased awareness about the client, his or her medical treatment, and, most importantly, the side effects of this treatment.

Side effects from cancer treatment - such as pain, scars from surgery, or fragile skin from chemo - require adjustments to the massage session. This isn't a new idea: many conditions, cancer related or not, require the therapist to tailor the session appropriately. The difference here is that many of these conditions occur simultaneously, so there are simply more adjustments to make. Lets say a client recently had a mastectomy, had lymph nodes removed in her right underarm, and her lower legs are currently numb. That's three major adjustments all at once. Massage is still possible, but it might take some extra preparation and creativity.

The way we view cancer has changed over time, but our view of massage during cancer treatment has been slow to catch up. The biggest fear is that massage will increase the chance of metastasis, that is, the likelihood of the initial tumor breaking off and traveling to another area. Conceptually, this makes sense - added pressure makes things move around inside the body. But not in this case. Cancer doesn't spread because of high pressure or increased circulation. Rather, it spreads due to genetic alterations, chronic inflammation, carcinogens, bacteria, and viruses.

Think about it: if massage was a risk for spreading cancer, so would almost any cardiovascular activity - walking the dog, riding a bike, working out at the gym. In that case, doctors would tell cancer patients not to do any of these things, and just stay at home in bed watching television. In fact, doctors almost always urge their patients to stay active. And while they might not say it explicitly, staying active should include getting regular massages.

Now that medical science has advanced so much in finding and treating cancer, it's often viewed as a chronic condition - something to live with and manage. In 2006, nearly 11.4 million Americans were alive after having been diagnosed with invasive cancer [source]. Because of this, massage therapists have be able to adapt their massages for clients with a history of cancer. Otherwise, they risk alienating a very large demographic.

In the next 3 posts, I'll be discussing the benefits of caring touch for people with cancer, the potential adjustments involved in massaging these clients, and the use of massage for both patients and caregivers in a hospice setting. My hope is that these posts can bring some insight into an important topic that few people think about but many should.

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Part One: Introduction
Part Two: Benefits
Part Three: Adjustments
Part Four: Hospice

I don't know if you've noticed (ha!), but I love talking about massage.

I guess that's why I have this blog. Some special offers every once in a while, but mostly just a chance to talk about my most favorite thing in the world. And it's a good thing for a practitioner to be enthusiastic, right? I love what I do for a living and that motivates me to learn new skills and improve on the ones I already have.

You wouldn't use an auto mechanic who hates talking about cars or a chef who doesn't care what he eats. Massage is my profession, not just a way to pay the bills, which means that it's an important part of my life. It's not the only part (thankfully), but it's often the most prevalent, and the best way for me to connect with others. Not just by giving free back rubs to friends (although I do plenty of that), but also by explaining to anyone who'll listen how muscles act the way they do and why muscles hurt and how you can make them not hurt so much. I know a lot of useful things about massage and I don't think it's fair to keep that knowledge all to myself.

Of course, it's a fine line between being excited and being pushy, and sometimes I have to be careful how much I geek-out at people. Sure, I would love for them to come and schedule massages with me, but more generally I just want them to know how awesome massage is, period. Getting new clients out of the deal is really just a bonus.

Year-End Massage Special: $30 Craniosacral treatments. Call the clinic at 503-445-8114 or contact me if you want to schedule one!

Craniosacral therapy is a light, clothed massage that works with the rhythm of the cerebrospinal fluid and the membranes in the head and spine. It's really good for TMJ disorders and headaches, and it's otherwise just a really, really relaxing massage. The treatment is part science, part intuition - a big part intuition. I just learned it, and now I need practice. So if you're at all interested, please let me know!

I was wary at first about writing this because I don't want to give you, my potential clients, all of my tricks and tips before you come in to visit me, but I finally decided that this is too important not to share.

Self-massage. Seriously. I want to teach you how to work out the kinks in some of your muscles all by yourself. It's not a substitute for a professional massage by any means, but it's something to keep your muscles happy and healthy in between appointments. Just another piece of self-care.

First area of discussion: your gluteus muscles, aka: your butt.

Why are these muscles so important? Imagine, for a second, that you didn't have them at all. Imagine trying to do, well, anything. You couldn't sit. You couldn't stand. You couldn't walk.

