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Health and Disease in the Vedic Tradition of India
Article by Jennifer Thomas
Some say that the Vedic tradition of India has a practical history of some 50,000 years or more. Whatever the period, however, it is clear that this tradition was first written down about 5,000 years ago. This was just before the epic Mahabharata war, involving everyone, took place. This culture was guided by the fundamental insight that we and our environment are really one.
This was realised in practice with direct observation and a capacity to communicate with the intelligences and powers of nature. The principles they established illustrate the wisdom and understanding of their original vision. They concern a life of harmony for the health and well-being of all existence. This tradition developed Ayurveda which accords with these ancient principles, and reflects the original observation and understanding that all is one appearing as many.
Ayurveda has been called ‘the mother of Medicine’ and ‘the sister of Yoga’; a science of human life and how to maintain it healthily. Health is the self-proposed attitude to maintain the balance of a day’s work as play without default. Disease arises in those who default and medicine is used to rectify the results of this default and it is discovered as an atonement. Proper behaviour maintains health while misbehaviour produces disease that results in some form of suffering.
Suffering or discomfort has a double function. It indicates that there is something wrong in the constitution and above all, it is also an atonement caused by nature which induces us to understand what to do and what not to do.
Treatment is rightly understood as the process of re-establishing health and not killing the pain or disease. All of these notions rely on the constitution of man and nature, which is based on three functional centres governing all of life.
Practical study and application of these principles involve diet and exercise, seasonal and daily routines to maintain balance, massage and its therapeutic uses, Panchakarma cleansing and purification techniques.
Massage in the Vedic Tradition
All massage stems from the instinctive impulse to rub and relieve the body whenever it is disturbed or hurt. Bathing involves similar instincts. Ayurveda’s unique and profound contribution of oil with massage, has refined and utilised these instincts to provide health and well-being.
According to Vagbhata – Astanga Hridaya: Sutra : 2 : 7-8 massage therapy should be used every day as it has the following benefits:
- It prevents and corrects the ageing process
- It helps overcome the fatigue of a routine of hard work in life
- It prevents and corrects disorders of the nervous system
- It promotes eye-sight
- It helps nourish the body
- It promotes longevity
- It helps one to get sleep
- It promotes sturdiness
Massage in India is a long-standing tradition from the first day of life, which continues to at least the third year. After three, once or twice a week up to the sixth year. Afterwards the child is able to massage others and receive massage in return. The child learns massage by massaging their grandparent’s feet, who in turn guide the massage. Massage pervades every aspect of life particularly in Kerala, wives are instructed prior to marriage, how to massage their husbands. Prior to marriage, ceremonial massage over a period of three days is given to a couple for stamina, psychic strength and to enhance beauty. After childbirth the mother is massaged daily for 40 days if the child is male, if female then 56 days.
Massage reflects the natural world constantly massaged by the elements. The Breath or Wind is understood to be the foundation of everything – Prana the life-giving or vital air. Disease begins with disturbed Prana. Massage directly deals with the blocked or agitated Prana promoting efficient circulation through the channels of the body to maintain health.
Massage ensures that the body can properly utilise a diet that promotes health and a sense of well-being. It nourishes by stimulating the inner resources of the body to maintain health. Ayurvedic massage belongs to an understanding that health and beauty rely on the circulation of vital life-fluids and appropriate removal of body wastes.
The skin and the digestive tract are the physical barriers which separate you from your environment. They control entrance into your system, permitting nutrients inside while refusing entry to pathogens.
Bodily wastes can also be excreted through both the skin and the gut. When excretion through other channels becomes inefficient the excess is directed out through the skin. Skin disease usually develops when the skin is clogged with toxic wastes. The health of the skin is thus intimately connected with the health of the digestive tract. Skin disease improves when digestive function improves, and when the skin is cleansed of all its impurities and toned to vibrancy, the digestive tract also becomes healthier.
Every human being needs regular oil massage. While self-massage is adequate for most people most of the time, everyone should seek professional massage from time to time.
Massage makes the skin soft and unctous reducing dryness, cold, rough and ageing skin. The rhythmic massage motion allays joint and muscle stiffness and makes all body movements free and rhythmic. The circulation of the blood increases, encouraging quicker removal of metabolic wastes. Massage also relaxes the body prior to more vigorous exercise.
Massage is particularly beneficial for those who work more with their mind than their body. With reduced anxiety and tension body-awareness develops leading to an expansive sense of ourselves or well-being. This state of ease brings an improvement of mental and emotional functioning, with a body felt as light and full of energy and vitality.
Snehana
An ancient practice of oeleating, anointing and lubricating, giving love and tenderness whilst removing dryness with the internal and external administration of medicated or non-medicated fats/oils. Snehana is used as the first stage in the process of detoxification before a client undergoes any of the five specialised elimination therapies of Panchakarma.
This preparation renders the body-mind more accepting of the coming purification by opening the channels and releasing the accumulated wastes of every form. The treatment is administered externally with Abhyanga Massage (Full Body Massage) and called Abhya Snehana or administered internally and is called Snehapana. Externally different types of Abhyanga are used with appropriate medications of an animal, vegetable or mineral origin.
The oils used such as sesame oil, preferably the black variety also help alleviate Vayu – the disturbed Prana, and promote digestion, metabolism and cleanses by helping the body to discharge toxins through sweat, urine and mucous. The body benefits by becoming supple and strong, vitality returns with a better level of functioning generally. Circulation of blood, lymph and Prana are stimulated to provide nourishment.
Effective with disorders such as diabetes, skin disorders, blood pressure, aches and pains in the joints as well as diseases of the nervous system. Chronic obstinate skin and urinary disorders.
Preventive massage rejuvenates and is an important part of Rasayana literally ‘the path of juice’- the regeneration of tissues. The preparation of medicated oil by boiling with other ingredients is a process that ensures the medicinal properties are retained – Ayurveda holds the view that oil can absorb the useful properties of various substances. Traditional tried and tested formulas with ritual procedures are used to ensure the treatment is effective.
Whilst used specifically as a preparatory procedure to further treatment, Abhyanga is ideally a daily ritual for the prevention of many disorders in the course of life particularly later life. The massage also cures many diseases as well. This profound treatment and method is therefore a specialised therapy in itself. Massage is the main vehicle for treatment and the goal as a part of Ayurveda, is to promote a healthy life without the need to cure disease.
