What your massage therapist wants you to know

Hi-ho, it's your favorite massage therapist, even if it's for a limited time only. And I've been doing a lot of reflecting lately, as we get ready to close one huge chapter of our lives and venture out into the pitch dark to open another. I feel like a neuron (nerve cell) who knows it's about to cease functioning (at least, in this particular capacity, as a massage therapist and med student living in Dallas) and sends out that last sacrificial lamb burst of energy to the surrounding neurons to give them one final boost. Relax, it's symbolic.

In the grand scheme of things, I wasn't involved in therapeutic bodywork for all that long, but with the average massage therapist leaving the field after merely 2 years, I'm practically a veteran with my 5-6. I don't necessarily feel like one, because the massage therapy field is so vast one could actually maroon themselves in it, and I haven't even scratched the top surface. Regardless, I found myself accumulating a collection of pointers that I started to impart practically every massage client that graced my doorway, and now I will share them here, in case anyone stumbles across this--therapist or client--and it happens to help. So this goes out to all the dear past, present, and future clients out there, no matter which massage therapist you see...

First, I need to get some semantics out of the way. We massage therapists are massage therapists. We are not masseuses, and we tend to cringe visibly at the word, because that word, no matter how legitimately it started out, now has an entirely different--and illicit--connotation, one that the legit licensed therapists out there have strived and struggled to distance themselves from. And that is the land of the happy endings, the backroom services, you get the point. By calling me a masseuse, you are essentially reducing my status, education, training, services, and value, to that of a hooker. I am licensed, educated, and legit, and I find the word highly offensive. There are some therapists that don't, but the majority of us do. So please don't make yourself look stupid.

Whew. That's out of the way. Second: massage therapists aren't psychic. I wish we were. Some of us have 6th senses and extra-sensory perceptive abilities, and a handful of us just might be downright psychic, but that's more the exception than the rule. Thus, if something is on your mind, please do speak up. You won't hurt our feelings. If the room is too cold or the pressure is too deep or the music too loud or soft, we won't know unless you tell us. If you say nothing, we're assuming all is hunky dory. Most of us will check in on you periodically during the session, and when we do, there has never been a better time to tell us if something is bothering you. There are some things we can't control, especially if we're working in a shared space or a facility we don't own, but we can control a lot of factors. (If you are more particular about your environment, I do recommend you see someone who works out of their home, because they can control everything from the room temperature to the cleaning products and laundry detergents they use.)

Next, please be truthful on your intake forms. Those forms are not meant to shove a microscope up into your business or track every move you make through the FBI's Carnivore system. When I ask you about your occupation, it's not like I'm going to charge you more because you're a high-level sales associate or think less of you because you bag groceries at Tom Thumb. See, I'm not looking for demographics so much as I'm looking for what your work environment is like: stressful deadlines to meet? Long hours at a computer? Lots of driving around all day? Pressure from the boss? Physical hard labor? And please--putting "entrepreneur" on your intake form obviously tells me nothing. Some people put this to try to impress others. It doesn't impress me. I'm an entrepreneur, too.

Now for please-be-truthful-on-your-intake-forms Part B: yes, I need to know your medical history. I know that from your perspective, I'm simply rubbing oil into your skin and making your muscles feel good, and all these questions about health conditions and previous injuries and medications are unecessary overkill. My job and its effects go a lot deeper than you might think. What I do can have a profound systemic effect that affects multiple major body systems. I need to know if you have high blood pressure. I need to know if your car rolled over 6 times on its way into the ditch, even if it was 5 or 10 years ago. I need to know if you have a contagious disease so I can protect myself and the rest of my clients. I need to know about that hip replacement or the reconstruction surgery or that herniated disc. And yes, as embarrassing as it may be, I need to know about any male enhancement supplements or medications you're taking. Because I need to know if I need to make any modifications to your massage so that you get as much benefit as you can and I can accomplish that as safely as possible. Yes, I know how to do this; it's part of our training. And here's the deal, y'all. At the end of my treatment form is a sneaky little statement that says something to the effect of, "I haven't left anything off or lied about anything", followed by the signature line at the bottom. And if you sign it, you're promising me you told the (whole) truth, and should the unthinkable happen and something goes wrong and you blame it on me and you had a pre-existing condition that you withheld from me and now you want to sue me because you think I caused this, you're outta luck.

Massage therapists have been known to work miracles. That's why people swear by us. But let's face it, we don't do everything. We can't "crack" your neck. We can't prescribe anything. We can't diagnose, so we can't tell you for sure what's wrong. Assessment of various conditions can be part of a therapist's training, so those of us who have learned how to assess can give you an idea of what might be going on from an overall muscle point of view, but we can't say for sure. Some of the aches and pains you feel might be tight muscles, or they might be some various bones slightly out of place, or they could be some vascular problems. Sometimes it's really hard to tell, because a joint slightly out of alignment can feel like a muscle ache. Massage therapists work muscles only, and they haven't been trained deeply beyond that. This means that you might come in for a certain ache or pain and after the session, the same problem is still there. This doesn't mean that the therapist wasn't good or didn't do their job or work the right area, it means that it wasn't a muscle problem to begin with.

Let me clear up a myth, and this one has two parts: One is, you typically can't get every ache or pain completely worked out in one session. It's going to depend on a lot of factors, like how long you've had the problem, how bad it is, if it's inflamed or not (inflammation impairs healing), your overall health condition, how often you get massage, how long a massage you get, the skill level of your therapist (hint: don't go get corrective massage from Massage Envy after your rollover car wreck; seek someone with more experience), and more. I've had countless clients who come in and they want me to work every single area, deep and detailed, because it all hurts, and they only sign up for an hour. I can understand this if they don't know better, but after a session or two, it becomes apparent, and I'm talking here primarily to those who should know better. I'm not Wonderwoman and I can't possibly address every body part in a single session. If your neck has a chronic crick in it from sleeping wrong but you also want a full-body deep relaxation massage also, you're going to need a lot longer of a session than 1 hour.