By that logic, if you sit or stand or walk at all, you're using your gluteus muscles. And if you use them, there's always a chance (a good chance) that you overuse them.

And how do you take care of overused muscles? Yea, that's what I thought.

On a related note, did you know that adhesions and tension (and trigger points!) in the gluteus muscles are a huge cause of low back pain? It's true. Sometimes if you alleviate the adhesions in your gluts (which is what I'm teaching you), you'll eliminate the pain in your low back - without touching that area at all. Magic!



The diagram is simple enough. Lie on the floor, put a tennis ball under your gluts (one side at a time). Roll around and shift your weight, see what feels tight. If you need this massage, you'll know - the pressure from the tennis ball will hurt. Be patient! Hold the painful positions for 10 or 20 seconds before moving on.

And that's it! Do this regularly (daily, weekly, whatever) and I bet you'll feel a difference.

As you can probably tell, I love words. I love writing, describing, imagining with pen and paper (or with computer keys and a text program). But there are some situations - and I'll be the first to admit this - where words are completely inadequate, where the English language isn't capable of grasping the concepts or conveying the reality.

One of those situations is massage.

While words are not my first job when giving massages (that would be, well, giving the massages), it's important that I keep good chart notes about my clients. This is definitely important when you share clients between practitioners (like at the clinic I work in), but it's also important so that you can keep track of an individual's progress over time.

In the chart notes, I have to describe the client's muscles. Describe what they're like, describe what I feel... but that's easier said than done. Muscles can be tight or loose, but those are just umbrella terms. I need specifics. I can say that a tight muscle feels ropey or tender, bumpy or crunchy, but all of those words verge on the metaphorical. I'm a health care practitioner, not a poet.

So... what's the solution?

Think of massage as a language. A non-verbal language - one that speaks through touch. A good massage therapist can feel tension and will know where the problem areas are without any verbal cues. A good massage therapist can actually communicate with the muscles.

Massage as a language is a great concept, but you still can't fill out a chart without words. Therapists knows these words - hypertoned muscles, adhesions, knots, etc - because we learned them in school. But we only learned them abstractly; that is, we learned the words in isolation. No one ever gave us a muscle to feel and told us what adjective went with it. That was for us to figure out on our own.

Naturally, every massage therapist has different experiences and interacts with different muscles. Everyone finds different examples to define the words they learned, so each therapist winds up with his or her own vocabulary. We all use the same words, but the words might mean different things to each of us. Well, that's just... great.

To throw some psychology into the mix and make matters worse, there's a study I read once about how putting our memories into words (that is, writing about them) actually changes what we remember. The mind no longer remembers the original situation; it remembers what had been written about it. Details get lost - a situation that couldn't be described perfectly suddenly becomes that imperfect description.

Massage is one of those situations that can never be recorded exactly right. If I note in my chart that a client's hamstring felt ropey or that the knots in her back were at a moderate-plus level, I'm at risk of forgetting the nuances, the details that I'm aware of on a non-verbal level. I can't write down my intuitions.

And of course, this isn't to say that I'd remember things better if I don't write anything down. I probably wouldn't remember much at all. And therein lie the problem.

Unfortunately, there isn't a good solution for this whole mess. Words are necessary for communication, whether to file an insurance claim or to remind yourself what you worked on during the client's last session. They're important, sure, but they aren't the only tool. When it comes to massage, one has to rely on any number of cues - verbal, non-verbal; scientific, intuitive - to get the complete picture. Words are just a small piece of a much larger puzzle.

10 reasons why you should get a massage after working all day in the office:

1. De-stress after a rough day.
2. Get the kinks and muscle tension worked out of your neck, shoulders and back.
3. Make the workday go faster in anticipation.
4. A chance to feel your body as a body, not as a machine that pushes paper, answers the phone, or enters data.
5. Give your eyes some time to relax before staring at a computer or television screen all night.
6. Nothing on TV at that time, anyway.
7. Best thing you can do for yourself on a monthly basis.
8. An hour to get excited for dinner.
9. An hour-long nap before dinner.
10. Some time to think about no one but yourself.

Blog posts might be a little slow for the next couple months. I started taking a Spanish class, and that's taking up a good bit of free time. Don't worry, though - I'll continue writing (and hopefully posting occasionally) and should be back to my weekly posts by the end of the year!