Massage Oil
The role of oil in Indian life and in particular Ayurveda has provided an enormous body of knowledge of its properties and value in health. Medicinal oils make use of the wondrous variety of valuable medicinal plants in India. The methods of extracting the appropriate standard of drugs and preparation of the medicated oil involve attention to time-honoured rituals to ensure that the medicated oil is effective and wholesome without inflicting any harm. Careful measured methods ensure that the structure and integrity of the materials is not disturbed. Ayurveda always looks to care for the whole community. A lesson modern western pharmaceutical health ignores as superstition.
Modern medicine subjects plants and other raw materials to deliberate modification in the name of economics, as does the food industry.
Chemical fertilisers and pesticides used to support mono farming.
Pharmaceuticals used to maintain farm animals.
Commercial processes involving heat, vacuum, freezing, microwaves, irradiation and chemicals used to try to preserve appearance for market
Oils are an example:
Cold-pressed oil: using a press to extract gives the highest quality and flavour besides cost
Semi-refined oil: using higher pressure and temperature to extract more oil brings a loss of vitamins
Refined oil: whilst labelled ‘pure’ is an empty oil
Note: Fats are basically the same as oils but solid at room temperature
Using solvents to extract, removes any value besides bleaching and deodorising the oil. Vitamins have to be added as well as preservatives otherwise the oil will become rancid.
Proprietary Ayurvedic medicines make available to the public products that have a sound history and are effective, but too costly and difficult for individuals to prepare. In Kerala and Tamil Nadu where massage is still practised according to the indications in the medical collections of Caraka, Sushruta and Vagbhata, healers prefer to make their own and they are not willing to share methods or formulas. Indeed they only give their oil to their clients.
Doshas
Ayurveda understands man, nature and all of life as a dynamic matrix of the Five Great Elements (Panch Bhutas) namely: Space-Air-Fire-Water and Earth. Active aspects of these elements combine into three biological, organising principles called Doshas: Vata (space and air), Pitta (Fire and Water) and Kapha (Water and Earth). These bio-energetic forms of the elements make up the unique individual constitution of individual bodies or types. Briefly, Vata is the power of wind which sets the other two Doshas in motion. Vata is chiefly about movement, with activity, with breathing, animation and inspiration. Pitta is the power of fire, the energy released by chemical and biochemical processes. This inner fire is concerned with digestion, combustion, metabolic transformation, oxidation, visual faculties, regulation of body temperature and the colour of blood and skin. Kapha is the power of cohesion, involved in the construction of the bones of the body, joint formation, as well as in mental strength, endurance and in resistance to disease. Kapha brings body stability, firmness, flexibility, resilience and coolness.
Health and the diagnosis of disease therefore focusses on the condition of the Doshas and the accompanying symptoms.
The Doshas, Vata, Pitta and Kapha have their centres in the colon, small intestine and chest respectively. A weak digestive fire is the root cause of all diseases with the accumulating toxins called Ama as the chief nourisher of disease. The disturbed vital air (Prana) brings about six stages of the development of disease, namely: accumulation, aggravation, overflow, location, manifestation and specialisation.
This brief introduction to the Ayurvedic Medical system can only broadly outline the subject. However, its eight branches of study can convey something of its range and depth.
The eight branches:
- General medicine – Kaya Chikitsa
- Pediatrics – Bala Chikitsa
- Psychiatry – Graha Chikitsa
- Ears, eyes, nose and throat – Urdhwanga Chikitsa
- Surgery – Salya Chikitsa
- Toxicology – Visha Chikitsa
- Rejuvenation – Rasayana Chikitsa
- Infertility –Vrisha Chikitsa
Five Fundamental Sutras
Everything that exists in the external universe has its counterpart in the internal universe of the human mind-body-spirit complex.
Air, Fire and Water are the principles most fundamental to life. They appear in the body as Vata or ‘that which blows’. Pitta or ‘that which burns’ and Kapha or ‘that which sticks’. The cosmic urges of Movement, Transformation and Stability.Like increases like. Under certain conditions ‘like causes like’ and occasionally ‘like cures like’.
Food is medicine, medicine is food. Food is that which is digested, medicine is that which helps it to digest.
Whatever affects the body affects the mind and vice versa.
Ayurveda describes a subtle and causal structure for the body-mind concerning how we are made; an understanding that reveals we are not our bodies and the basis for life is in the source not the appearance, we commonly mistake appearance to the senses for existence.
Ayurvedic concepts of life have their roots in the Vedic chants that formed the foundation of subsequent Indian thought. A view based on sound not sight as in modern western thought and language. Veda is an oral-aural tradition using Sanskrit, as ‘the Lord’s language’ it reminds the user of the source and structure in the light of which subtle habits of mind are clarified. The original vision is sustained.
Listening, quite simply brought forth a vast body of knowledge to experience. Ayurveda with its large view eventually absorbed, modified and applied this knowledge. Its gross, subtle and causal themes involve the six great philosophical systems of Indian civilisation: Nyaya -Vaishesika, Sankhya -Yoga and Mimansa-Vedanta respectively.
Types of Massage
Ayurvedic Massage, whilst an important practice for every body, in the prevention of disease as well as the maintenance of health is also involved in the treatment of many diseases. The range of procedures is extensive and a massage practitioner plays an important role in treatment delivery directed by an Ayurvedic Physician.
Without considerable on-going study of Ayurveda and its foundations, the massage therapist, however practiced in technique is necessarily limited; they will not be able to penetrate the wonders of Ayurveda or offer what is possible for the patient.
Finally, I trust this brief introduction will encourage you to study as a means for your health and well-being this vast subject.
Future articles will explore Ayurvedic massage in greater depth.
Resources
Caraka-Samhita Vols 1+2, Jaikrishnadas Ayurveda Series, Sharma,
Priyavrat (Ed/trans) Chaukhambha Orientalia.
The Ultimate Medicine, as prescribed by Sri Nisargadatta,
Ed. by Robert PowellBlue Dove Press
The Supreme Yoga, Yoga Vasisthatrans, Swami Venkatesananda
Chiltern Yoga Trust
Non-Dual Yoga of Jean Klein, Interview with Stephan Bodian
The Yoga Journal
Secrets of Marma, The Lost Secrets of Ayurveda, By Drs. Lele,
Ranade and Frawley Chaukambha Sanskrit Pratishthan
To Heal or to Harm, The Vital Spots in Two South Indian Martial Arts,
by Phillip B. ZarilliUniversity of Exeter
Ayurveda for Health and Long Life, by Dr. R.K. Garde Taraporevala Sons & Co.