The second part is, if you're in chronic pain or stress, you can't survive on one or two sessions a year. I had clients who, despite my best attempts at client education, I would only see them about every 6 months. Every time, they came in only when they were in enough pain that it started to affect not just their work life but their hobbies and sleep as well. If you haven't been in in a while, by the time I finish working on you, I've only begun to scratch the surface. There is a whole lot more follow-up bodywork (i.e. additional massage sessions) that needs to be done in order for us to actually make any progress. If you've got chronic issues, you probably actually need once a week, maybe more in the very beginning.

Next. let's talk pressure and deep tissue for a moment. First, don't judge a therapist's ability to go deep based on his or her size. Sure, it makes sense that the therapist who is also a bodybuilder can probably go a bit deeper than someone small, but don't bet the farm. And do not, by any means, make any assumptions based on the therapist's gender! Some of the smallest, thinnest female therapists can bring the biggest male clients to tears on a regular basis.

Second, there is no "no pain no gain" when it comes to massage. Get that myth out of your head, because it just makes you sound outdated...and wrong. Some of the gentlest techniques pack the most musculophysiological bang for the buck. Lymphatic drainage, gentle myofascial release, light pressure on a trigger point, Reiki, Cranio-sacral, etc, have all been known to work wonders for even the most chronic of problems. It's all about working smarter, not harder. Please don't be one of those strange people with something to prove (to themselves or the rest of the world) who have contests with themselves to see how deep a pressure they can take this time. It's not a contest. It's not the stock market, where it has to keep increasing to do any good. If it's doing you some good, it's doing you some good, even if the pressure is actually lighter than last time. Just go with it.

And on a sidenote, please don't be one of the occasional sick douchenozzles who don't think it's deep enough pressure unless they see the therapist squirming and hurting him- or herself in the process. I actually have heard stories of clients who didn't think it was good enough if their therapist wasn't struggling. I don't know what kind of sick psychological profile it takes to be that weird and pathetic, but I certainly refuse to work on that kind of client in my office. To those people: straighten up and be normal. Take your little fixations elsewhere. And please, adopt out any animals you have.

Now I'm going to talk about business and money, because to our un-credit, too many therapists are too chicken shit to do so, and some things need to be said. First, if your therapist is self-employed, it's OK not to tip. Tipping is appreciated by nearly all therapists, but seriously, they (should) have set their prices at a level they already think is fair and can live with. Tipping with me was always optional, but I felt uncomfortable for those I knew weren't made of money that felt an internal pressure to tip. Please, never feel pressured to tip me. I am seriously not going to think any less of you. I am spilling my guts in complete truth when I say that I would rather you save the money to use on future sessions (especially if money is an issue and you can't come in that often), or when I say that I would rather you talk me up to your friends and family and refer them in, instead of tipping.

That said, please understand that the tipping-optional rule is for self-employed therapists only. If they work at an establishment, chances are they keep less of what they make (due to mandatory overhead contributions or lower pay scales, and some establishments who pay MTs on a split percentage basis may require the therapist to take an even lower pay rate on a discounted massage, such as with a coupon or a special), and thus they'll depend more on tips than someone who is otherwise self-employed. Sure, one could argue that it's technically "their choice" to work at those places, but still - it may not be their first choice. They may have preferred to open their own business but perhaps they live in a location (neighborhood with strict zoning, or an apartment) that prohibits massage therapy (or running any home-based business, for that matter), and storefront flats are prohibitively expensive. So, if you have the money to frequent an establishment (which generally caters to those with greater means anyway due to their higher prices), please do the decent thing and tip them a little extra if you appreciate the service you received.

And please don't do the slimy thing and schedule a lower-priced Swedish massage and then once back in the room, request an advanced technique that would otherwise carry a higher pricetag. I had many a client try to pull this one when I was working at another massage establishment, and it only made them look trashy. The scenario went like this:

Receptionist: And would you like Swedish, Deep Tissue, or an advanced technique?
Client: Hmm...what's the difference?
Receptionist: Swedish is a basic relaxation, Deep Tissue is good for working out knots and going a little deeper into the muscles, and those are the 2 most popular. However, we also have Neuromuscular Therapy for targeted work, and Shiatsu and Pre-natal massage.
Client: Hmmm, OK...is there a price difference?
Receptionist: (states the prices, the Deep Tissue being only $10 more than Swedish, and any Advanced modality being $10 more than Deep Tissue)
Client: (hemming and hawing, and finally): I'll just stick with the Swedish.

Of course, I was around the corner, working on paperwork where I can't be seen. I heard the whole thing. I greeted the client and took them back to the treatment room.

Me: OK, so we're doing an hour-long Swedish relaxation massage today?
Client: Well, yes, but I need a little extra on my back, and I like firmer (read: deeper) pressure there, too.
Me: (now in the uncomfortable position of having to break it to them tactfully that they cannot get what they really want because that's not what they signed up for. Actually, it wasn't uncomfortable to have to do, it was just that I had to be ready for any of the various reactions that could arise from the truly special snowflakes as they went from semi-Jekyll to outright Hyde.) My biggest tip-off was when a male would sign up for a Swedish (yeah, right - most males wanted Deep Tissue and specified as much). In short, don't try this at home--or anywhere else.

Lastly, I want particularly my clients to know that I've had a lot of fun with y'all and that I do hope we cross paths again. After all, it's a small, small world.

(Stay tuned for an eventual Part 2, specially for those I call Massage Virgins)