Researchers Find That Massage Has Physiological Effects

Details:
53 adults, half of whom received a 45 minute Swedish massage, the other half received a 45 minute light touch session. The subjects who received the Swedish massage showed a significant decrease in cortisol (stress hormone) and arginine vasopressin (hormone linked to aggressive behavior), and showed a significant increase in lymphocytes (white blood cells - immunity).

All that to say: massage is good for you, and now there's some scientific proof.

I get asked pretty often if a trigger point is the same as a muscle knot. People have heard of knots. They know what a knot feels like. Trigger points are a more foreign concept; you typically wouldn't run into one unless looking for it. The pain patterns associated with trigger points aren't very intuitive - unlike a knot, trigger point might not be located in the same spot as the pain.

To help understand the differences between these concepts, I drew some pictures. For the record, these illustrations are in no way accurate representations of muscles, knots or trigger points... or pain (red area):

A Knot


A Trigger Point


Things to note:

• Knots are bigger, often visible. Trigger points are much smaller and can usually only be detected by palpation.
• Knots hurt on the knot, with minimal spillover onto the rest of the muscle. Trigger points hurt at the source as well, but they often refer pain to remote areas.

It's a common story:

A client comes in for a session and says he wants me to work on his neck and shoulders. That's where the pain is, he tells me. I begin the massage by focusing on these areas, warming up and loosening the muscles. But when the client flips onto his stomach, I take note of his mid and low back. Just the look of these areas tells me that his muscles are tight. I touch them briefly - yep, they definitely need to be massaged.

I have a quick moment of self-doubt: My client didn't mention his back at all - maybe it doesn't hurt? He seemed very sure of where his problem areas were; should I really second-guess his claims? But my instinct wins out and I spend a fair amount of time massaging his back.

And it pays off. After the session my client says, "Wow, I had no idea my back was so tight until you started massaging it."

Or replace "back" with arms, neck, legs, gluts, anything. This interaction happens all the time. But why does it happen so much? Do people really not know where they hurt?

The short answer is yes. The body (rather, the brain) is great at habituating to pain or ignoring it altogether. This is a great skill - for survival. Severe, constant pain can be crippling, there's no denying that. For some, being able to focus their attention away from the pain might be the only way to get through the day.

But on the flip side of the coin, not paying attention to what's going on in your body lessens your awareness. If you don't notice that your leg hurts after you bump into a table, you won't think to put ice on it. If you don't realize that you hunch your shoulders in stressful situations, you won't bother trying to loosen them up.

Your body awareness also accounts for a big part of your body image, or how you see yourself. If you aren't aware of your body's shape, or its aches and movements, there's no way for you to feel truly connected to it. Lacking a firm grasp of what your body looks like and feels like is thought to be one of the underlying factors in eating disorders.

To bring this whole concept back to massage: Touch is hugely important in developing a positive self-image and maintaining body awareness. In both massage research and developmental psychology research, this fact holds true (the article linked above cites a number of studies).

In the end, finding a comfortable attitude towards your body means being neither hyperaware of every discomfort nor completely oblivious to the most basic things. Sure, sometimes your tension will take you by surprise, but knowing your body well enough to know when it needs help - a massage, a doctor, a nap - means that you're taking active steps towards a healthier life.

Belmont Street Fair is this Sunday! The "core" of the fair (the part that's closed to vehicle traffic) is from SE 34th to 37th, but there will be live music, food, and special events all along Belmont from 20th to 58th. Free shuttles are there to take you up and down the street.

I'll be giving free chair massages up at the Good Food Here pod (12+ delicious food carts) at 43rd. It'll be a great spot for lunch - get a massage while you wait for your food, listen to live music while you eat.

And if you mention this post when you stop by my massage station, I'll give you a coupon for a discounted massage. Hope to see you there!

People ask me all the time what kind of massage I do. It's a deceptively simple question - naming off a few massage styles might suffice, but I feel that such a basic answer wouldn't actually explain much.

I'm trained in certain styles, and I'm knowledgeable enough about others to utilize them regularly. But then there are some that I know next to nothing about in the way of specifics; just the underlying concept is enough to influence my technique. Each different style blends into the other and it's impossible to tease out any one of them without destroying the subtlety.