New Atlas of Human Anatomy, 3D Anatomy National Library of Medicine Visual Human Project, Ed. Thomas McCracken
Anatographic, Ashtanga-Hridayam, by Vagbhata Prof. S. Murthy
(Ed/trans) Krishnadas Academy, Varanasi
Science of Soul, Self and God Realisation Series, Yogeshwarananda Saraswati Yoga Niketan Trust.
Four-Dimensional Man, Meditations through the Rg Veda,
by Antonio T de Nicolás, Nicholas Hays Ltd.
Massage Therapy in Ayurveda, Pancakarma Therapy Ayurveda Series,
by Vaidya Bhagwandash, Concept Publishing Company.
Ayurvedic Beauty Care, Ageless Techniques to invoke Natural Beauty,
by Melanie Sachs, Lotus Press.
Ayurveda and Aromatherapy, The Earth Essential Guide to Ancient
Wisdom and Modern Healing, by Drs. Light and Bryan Miller, Lotus Press.
Ancient Indian Massage, Based on Ayurveda, by Harish Johari Munshiram, Manoharial Publishers.
Ayurveda: Secrets of Healing, Complete Ayurvedic guide to healing
through Pancakarma, herbal remedies,diet, seasonal therapies and memory,
by Maya TiwariLotus Press.
Jennifer Thomas RGN BA
Ayurvedic Lifestyle
Counsellor 35 years in Community Public Health
14 years Study/Practice Ayurvedic Massage
8 years teaching
Ayurvedic Massage at Ayurveda Elements
and Nature Care College
Currently part-time Practice Nurse withCommunity Medical Centre
Private practice in Willoughby for 14 years
Phone 02 9958 8839
Email greatgoona@westnet.com.au
Article by Greg Morling
Up to 80% of people who have lost an arm or leg often perceive the limb as though it was still there and with this perception there can be pain. This article examines the research and discussion surrounding this fascinating area and outlines how massage therapy may be beneficial in reducing this sometimes frightening and disturbing pain.
All of us, from time to time, meet clients who present with conditions that keep us thinking and reading late into the night as we search for suitable palpatory methodologies that other colleagues may have used to ease the pain or discomfort in their own patients or clients. In 2006, Susan triggered this response for me and initiated my research into how massage therapy may help relieve the pain she was experiencing in her lower left arm that had been amputated five weeks earlier.
Like Susan, some clients may have had an arm amputated because of the presence of a tumour. There are other reasons for amputation; car or bike accidents (trauma), disease, and congenital defects. While the majority of amputations involve the lower limbs I have focused this article, and my research on the amputated upper limb. The reasons for this decision should become clear as possible forms of treatment are discussed. Phantom limb pain can occur immediately following amputation, months, or even years later. In most cases, a phantom arm hangs straight down at the side when the person sits or stands, but it moves in perfect coordination with other limbs during walking – that is it acts like a normal limb. Sometimes, however, the amputee is sure the limb is stuck in some unusual position. One man felt that his phantom arm extended straight out from the shoulder, at a right angle to the body. He therefore turned sideways whenever he passed through doorways, to avoid hitting the wall. Another man slept on his stomach because his phantom limb was bent behind him and made it impossible to sleep on his back.
The eerie and powerful reality of phantom limbs is no more evident than in the classic explanation, from V.S Ramachandran’s book, ‘Phantoms in the Brain’ explained by an 11 year old girl- born without forearms or hands but with vivid phantom hands – of the way she learned to do simple maths at school: She placed her phantom hands on her desk and counted on her out stretched phantom fingers! The first thing that a massage therapist should learn from this 11 year old is the reality of the limb that is not physically present; there is never a phantom limb, rather there is a usually always phantom limb pain.
The sense of reality is also strengthened by the wide range of sensations that a phantom limb can have; pressure, warmth, cold and many different kind of pain are common. A phantom can feel wet. Or it can itch, which can be extremely distressing, although scratching the apparent site of discomfort can sometimes actually relieve the annoyance. Energy workers should take special note of this last fact.
Naturally, of all the sensations in phantom limbs, pain, which as many as 80% of amputees suffer, is the most frightening and disturbing.
A striking feature of phantom limbs, which reinforces the reality still further, is that the phantoms are experienced as part of oneself. That is, clients perceive them as integral parts of the body. Nana Dawson-Andoh, a researcher in this field, describes this as the ‘I-function,’ where the brain retains a very definite sense of self which includes the missing ‘real’ limb. These feelings are sometimes referred to as ‘stump hallucinations,’ is the subjective sensation, not arising from an external stimulus, that an amputated limb is still present.
Amputations are not essential for the occurrence of a phantom. In some accidents, particularly when a rider is thrown off a motorcycle and hits the pavement, the shoulder is wrenched forward so that all the nerves from the arm are ripped from the spinal cord, resulting in brachial plexus avulsion. The resulting phantom occupies the now useless true arm and is usually co-ordinated with it. But if the victim’s eyes are closed, the phantom will remain in its original position when the real arm is moved by someone else. Even though the real flesh and blood arm is incapable of responding to stimulation, the phantom version is usually quite painful. Regrettably, even if the true arm is removed surgically there is no effect on the phantom or on the pain.
Similarly, paraplegics who have no feeling in, or control over, their body below the spinal break – often have phantom legs and other body parts, including genitals. Some paraplegics complain that there legs make continuous cycling movements, producing painful fatigue, even though their legs are lying immobile on the bed.
The powerful impression of a stable, embodied self is taken for granted. But it’s a perception that’s possible only because of the body image created by the brain.
A significant element of that image is a mental map of the body surface, generated by the cortex of the brain using the sensory signals it receives from the skin. Other regions of the cortex control other components, such as the position of the muscles and joints (proprioception), the intention to move, and also the viewing of the body’s movements.
But the brain’s idea of itself can be distorted by the amputation of a limb. Since there is no visual feedback, initiating motor intention does not activate proprioceptors. Over time, phantom limbs are deemed by the amputee to be overflexed, which causes a cramping pain. The question that arises is that if the inconsistency between the intention of the brain and the perception of the body’s action was to be resolved, could the phantom pain be eliminated?
