Massage school seems like it was a long time ago. Immediately after passing the national certification test and getting my state license, I began working as a massage therapist. But I quickly found there were a few things I should have paid more attention to while I was in school---and I noticed there was a lot I needed to know which wasn't covered during my 11-month program.
I know every massage school is different, and there is a movement to standardize many programs. But even if every school teaches the same thing, individual teachers focus on different things--what they think is important; what their specialty is; what they think we'll need. A four-hour seminar in a yearlong, 500-plus hour program doesn't really stick in the brain too well.
I talked with 20 massage therapists and got their ideas about what they found out they needed to know. Some are newly out of school; others having been massage therapists for more than 10 years.
Here are a couple things I found I should have listened to a little closer.
1. Rotator Cuff
Probably 95 percent of the clients who walk through my door tell me their major area of concern is their shoulders and neck. Since many people spend a lot of the their day driving and working on computers, shoulders are usually rolled forward, leading to tightened rotator cuff muscles which can cause stretched-out rhomboids, trapezius and levator scapulas.
I didn't pay any attention to these muscles until I received a massage from a co-worker. He lifted under my left shoulder blade, and I almost jumped off the table. Fortunately, he was kind enough to both back off a little and tell me exactly what was going on, including the problems tight rotators can create.
I've had several clients tell me I'm the first massage therapist who actually works the rotator cuff muscles. I've learned many "tricks" to help get rid of this problem, including stretches and exercises to combat this hunched-forward look.
Most massage therapists I talked with remember something about rotator cuffs, especially if part of their training included sports massage. But most didn't understand that these muscles affect many "unathletic" people, and so they don't always work this area of their client.
Every massage therapist I talked with wished they had a mentor when they left school. All too often, they had questions about techniques and modalities, and had to figure out problems by looking in their notes or textbooks.
For my first job, I was fortunate enough to work with several other massage therapists. I knew I could run into the break room and ask questions about how to deal with specific problems, such as how to get rid of clients' headaches. I also learned many new techniques simply by hearing them talk about their clients, and then being shown different ways to release lower back muscles, stretch out hamstrings and give a 20-minute scalp massage.
I've also tried to "pay it forward" by being supportive of newly licensed massage therapists.
3. Body mechanics and self-care
Yes, this was really emphasized in my school. We were given exercises about how to stretch our hands, arms and back. And there was a lot of talk about positioning our bodies and the massage table.
I can't remember how this was applied while we were learning Swedish, deep tissue and other modalities. Sure, we talked about it, and on occasion one of the instructors pointed out to me that my shoulders were slumped or I wasn't using my legs enough. Another massage therapist told me she was fortunate--her school had mirrors on two walls, and the instructors would stop everyone while practicing technique, asking them to check their body mechanics in the mirrors.
And so protecting myself didn't really sink in until I hurt myself--I was using my elbow for deep-tissue work and ended up straining my biceps when I tried to twist my arm and deepen the pressure at the same time. This could have been prevented simply by lowering my table another notch, something I didn't think I had time to do between clients.
I also had the pleasure of seeing another massage therapist work during a couple's massage. I was amazed at how effective his techniques were while using a lot less pressure (so I thought) than I was. I now focus on keeping my table set at knuckle height or below, making sure I keep my knees bent and use my core muscles instead of my arms for strength.
4. Hot packs, cold packs and other heating/cooling products
Why didn't I remember the incredible impact that using hot and cold treatments have on the body? Sure, we talked about RICE (rest, ice, compression, elevation) when someone is injured. And we had several classes on hydrotherapy, though I didn't get the chance to actually use heat or cold during a massage. But I don't remember every being told how much easier my job would be if I used heat on a congested area. And I wasn't exposed to any products which created heat or cold, such as Biofreeze or Aloe Heat Cream.
More importantly, my clients notice the difference. They feel more relaxed when these treatments are used, and they get off the table feeling as if they've got their money's worth. Heat and cold packs are also something I recommend many clients to use at home.
I've noticed a big difference in how injuries recover using heat, and many of my clients with arthritis swear by hot packs.
5. SOAP notes
I'm surprised at the number of massage therapists I talked with who don't like to use SOAP notes. In fact, one resort I worked at doesn't let their therapists know anything about their clients, except the client's name and the service asked for. Yet, this is both a tool for making your client feel more comfortable with you and a way to know what works. Simple questions, such as, "Are your shoulders any better this week?" go a long way to keeping your client happy.
While many massage therapists don't like filling out forms (they don't have time, it's the same thing every week, etc.), each therapist should write something about what happened before, during and after every session, even if it's only one sentence. This helps protect you from any liability issues which may arise.
One massage therapist told me about a client she had who didn't remember what happened during any of her sessions. She developed a "spascription" sheet, which she gives to all of her clients. It tells what went on during the massage, any suggestions for home care (such as stretching or hot packs), any extra products she used (such as arnica or essential oils) and their next appointment. She completes and copies this right after the massage while her client is getting dressed.