But more to the point: the layperson, the typical massage client, doesn't care about individual modalities. They don't care if you use myofascial release, Reiki or craniosacral massage; they just want to know if you can get the job done.

You can say, I am a deep tissue massage therapist. But that can't be all you do. I had a client who initially wanted (and needed) for me to use my elbows, dig as hard as I could into his back and shoulders. After a few sessions, though, we had to step back and take a new approach: his muscles were looser and could no longer tolerate (and would no longer benefit from) the pressure I had been using previously. I needed to adjust my massage technique to meet new demands.

How best to explain it? I think Bruce Lee does a pretty good job to illustrate the philosophy in this 1971 interview:

[Can't embed the interview, but click to watch the pertinent clip]

"you see, actually I do not teach Karate, because I do not believe in styles anymore... I do not believe there is such thing as like Chinese way of fighting or Japanese way of fighting, or whatever way of fighting because... unless a human being has 3 arms and 4 legs, we will have a different form of fighting... so styles tend to not only separate man because they have their own doctrines, and the doctrines became the gospel truth, that you cannot change, you know?  but if you do not have style, if you just say here I am, as a human being, how can I express myself?  totally and completely... That way, you won't create a style, because style is a crystallization, as opposed to a process of continuing growth..." [emphasis mine]

Sure, Bruce Lee is talking about martial arts, but the concept holds true for massage as well. The most important thing is the ability to flow seamlessly between one style and another, to incorporate techniques from a variety of sources and create a unique, personal massage style.

Technically speaking, this type of massage is known as "integrative massage". But calling it that gives the image of an established style you can find in a textbook. In fact, no two "integrated" massages are the same. Each therapist brings a different background of knowledge and experience to the massage. Likewise, every client (and even the same client over multiple sessions) brings different needs and goals to the session. The best massage style needs to reflect this continual changing and shifting of skills and priorities.

And with that in mind, I'll leave you with another Bruce Lee quote:

Empty your mind, be formless, shapeless — like water. Now you put water in a cup, it becomes the cup. You put it in a teapot, it becomes the teapot. Now water can flow, or creep, or drip, or crash! Be water, my friend.

Massage as water. Something to meditate on, no?

Step one: Establish a need for a better pillow.

Now that I don't spend the majority of my day in an ergonomically maximized cubicle, I need to be more aware of my neck. Massage therapy is hard on the body - it's truly the blue collar job of the healthcare industry - but after a few months I seemed to be taking it especially hard. My neck and shoulders were in constant distress, and no amount of self-massage or chiropractic adjustments could do the trick.

A lot of my clients come to me with tight muscles in their neck. It's a common problem. Much of the cause comes from posture, emotional stress, or just day to day living, but quite a bit of it stems from the physical strain placed on the neck when sleeping. Unfortunately, the way we sleep and the pillows we use are often contrary to what our body needs.

It took some time, but what I had been telling clients about sleep started to ring true to my own situation. Here I was, waking up every morning in pain. Maybe it wasn't me; maybe the real problem was with my pillow.

Step two: Accept that a decent pillow is not a luxury item.

I had never thought about my pillow much, but I should have. My pillow was at least three years old, and it hadn't been great quality to begin with. It was an inexpensive means to a predicable end: I was going to fall asleep every night no matter what, so the quality of my pillow wasn't a big deal, right? Wrong.

Quick: Think about your pillow. How old is it? What is it made of? Does it support your neck? Is there an appreciable difference between sleeping on your pillow and sleeping directly on your mattress?

If you're unsure of what a better pillow would do, try this tonight when you get in bed: roll up a hand towel and place it under your neck for extra support. How do you feel in the morning? Is your neck less sore? Did you sleep better?

Step two point five: Stop sleeping face-down.

Granted, the pillow under the neck trick doesn't work for stomach sleepers. Are you a stomach sleeper? Don't be.

Think about your neck for a moment. It's most comfortable in a neutral position, neither rotated nor bent, right? Think about the position of your body in when you sleep on your stomach. Your neck is stuck in rotation for 6-8 hours at a time! It's no surprise your muscles can be so angry in the morning.