Several theories have been developed over the past 10 years that have attempted to answer this question, most notably, by Ronald Melzack and Vilayanur Ramachandran. Not surprisingly, neither has included a tactile component to possible therapeutic treatment.
The earliest hypothesis regarding the cause of phantom limbs and pain was that of neuromas. These were thought to be nodules comprised of remaining nerves located at the end of the stump. These neuromas presumably continued to generate impulses that travelled up the spinal cord to portions of the thalamus and somasensory domains of the cortex. As a result, treatment involved cutting the nerves just above the neuroma in an attempt to interrupt signalling at each somasensory level. Canadian massage, Anna Kania briefly covered the process of massaging these neuromas at the end of the residual limb and/or the
muscle and soft tissues in a 2004 article published in the Amputee Coalition of America’s Journal. This massage process and other related theories were deemed unsatisfactory because of the fact that the phantom pain always returned, indicating that there was a more complex reason for the persistent phantom limb pain.
Melzack developed the concept of the neuromatrix and the neurosignature. This idea held that the brain contained a neuromatrix or a network of neurons that analyzed the sensory information and allowed the perception of feeling. Then the neurosignature, which consisted of the three primary neural pathways (from the thalamus to the somatosensory cortex, from the reticular formation of brain stem to limbic system, and the parietal lobes) was activated and informed the brain that the detection of sensation were from itself. He also maintained that the neuromatrix, which was essentially a brain map of the body, was pre-wired by genetics. Melzack pointed to his research that showed that people born without a limb could experience phantom pain as well. While they don’t appear to have worked together, V.S. Ramachandran’s description of the little girl’s ‘finger counting’ process seems to give further evidence confirming Melzack’s theory. He postulated that the brain was predisposed to believe that all its limbs existed and so sent out an output signal to it through the neural pathways in the neuromatrix. But because there was no limb, the brain acquired no sensory feedback, and in an attempt to compensate increased the intensity of its signals, which induced the phantom pain. These findings led Melzack to believe that “the body we perceive is in large part built into our brain – it’s not entirely learned. In fact, you do not need the body to feel the body.”
Ramachandran had further answers to the question of phantom limb pain. He was inspired by previous experiments by Michael Merzenich that had studied the homunculus (blueprint representation of the entire body surface, which identifies the locations of sensations felt on the skin) of monkeys. Ramachandran wondered if amputees who complained of phantom pain could be suffering from rearranged body maps, and formulated his cortical remapping theory. He examined the reorganized homunculus of patients with removed limbs. In 1971,
Ashley Montague wrote what I describe as the lost testament for bodyworkers; Touching; The Human Significance of the Skin, in which he also addressed this relationship. The diagrams below represent
 The motor homunculus
 The sensory homunculus By using q-tips to brush the face of a patient, Ramachandran was able to produce sensations in their phantom limb. So each time a patient smiled or scratched their face, they stimulated the arm region of the body map causing a sensation in their phantom limb. This part of Ramachandran research has influenced the treatment protocols I suggest a massage therapist might employ therapeutically when working to help eliminate phantom limb pain.
Ramachandran reasoned that in order to move the phantom limb out of discomfort it was necessary to allowing the patient to see the movement they wanted to make with the phantom limb. He developed an ingenious method using mirrors that provided the brain with this visual stimulation. A midvertical sagittal mirror was put in front of the patient, and they placed their remaining limb in an exact mirror-symmetric location opposite to their phantom limb. The reflection the intact limb was optically superimposed on the perceived location of the phantom limb. The graphic shows this rudimentary version of this apparatus (mirror box) that I made and use in my practice. The difference to mirror boxes used by hospitals and rehabilitation centres is the white rectangle at opposite end of the arm hole can be flapped down to providing access to the present limb so it can be viewed as if the amputated limb is present and being massaged. This tactile component enhances the visual impact on the conscious belief that the amputated limb is still present and can be moved and massaged out of the pain, cramp and general discomfort the client may be experiencing.
Ramachandran has been successful with helping patients ease the pain for their phantom limbs using this therapy. His research showed that six of ten patients instantly felt their painful phantom limbs moving, and a few were able to shift their phantom limbs out of painfully awkward positions. One patient even managed to correct his body image, and his phantom limb eventually shrank away to nothing. The tactile component I use adds a further therapeutic process.
 Mirror box with massage access flap The other form of therapy can be administered by both the massage practitioner and the client. The process involves ‘mapping’ the positions on the limb stump that reproduce corresponding sensations on the rearranged homunculus. These sensations occur, from my experience, on the client’s face. By massaging these points I have found that phantom limb pain can be reduced. While both of these massage procedures may be quite useful in reducing phantom limb pain, the tactile mirror box needs the presence of the massage therapist for treatment while the mapping points can be located by the therapists for the client and then a massage protocol can be designed for the individual client to do self-massage.
 Diagram showing numbered facial positions that may be massaged to help eliminate hand and arm pain in the phantom limb This is a very new area for massage therapists and I believe it warrants further research. It also an example of how varied and useful our skills can be as a complement to most conditions and pathologies.
Article by Eleanor Oyston
There is much to be offered by the massage community to our general population when it comes to health management.
Often clients are given a gift voucher by a friend or a family member because it has become obvious that they are ‘stressed’, anxious, in chronic pain or just exhausted. The hope is that an hour of reconnecting with ‘what is’ will inspire the loved one to take better care of them self.
More and more doctors are recommending massage as a stress management tool and CAM (complementary and alternative medicine) is being talked about throughout the medical and natural therapies communities.
There is active debate around what we call massage for folk with medical problems and James Waslaski, an American massage therapist, argues that we need to use the correct terminology when offering training to massage therapists. Once again the ‘fear’ of triggering a medical emergency during or following a massage treatment and the subsequent litigation is driving the debate, primarily from within the massage or CAM community.
You might be interested to know that, in my experience, the medical community doesn’t think that we can change the body to the degree we imagine that we can and that once a rapport with a doctor has been established, the medical practitioner will encourage all kinds of safe touch (massage, Bowen, reiki etc) for patients with complex medical issues.
The challenges we face as a professional body of massage therapists is how do we provide the highest standards of care to the sickest clients? Can we train massage therapists well enough so that people are never faced with feeling ‘untouchable’?
Just last week, on a Quest for Life program, I met a young father of two who had undergone a bone marrow transplant which meant that he had been in his own bed for less that two months since January this year. This amazing young man continues to be immune compromised and knows that massage helps his emotions, his muscles and his platelet count.
During his much extended stay in the transplant unit of a major hospital he resorted to having a suitably trained massage therapist visit him under the guise of a family friend.
His hematologist wondered why he was seeing such rapid improvement in his patient and the patient could not tell him the truth for fear of compromising the therapist. This young man could hardly wait to tell his story to the team at Quest for Life… .a safe place to share you must treasured stories.
In 2004 Memorial Sloan-Kettering Cancer Centre (MSKCC) in New York conducted a three year, longitudinal research study on 1290 patients who were connected to their hospital as either an in-patient or out-patient.
The research was published in the highly regarded medical publication ‘Journal of Pain and Symptom Management’.(1)
The findings of this highly regarded research was that following massage patients showed, on average, a 50% decrease in symptoms of pain, fatigue, anxiety, nausea, depression and we know from studies already published (not with the status or size of the MSKCC study) that the benefits of massage for people in hospital are:
- symptom management,
- lowering blood pressure,
- stress and anxiety reduction,
- pain control, and
- an enhanced feeling of well being.
Research is also showing that moderate regular exercise halves the risk of death in women with breast cancer and that the benefit of chemotherapy for the 22 major adult malignancies is estimated to be around 2%.(2)
If these results were published by a pharmaceutical company it would be front page news!
In November 2005 in San Diego, USA, the second Society of Integrative Oncology (SIO) Conference didn’t even debate massage for people with cancer. From my observation it now seems to be an accepted practice and almost every hospital represented at the conference either had a massage unit in full swing or was creating one. A notable exception and disappointment for me was that the only Australian hospital, represented by the oncologist in residence, is not even contemplating the development of a massage facility.
The SIO Conference in 2006 held a Massage forum to discuss how to introduce massage into hospitals and the following guidelines emerged.
- CEO or government commitment to implement massage in hospitals.
- Suitable training programs to ready therapist for establishing the service.
- Establish a pilot program in a major cancer centre with at least 1 full time and 2 part time staff.
(The full time team member is employed as a practice manager, responsible for the entire interface with hospital management and ward staff, scheduling of treatments and supervision of therapists.
Two part time staff will need to be suitably trained, selected by the practice manager and open to working with hospital staff.
All staff employed in the initial team would need to be asked for a long term commitment of at least 3-5 years.)
Once the initial program is established the practice manager would need to expand there role to include training of future therapist in conjunction with established training programs.
Incorporate research goals into treatment programs offered in hospitals.
- Expand massage services to include other complementary therapy services such as acupuncture and herbs as well as offering massage treatment to hospital staff.
Note:
World best practice shows that massage staff must be employed and remunerated at the same level as similar service providers in the hospital system e.g. occupational therapists, nutritionists (massage therapist pay the same for there education and continuing education as these professionals).
In conclusion, let me say that we have excellent massage services available in some hospitals, mostly by contractors or volunteers.
I have established, and teach an accredited training program at The Quest for Life Centre; Massage Cancer and More to teach qualified massage, tactile and Bowen therapists how to work with people with cancer and other life changing illnesses. There is also an extension program to further develop therapist skills so that they can work in hospitals, offering medical massage as a salaried part of the health care team.
At this time, in Australia, this is the ONLY pathway that has the capacity to place massage therapists in hospitals and therefore, part of mainstream health care.
Continuing the high standards set by Massage Cancer and More, Gayle MacDonald, the author of ‘Medicine Hands’, will come from America to teach two courses on massage for people in hospital at the Quest for Life centre in March 2008 (please see the advertisement in this edition of Mostly Massage). Gayle has been massaging in hospitals for 15 years and we can learn much for her experience. Also Phase 2 – Massage in Hospitals training program at the Quest for Life centre is written and is ready for peer review by medical and massage educators. n
References:
- Massage therapy for symptom control: Outcome study at a major cancer centre by Barrie R Cassileth, PhD and Andrew J Vickers, PhD; Journal of pain and symptom management. Vol 28 No 3 September 2004
- New frontiers in medicine: The body as the shadow of the soul. By Craig Hassed; proceedings of AIMA Conference August 2007.
Eleanor Oyston is a Cytotechnologist, Massage Therapist and Bowen Practitioner who has had a distinguished career in Pathology and Medical Research. For the last 6 years she has worked with Petrea King at Quest for Life Centre bringing a unique understanding to tactile therapies.
Eleanor developed and teaches her own course, Massage, Cancer and More -“Dispelling the Myths” and publishes her opinions and knowledge regularly in professional magazines.
Eleanor runs a clinic from her home at Burra Creek, NSW, and at rooms in Farrar, ACT. She is also actively involved with John Coleman, Naturopath, developing a homeopathic and Bowen based program-managing clients with Parkinson’s disease.
Article by Barry Bolos
Insurance is not rocket science, nor is it a complex mathematical equation and formula.
It should always be the case that premium charged is reflective of the risk to the insurer. For many reasons insurance companies do not fully understand the risk, so how do they come up with a price of between $220 – $350 for massage therapists.
Mainly decision makers sit in ivory towers, far removed from what happens in the real world. So what you have is in effect decision made on stereotyping and assumptions not on research. What is surprising is that most insurance companies and brokers will only embark upon researching and promoting a proposal if they consider it to be a viable proposition dollar wise in terms of premium income and claims.
The industry has close to 25,000 qualified practitioners currently operating and the incidents of claims made against these massage therapists is minimal. Something you expect an insurer to know and also appreciate.
Gone are the days where a massage therapist (and the industry) was not considered mainstream. In today’s world therapists are:
- Trained and qualified;
- Comply with a code of behaviour;
- Belong to industry associations and comply with standards and guidelines laid down by these associations.
The approach should be simple.
Spend time with industry groups and conduct your own research. With a step by step approach, form a clear understanding of how they operate, everything from practices to procedures to training to industry standards.
Armed with this knowledge approach a vast array of underwriters and educate them on what really occurs in your day to day operations.
The incidents of claims made against massage therapists is minimal, something you would expect an insurer to know.
Looking at the broader picture, it appears other industry groups are gaining the recognition of insurance companies/brokers.