I was a stomach sleeper until last year, after I found myself constantly berated by teachers at massage school. How did I finally break the habit? Training. I'd lie in bed on my side right up until I was about to fall asleep, at which point I'd flip onto my stomach. After a few months I had made myself comfortable enough with lying on my side that I could last the night. Trust me, it's a challenge worth taking.

Step three: Weigh your options.

Now that you've verbalized your problem, it's time to find a solution. Take a look at what's out there. Honestly, there are a ton of pillow types nowadays, so you may have to sift through quite a bit to find what works best for your neck and your budget. The internet has a wealth of information and good deals, but I suggest going to at least one store first to get a feel for your options.

As for me, I wound up spending a good bit of money on a memory foam contour pillow. But it wasn't a splurge, it was an investment in my health. The difference in neck support (and subsequent sleep quality and tension relief) is enormous.

Sleep is supposed to be relaxing, replenishing. If you wake up sore, something's not right. Maybe your best bet for now is to stick with a rolled-up towel for neck support, and put that top quality pillow on your wish list. But even that extra little effort will go a long way to help make your sleep as restful as possible.

Perhaps you've noticed the new little "like" button on this website. That's right, friends, I (that is, the professional side of me) now I have a Facebook presence! So if you're also on Facebook, please "like" me - not only will I keep you up-to-date with new blog entries, but I'll also be offering exclusive deals and discounts just for my Facebook fans.

I'm naturally drawn to kids, although I can't completely explain why. I just like them a lot. If I meet a mother and child, I'll usually spend most of the interaction earning the kid's trust.

Up until mid-way through college, working with kids was the only way I earned money. Babysitter, figure skating instructor, camp counselor, tutor, friend and human jungle gym. Ok, not all of these positions were things to put on a resume, but I wouldn't have traded them for anything. And now that I'm a massage professional, I have even more to offer kids than being a board game partner or swing pusher.

Something I was taught awhile back: You can never compliment a child too much. There's no such thing as unnecessary flattery, telling a child too often that he or she is beautiful or smart or a rockstar. Likewise, what I've learned for myself is that you can't give a child too much caring, physical contact. The more times you hug a kid or hold her hand or pick him up and spin him around, the better.

(And bear with me for a second - I'm going to completely disregard the obvious issue of good touch and bad touch. Assume for the sake of this entry that everything I say refers to welcomed, non-sexual touch.)

The benefits of touch are true for adults, but they're true tenfold for kids. Relaxation, internal balance, and a positive self-image, not to mention the warm and fuzzy feeling that someone cares about you. Kids grow and mature at an insanely fast rate, so supportive care is essential to a good outcome.

Since frequent, caring, touch and massage are important for kids on a general scale, it's easy to imagine the benefits derived from massage for children who do need extra care. This need can come in all sorts of packages: young athletes who need to keep their muscles strong and healthy so that there aren't problems later on. A child who reacts to a stressful environment (at school, at home) with physical tension, resulting in headaches and stomachaches. An active kid who needs to reduce scar tissue after a broken leg or regain range of motion in a sprained ankle. Children who need help managing a lifelong illness or condition such as autism, ADHD, or cancer. The benefits of massage in any of these cases are too great to be overlooked.

When I tell people that I specialize in pediatric massage, it always takes them a moment to understand. I don't think that anyone would ever disagree that massage could be beneficial for children, but it just isn't something they had ever considered. My goal is to change that. I want massages to be a part of every child's (probably very, very busy) schedule, as regular as a haircut and as important as a check-up.

Trigger points: tiny spots on a muscle that can cause an awful lot of pain.

I talk about trigger points all the time. I love trigger points. I don't love having them - and believe me, I've had whole bunch of them - but I love that they exist. They're a simple answer to one of life's most frustrating questions: why am I in pain?

(...and I'm talking about physical pain, obviously.)

What's with the name? Well, a trigger is an event that causes another event. Imagine, if you will, a line of dominos. Pushing over the first domino is the trigger event. Each domino topples over, and the fall of the last domino is the final event. Do these events happen in the same place? No. The final fall might be several feet away from the trigger.

When it comes to the body, trigger points are "hyperirritable spots on the muscle fibers". To put it simply: if you poke a trigger point, it hurts more than it should. And, like the domino metaphor implies, these trigger points can result in pain elsewhere on the body, a spill-over from the main site. This is commonly known as "referred pain".

Take, for example, shoulder pain. It's a common problem, especially among those who sit at a desk for long periods of time. Pain can manifest in multipie places - pain at the rotator cuff, pain at the front of the shoulder, pain at the top of the arm. Common sense would tell you that the pain stems directly from the muscles in that area. Just massage where where it hurts, and the pain will go away. Right?

Wrong. Well, the pain might go away for a while. Massage is great at providing immediate relief. But most of this shoulder pain is actually due to trigger points in the neck. If these points don't get treated, the pain is doomed to return.

The best part about trigger points is that they run on a similar pattern in everybody. Specific trigger points will refer pain in predicable ways. Shoulder pain comes from trigger points at the front of the neck; head pain comes from trigger points at the back of the neck or the jaw. Because these points are mappable (and yes, there are "maps" available), my job as a massage therapist becomes a sort of espionage mission - find the trigger points, attack them, and make them disappear.

As you can imagine, Trigger Point therapy is not a relaxation massage. The best method to get rid of trigger points is with direct compression - pressing (softly) onto the points until they release, which usually takes multiple sessions. It requires the client to be an active participant in the treatment, both in communication during the session and in modifying activities and poor posture habits to keep the trigger points from returning.

No one should have to live in pain, especially when a solution might be as easy as a massage treatment. If you or someone you know could benefit from Trigger Point therapy, don't hesitate to recommend it.

This Saturday, I'll be working at EcoPalooza in NE Portland.

From the website:

What is EcoPalooza?

Ecopalooza is a free summer concert event, taking place on August 7, 2010, at Fernhill Park in Portland, Oregon with the theme of raising environmental awareness and conservation while promoting alternative energy sources.

The solar powered stage by Sustainable Waves is an exciting pollution free power technology that will yield zero energy consumption from the city of Portland. It is an excellent example of using an emerging and viable alternative energy source.

EcoPalooza will also be raising funds for two local non-profits: Minority information Outreach and Friends of Trees.

You can find me in the medical tent with my clinic, Grain Integrative Health. I'll be there from 2pm-6pm giving free chair massages. Free acupuncture will also be available. Hope you can stop by!

I've massaged CEOs. I've massaged children and teens. At my volunteer job, I regularly give massages to the homeless and those who are just starting to take care of themselves.

What's the difference between these populations? As far as I'm concerned, nothing. What matters are just the individual differences between each person - muscle use, stress level, goals for massage. Someone running a 500-person company can hold tension in exactly the same way as someone who doesn't know where her next meal will come from. Pain, adhesions, trigger points: these things don't discriminate based on someone's social status.

I love massage because I'm able to help people regardless of who they are.

Just as I treat everyone equally across jobs and income and life choices, I'm also no longer part of any hierarchy. Sure, I'm a professional. I went to school and trained in massage. But there's no corporate ladder for me to climb or bosses to report to. I work alongside doctors, but I work with them, not under them. We all have different roles to play for our clients and patients (many of whom we share), and each of these roles are important.

I love massage because I have a unique role in people's lives.

A great article from The New Yorker:

Hospice care for dying patients by Atul Gawande

As you can guess from the title, this article is about caring for end-of-life patients. Massage therapy has become increasingly important in hospice care (which is becoming a more prevalent and accepted option), and the more I read about it, the more good I feel massage can do in providing patients with supportive and meaningful touch at the end of their lives.

The article doesn't specifically mention massage, but it's easy to see how massage therapy would fit in with hospice care. At a later date, when I start blogging about oncology massage, I'll touch more on the role of massage for the dying.

I love dancing. I used to figure skate - ice dance, specifically - and since then I've dabbled in a variety of other dance styles. Sometimes I'll go out dancing with friends, although I prefer dancing when there are specific elements and guidelines to follow - not like your typical Friday night club scene. Most of all, though, I like staying in motion.

It's easy to think of massage as a dance. Each massage type (Swedish, deep tissue, Zen Shiatsu, etc) has a variety of potential elements, a specific catalogue of strokes to choose from. From this, the massage therapist pieces together a routine.

Sometimes the massage is heavily choreographed. Just like a figure skating routine, every move has already been determined; the therapist's job is to follow the outline. I use this type of massage mostly with clients who have acute injuries or chronic pain. With highly focused and repetitive massages performed over multiple sessions, adhesions can be broken down and trigger points can be released.