Herbalists $280.00
Naturopaths $300.00
Judo Instructors $400.00
The above occupations carry more risk than a massage therapist, it is only because these industries have lobbied hard and knocked on many doors that they have achieved these rates.
Premiums should be around the $140.00 to $160.00 range.
A quick guide in regards to insurance terminology and what it should cover is as follows:
- Public Liability – slip and fall;
- Product Liability – goods used and sold e.g. oils;
- Treatment Risk – the actual risk associated with a treatment;
- Professional Liability and/or Professional Indemnity – any advice / guidance you may give in line with your training and associations.
In a nutshell, packages are designed to provide cover the moment a client enters your practice as it is from here that you have a duty of care. (Providing the massages you undertake do not extend to skeletal manipulation and chiropractics.)
Barry Bolos has been associated with RGIB Insurance since 2002.
His role is to focus on assisting industry groups and associations to formulate packages for the individual members and their respective association as a whole. He believes strongly in role
of research when formulating and facilitating the correct premiums for his members.
Skill For Massage Therapists
Article by Barbara Simon
If you are looking to learn a new skill that gives you the opportunity to move into more effective back care with your own clients then Dorn Spinal Therapy is just the right modality for you. Sure as massage therapist you would see many clients suffering from some sort of back or neck pain and often you have to send them off to see a chiropractor or osteopath or other health care practitioner. But Dorn Spinal Therapy can stop that as it allows you to work on your clients’s structural alignment before performing a deep tissue massage and address the muscular problems. And it seems very logical that massage on a structurally aligned body is much more effective than on an imbalanced body.
Dorn Spinal Therapy offers your patients a safe, gentle means of correcting spinal abnormalities. With only minimal training and some practice, this therapy can be included in your practice in conjunction with your other services for your clients’ overall well being. It has been discovered in Germany by a farmer called Dieter Dorn some 35 years ago and after being kept inside german and european borders for a long time it is now conquering the world with the help of some dedicated practitioners having migrated to other parts in this world. Dorn Spinal Therapy definitely has a great future because it is easy to learn, effective, safe and clients respond very well to the treatment.
The first step in Dorn Spinal Therapy is to evaluate the patient’s leg lengths. And this is one of the crucial steps in Dorn Spinal Therapy as a leg length discrepancy can lead to a variety of problems, not only back problems but also headaches. So it is vital in every treatment to check and balance the legs. Usually the leg length remains balanced after the first treatment given the client does the easy home exercises regularly.
The next step is to check the sacrum and coccyx for any imbalances and with the client in movement we can easily balance these. What means the client in movement? That is another vital part of Dorn Spinal Therapy – your client is helping you and therby himself to ensure the safety of the treatment. When you work to correct the left sacrum your client swings the right leg to keep the structure flexible and make it easier for the bones to shift. The same process happens when working on the spine. The client always swings the opposite leg or arm to where we are working on. It also ensures that we can never move vertebrae too far as the muscle engagement on the other side of the spine creates a natural barrier to the spine.
That brings us to the next step, working along the spine. We use our thumbs to find any given deviation in the spine and then work on each individual vertebra to realign the entire spine. And as mentioned above the client is engaged in the process by swinging the leg or the arm when working on the upper spine.
Even working on the neck is simple and very effective, the movement of your client here is a constant turning of the head whilst you work on any unaligned vertebra. And I know that it sounds scary to work on the neck but with Dorn Spinal Therapy you will have the confidence to do so easily and help so many clients suffering from back headaches and stiff necks.
With the body aligned we then perform a gentle spinal stretch massge, using St. Jons wort oil. This massage has been developed by Dr. Breuss and is a fabulous massage to relax your client after the treatment and take the focus off the pain.
Of course you can combine Dorn Spinal Therapy with any other type of massge or treatment you have at hand to reduce pain but you will see that your outcomes are just so much more satisfying – and your clients are very happy.
Barbara Simon is a German trained Natural Therapist and Dorn Spinal Therapist who trains healthcare practitioners here in Australia a
nd overseas in Dorn Spinal Therapy. For more information please give Barbara a call on
02 9918 8057 or visit her website www.backcaresolutions.net
Article by Lori-Ellen Grant
When you press your thumb deeply into tissue, using acupressure, there is a sense of connecting, one person to another. With this link established, the Qi (pronounced “chi”) flows. Qi energizes, stimulates and transforms. When acupressure techniques are combined with knowledge of Chinese Medicine, the science and the art, it is possible to influence the entire body and its ability to heal.
What is Acupressure?
Acupressure is a form of physical manipulation that uses the fingers/thumbs to apply pressure to traditional acupuncture points. As well as being used within a massage session, you can teach clients to use it at home. It can correct internal organ malfunctioning, stimulate blood circulation and release muscle tension. It can also help to relieve acute pain, manage chronic conditions and is excellent for promoting and maintaining general health.
The Nei Jing (one of the earliest Traditional Chinese Medicine texts) states that 5,000 years ago, the Chinese discovered that pressing certain points on the body relieved localised pain as well as benefiting other more remote areas of the body. Soldiers reported that, surprisingly, symptoms of disease were alleviated where stones and arrows had struck or pierced particular parts of the body.1 As a result, Chinese physicians learned to strike or pierce certain points on the body to alleviate specific illnesses.2
Acupressure may also have developed quite intuitively, through the treating of injuries incurred through labour. In the age of hunter gatherers, injuries such as fractures, contusions and strains were common. When these occurred, people would instinctively apply pressure to stop bleeding and rub afflicted areas to reduce swelling and alleviate pain. Gradually, as understanding of these techniques increased, people synthesised some primitive acupressure methods, which later helped to inform the acupressure techniques used today.3
How does Acupressure work?
The principle behind the use of Acupressure treatment is to increase the circulation and functioning of Qi4 through the meridians that connect internal and external functions of the body. “Meridians/Channels are an invisible network linking vital substances to organs and carrying nourishment and strength. Meridians/Channels unify all parts of the body which is essential to remaining in a harmonious balance.”5
Once you have assessed which meridians are causing symptoms of pain or dis-ease, you can choose the most appropriate acupressure points. When an acupressure point is manipulated, it activates the associated channel / meridian, allowing qi to flow freely through it. This assists the muscles to relax, balances the meridian, and harmonises the internal organs. This process of nurturing and balancing links the inner and outer aspects of the body, supporting overall health and healing.