Other massages, though, are improvised. The catalogue of strokes is the same as before, but the actual massage routine is unplanned. The dance style that comes to mind here is Argentine tango. In this dance, there are elements and rules that are universally taught, but each dance pattern is created on the spot, on the dance floor.

Both tango and massage are partner dances. The leader and follower in tango have separate roles: the leader leads, the follower, well, follows. But the dance is more than just two individuals going through the motions of a tango; it's the relationship between the partners that defines the quality of each step and the attitude of each dance.

The therapist and client have a similar give-and-take relationship. The therapist uses his or her body - hands, arms, elbows - to interact with the client's body - the muscles and skin. Just like in tango, though, the connection between the therapist's hands and the client's muscles is what defines the massage: the pressure, direction and type of strokes used, and the attitude or intention that the therapist sets within the session.

Some massages are graceful, like a relaxation massage, while others are utilitarian, like a sports massage. Some have well-defined goals; others rely more on interpretation. But despite these differences (or because of these differences?), every massage is a beautiful and unique dance.

A lot of people come to me with problems in their neck and shoulders; anything varying from intense pain to general stiffness. Any number of things can cause this, including sitting at a desk all day or holding your head in a tilted position when reading or chopping vegetables.

Stretching out your neck and shoulders is super important to keep the muscles happy. This scalene stretch is one of my favorites:


Image copied from Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual.

This stretch can be done sitting or lying down.
1. If you're lying down [as shown], place your left hand underneath you. In a sitting position, simply sit on your left hand. This will prevent your left shoulder from rising during the stretch.
2. Rotate your head towards your right elbow. Take your right hand and bring it over your head to your left ear. Using this hand, gently push your head towards the right side. You should feel a stretch on the left. WIth your head rotated in this manner, you are stretching your anterior scalenes.
3. Doing this same stretch while facing forward will stretch your middle scalenes.
4. Doing this same stretch while rotated away from your elbow will stretch your posterior scalenes
5. Hold each stretch for about 10 seconds. Repeat on the other side.

This recent discussion on The View about Al Gore and massage therapy just came to my attention:



Partial transcript:

Elisabeth Hasselbeck: I think it's also a good message in terms of massage, because a massage always has the potential to go wrong. You know what I mean, you're always, like, one push away from something weird happening all the time.

Joe Scarborough: Hold on a second. Alright, a one hour massage - alright, you're teetering. A three hour massage - you're diving in head first ... My mom used to tell me, "nothing good happens after midnight". I can tell you, nothing good happens after the first hour of massage.

[Laughter, commotion]

Elisabeth: I think it must've been for Tim's birthday, and he was playing football ... and I said, you know what, you're sore, I'm going to get you a massage ... I ordered a massage from Tacoma Athletic Massage, and I'm ready and... We live in a small apartment ... the doorbell rings .. I'm looking through the peephole and I see the table. I open the door and there's this hot chick coming to give Tim a massage!

Sherri Shepherd: Was it awkward for you?

Elisabeth: Oh, awkward, not to mention I had hormones raging from pregnancy ... The girl walks in, and she's fantastic, really nice ...

[interruption of "wink wink" sex joke from other commentator]

Joe: Your husband's thinking you must be much more open-minded than he thought.

Elisabeth: No, he was so uncomfortable because he knew how pissed off I was, cause she had music going, and I'm in the other room, I'm like, "this is horrific!"

A few points:

• The commentators on The View generalize an entire profession based on one alleged incident (Al Gore sexually harassing a massage therapist), complemented by one description of a non-event (an attractive massage therapist coming to give someone a massage). This is, to say the least, extremely insulting.
• Elisabeth gives a half-story about an attractive woman coming to give her husband a massage, leaving the audience to fill in the blanks and reach the conclusion that massage therapy = attractive [heterosexual] women = sex. This conclusion is just so blatantly incorrect and offensive that I'm still having trouble wrapping my head around it.
• Somehow, the commentators succeed in completely flipping the entire situation. The story in the news is that Al Gore sexually harassed a massage therapist, and yet the message coming out of The View is that massage therapists are all sexual predators.

In the modern world, where massage therapists (and anyone who has benefited from massage) are trying to give a (well-deserved) good name to the profession, the commentators on The View are taking us all in the wrong direction. Instead of talking about the positive effects of massage (and educating their audience about how massage should not be equated with sex), they're continuing to spread a misleading stereotype (on national television, no less!) by tapping into their audience's fear and ignorance.

You may have noticed the phrase in this website's address: happy medium. You've probably heard the term before, and know more or less what it means. It's about balance: The phrase is usually employed as a goal, something to strive for and hopefully reach.

Find a happy medium.

I hear this phrase most used in casual conversation in order to illustrate something without thinking too hard. Yes, yes, find a happy medium between one thing and another, but why? and how?

It isn't stressed enough just how important having a balanced life is. Of course, balance isn't a one-size-fits-all prescription. A student might need to spend most of her time studying, with only intermittent (but just as necessary) breaks to hang out with friends or watch a movie. A father might feel that spending quality time with his family is more important than working overtime. A retired professor may realize that his most fulfilling moments are those he spends writing his book and those he spends with his wife. Everyone finds their balance differently.

Balance comes in many forms, the two most general being internal and external. Internal balance is what we all learned about in science class - the activation of the parasympathetic nervous system. In this state, all systems in the body are working properly; maybe not at their maximum capacity (for example, your heart is hopefully not beating as fast as it could), but functioning at the perfect point of not too little, not too much.

This is the "rest and digest" phase. It's what your body comes back to after you've finished sprinting for the bus or speaking in public or freaking out over missing car keys. In those situations, your body tenses up and your mind focuses on a single mission. Heart rate goes up, blood pressure goes up. Non-essential systems (digestive, immune) take the backseat. But once the situation passes, you need your body to relax and come back to normal.

Massage has a very clear benefit in these situations. A relaxation massage helps to stimulate the parasympathetic nervous system so that, internally, you can find a sustainable balance.

But what about external balance? That's the kind of stuff that people have direct control over. Work, exercise, friends, family, personal challenges, self-care, emotional connections, creating things (art, music, movies, food, drink, etc), enjoying things (likewise). Each category may hold different weight in your life, but they all help keep you in balance. Too much time at work and you might neglect the importance of social connections. Too much time out late with friends and your job performance may start to suffer.

Massage can't address all possible balance problems, but it is a good solution for one of the most overlooked categories: self-care.

Self-care can come in all different forms. It can be an hour of unwinding after a particularly stressful week. It can be taking care of the muscles you overuse, whether at work or at the gym. It can mean finding a spot, mentally, where you can have time for reflection or reconnect with your body.

Massage shouldn't be a rare treat or a vacation-only experience. Rather, it should be a basic form of self-care. Getting regular massages can promote both internal and external balance, and can help you find your happy medium.

Up until February of this year, I worked at an insurance company. Not selling insurance; rather, I was one of those many, many people working behind the scenes. I worked in a cubicle and could spend days at a time not interacting with anyone beyond a smile as I walked by on my way to the printer.  Every day was a combination of filling out forms and imputing data. The work was mindless and it felt pretty meaningless.

Our supervisors assured us constantly that we were a positive force in the world, that because of the work we did, people were able to get the insurance they needed to keep themselves happy and secure. And sure, if you looked at the big picture (while still taking into account every little piece of the insurance process), this was true enough. But that is a very hard view to keep, and what I did day-to-day usually felt like it mattered very little.

But now I give massages. I work with clients directly - and not just work with, help. I help people every day. And though I obviously can't see firsthand every effect my massage might have, I'm able to witness enough - a muscle softening against my hand or a client's blissed-out grin when the massage is over - to know that I'm making a difference.

It'd be hard to deny that I have a passion for massage. But besides massage, my passion is writing. Because of this, I'm starting a massage blog - an easy way to connect the two things I love.

Not only can I share my thoughts on massage, but I can connect with my audience - that's you - on a new level. Sure, I have a website that explains who I am and what I do, but the blog allows for personal and dynamic communication. Hooray, technology!

Obviously, this requires more dedication than a static page. But I have a lot of things to say and share, and I think I'm motivated enough to make this blog worthwhile. I hope to add new posts on a weekly basis, so be sure to check back frequently.

In the meantime, welcome!