Massage styles and Acupressure
Acupressure relates to and can compliment several different styles of Massage. Chinese massage or Tuina (Chinese for “pushing and pulling”), which places emphasis on soft-tissue manipulation and structural realignment, also incorporates acupressure into techniques. Shiatsu, by contrast, is actually a Japanese form of acupressure. Its literal translation is finger (shi) pressure (atsu). Pressure is applied with hands, thumbs, fingers, elbows, knees and feet, depending on the style of Shiatsu practiced. It can consist of simple manipulations and pressure applied to acupuncture meridians and points.6
A common question is the relationship between acupressure points and trigger points; palpable nodules in taut bands of muscle fibres. Compression of a trigger point may elicit local tenderness, referred pain, or a local twitch response.7 While acupressure points can, at times, correspond to trigger points, there is an important difference between the two. Manipulating a trigger point releases tension in the affected muscle and the structures directly surrounding it. In contrast, stimulating acupressure points means working with an awareness of the whole channel in the body, not just the portion of it where the symptom is localised. This means supporting and energising all of the channel’s functional connections, both inner and outer.
When can Acupressure be used?
There are two ways acupressure can be most useful for the massage therapist. One is addressing common ailments seen in the clinic, such as tiredness, insomnia, sinus problems, headaches and stress related symptoms, to name just a few. When dealing with these, treatment may incorporate not only points related to meridian theory, but also specific locations around the body known as ‘empirical’ points. These are key acupressure points that are highly regarded for their functional effect on such ailments.
Another useful application of acupressure for massage therapists is to treat musculo-skeletal problems, with a focus on meridian theory. Where is the problem and which meridians traverse the affected area? Through stimulating points on the related channel, above and below the ailment and/or locally, a functional effect can occur. The stimulation of these points encourages qi flow in the meridian and assists in reducing pain by moving the qi through the affected area.
Clinical study confirms benefits of Acupressure
A recent study published in the British Medical Journal has shown that Acupressure is effective for treating back pain in terms of reducing disability and pain scores and increasing functional status. The study, which compared Acupressure and Physical Therapy,8 showed that overall Acupressure was more effective in these areas both immediately after the treatments and at the 6 month follow up.9
In my personal practice I have had some great successes using acupressure. In one case, a 40 year old female client presented with chronic headaches which she had been experiencing for 10 years. During six massage sessions over a 4-5 month period, I incorporated acupressure into my treatments, using both meridian theory and empirical points with excellent functional effects. The client experienced a great reduction in her pain levels (from 9/10 to2/10), with the result that she needed less medication to treat her symptoms. She also reported a marked increase in her ability to function effectively at work.
There is huge potential for the use of acupressure clinically with its clearly defined framework of Chinese Medicine and intuitive approach during palpation; the science and the art. These two are like night and day, one filled with reason, the other intuition. Together there is a whole approach, a balance, harmony and therefore, health. n
Notes:
- Veith, Ilza (translation), “The Yellow Emperor Classic of Internal Medicine’, Berkley, University California Press, 1949
- Chang, Dr Steven Thomas, ‘The Complete Book of Acupuncture’, Berkley Celestial Arts, 1976
- Li, Bin, (Tuina Practitioner/Teacher), Chinese Tuina/Massage Notes, CCHH, 2005
- Qi functions to: Nourish, Hold, Warm, Transform, Move, Protect. – Tukapua, Cameron, Form and Movement Notes, CCHH 2005
- ‘Huang-di Nei Jing Su-wen’(Inner Classic of the Yellow Emperor), Beijing, People’s Press, 1963
- Shiatsu Therapy Association of British Columbia – www.shiatsutherapy.ca/
- Travell, Janet; Simons, David; Simons, Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams.
- This included manual pelvic traction, spinal manipulation, thermotherapy, infrared light therapy, electrical stimulation and exercise therapy
- Tony Hsiu-His Chen Treatment of low back pain by acupressure and physical therapy; randomized controlled trial, February 17 2006, British Medical Journal 2006;332 (25 March), doi:10.1136/bmj.332.7543.0
Lori-Ellen Grant, D Acupuncture, D Body Therapies, RMT, MNZRA
Lori-Ellen trained as a massage therapist 7 years ago and more recently has qualified as an Acupuncturist. She has led seminars in NZ and Australia on Acupressure and is currently an undergraduate lecturer at the NZ College of Chinese Medicine in Christchurch, New Zealand.
She also runs her own successful Acupuncture and Massage Practise
(www.wholebody.co.nz) and is a guest speaker at the Canterbury College of Natural Medicine.
Article by Bruce Stark
As human beings we are designed to grow, develop, learn, explore, and try new things–illustrative of our evolutionary process. Once the primary needs of safety and survival have been addressed, we have a natural curiosity and impulse that can initiate our desire for continued change and development. In the bodywork session we as bodywork therapists are routinely presented with people who are experiencing impediments or restrictions to that evolving nature–they may have a physical injury preventing them from doing what they need to do; stress may be impacting on their ability to respond in a relaxed and engaged way; or past or present traumatic events have short circuited their usual coping mechanisms.
Transference is one of the tools that we as humans use to support this evolutionary growing process. Transference is a normal, psychological phenomenon in which unconscious thoughts, feelings, expectations and biases of our clients are projected onto another–for example, us as bodywork therapists–and these projections may affect how our clients interact with us. For example, because we are in a helping role, our client may see us as a “parent” or other care giver and may perhaps subtly respond to us as if we were that parent or care giver. From the somatics perspective, transference represents an opportunity for the client within the context of the therapeutic setting to practice new ways of being or relating to their body or to the injury or distress that supports their learning and integration of new patterns or understanding.
In the massage or bodywork session transference can present itself as a transfer of power. We are often seen as an extension or adjunct to the field of health care and our clients may expect that we will be the “experts” about their body and that they are coming to us in order to get “fixed”. They give up the responsibility for their healing process or their sense of well being and expect that we will do something “to” them that will make them better. Somatically, healing is a process within each of us which utilises our physiological and mental/emotional resources for healing, and our role as massage therapist is to facilitate the body’s ability to access those resources to heal and balance itself. By doing things with the client we are able to support these self-regulation and self-healing processes of which the body is capable.
When we work with the body we model the awareness of and the attention for our clients so that they may come to a greater understanding or awareness within themselves. We help to transfer the power back to them so that they may be able to recognise and experience these self-regulating resources directly. Therefore, when we take a facilitative approach instead of a “fix-it” approach we begin to empower our clients to directly experience their self-regulating mechanisms. Evolutionarily, they get the opportunity to experience themselves in the therapeutic relationship in a way which helps them to trust the healing process and to be more directly involved in their healing or repatterning.
Article by Whitney Lowe
Introduction
One of the more common causes of anterior knee pain is a patellar tracking disorder, often referred to as patellofemoral pain syndrome or PFPS. This condition may be painful on its own, or lead to other painful problems such as chondromalacia patellae or osteoarthritis in the knee. Tracking problems are commonly a result of soft-tissue dysfunction. Consequently, massage therapy can play an important role in addressing this condition.
The Pathology
The knee is composed of two different joints: the articulation between the tibia and femur (tibiofemoral joint) and that between the patella and the femur (patellofemoral joint). Tracking disorders occur at the patellofemoral joint, so our discussion of biomechanics focuses on this area.
The patella is embedded within the tendon that attaches the quadriceps to the tibia. Because it is embedded in the tendon, the patella moves superiorly along the line of pull created by the quadriceps. The quadriceps group does not pull in a straight superior direction, but in a slight diagonal. This is because the quadriceps (with the exception of the rectus femoris) originate on the femur. The femur has a natural varus angulation so the quadriceps group pulls along this diagonal line. A varus angulation is one in which the distal end of the bone deviates toward the midline of the body. The degree to which this pull deviates from a straight vertical line is called the Q (quadriceps) angle.
The Q angle is determined by the intersection of two lines. The first line connects the tibial tuberosity with the midpoint of the patella. The second line connects the anterior superior iliac spine (ASIS) with the midpoint of the patella. The angle between the two lines is the Q angle and it determines the deviation from straight vertical that the quadriceps pull creates on the patella (Figure 1). Most individuals have some degree of femoral varus, so it is normal for the quadriceps to pull the patella laterally to some degree. Sources disagree on the how much of a Q angle is too much, but the majority indicate a Q angle greater than 150 for females and greater than 100 for males is excessive.1
The patella has a ridge down the middle of it, and this ridge must fit in the groove between the two femoral condyles (Figure 2). As the knee is extended, the patella moves in a superior direction and glides between the two femoral condyles. As the knee is flexed, the patella moves inferiorly. During movement, the ridge on the underside of the patella must stay centered between the femoral condyles. If it does not stay centered, a patellar tracking disorder could result. When the patella does not move correctly between the ridges created by the femoral condyles, excessive friction on the underside of the patella occurs. This friction may eventually cause the articular cartilage to soften and wear down – a condition called chondromalacia patellae.
Other structures around the knee joint, such as the quadriceps retinaculum and the fibrous joint capsule are richly innervated and may also be a source of pain. The medial and lateral sides of the patellar tendon have fibrous continuity with the joint capsule, and it is likely that excessive stress on the tendinous fibers may then pull on the capsule. Due to the rich innervation of tissues in this area, it doesn’t take much tensile force to cause pain.
Treatment approaches
Conservative treatment is generally preferred for PFPS. This is especially true if it is unclear as to which tissues are involved. Conservative treatment includes bracing, activity modification, patellar taping, and quadriceps strengthening exercises such as those that emphasize the vastus medialis obliquus (VMO). The VMO is the most distal portion of the vastus medialis muscle, whose fibers angle in an oblique direction to offset the lateral pull on the patella.
If conservative measures are not successful in alleviating the problem, surgery may be used. One of the common surgical procedures for this problem is the lateral retinacular release. In this procedure the lateral retinaculum is cut in order to decrease the amount of pulling on the extensor mechanism in a lateral direction. However, the effectiveness of lateral release surgery has been questioned.2 One reason may be that the optimal biomechanical balance around the joint is disturbed due to cutting important soft-tissue restraints around the knee.
Massage is very helpful for this condition because a significant part of the problem with PFPS is pain originating from the soft tissues around the knee. Changes may not be immediate as you are trying to alter biomechanical patterns that have been established for some time. However, the client should feel some improvement in symptoms within about 3-4 sessions.
Excess tension in the quadriceps is an important factor in PFPS, so massage methods aimed at reducing tension in the quadriceps are helpful. After more superficial warming techniques such as compressive effleurage, deep longitudinal stripping is effective for treating the quadriceps and retinacular tissues (Figure 3). Techniques like deep longitudinal stripping are helpful on the vastus lateralis to decrease its contribution to lateral patellar tracking.
Specific multi-directional friction techniques around the retinaculum are also helpful (Figure 4). Special attention should be paid to any area where the client reports greater pain, especially if that pain is consistent with the pain they have been feeling when doing activity.
Various fascial elongation methods applied to the quadriceps, and especially to the vastus lateralis are also valuable. Pin and stretch techniques are particularly effective here (Figure 5). In later stages, adding resistance to the eccentric action of the quadriceps during their elongation can enhance the active techniques further. Additional eccentric load can be added with resistance bands, weights, or with the practitioner’s hand. Stretching the quadriceps group is also very important during the rehabilitation process.
Conclusion
Due to its pathology, PFPS responds very well to massage. However, in order to derive the best therapeutic benefit from massage applications, the practitioner needs to understand patellofemoral mechanics and the role played by soft-tissues in this problem. When the anatomy, biomechanics, and massage options are understood, you can help many people alleviate this painful knee disorder.
*Portions of this article were originally published in Massage Magazine, Issue #112.
Notes
- Reider B. The Orthopaedic Physical Examination. Philadelphia: W.B. Saunders Company; 1999.
- Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S. Lateral release of the patella: indications and contraindications. Am J Sports Med. 1990;18(4):359-365.
Article by Robert Medhurst BNat, DRM
There are many articles written on the processes you can employ to build your massage business, but what are the things to look out for to avoid failure? This is what the author of ‘The Business of Healing’, Rob Medhurst offer four reasons….
Overextending yourself on set-up costs
If you’re one of the rare and precious individuals who’ve set yourself up in commercial premises, thank you. You’ve bitten the bullet and decided to give this massage business everything you’ve got. We need more of you. There’s a good chance that you’ll do well but have you bitten off more than you can chew? With a rental bond, insurance, stamp duty, phone connection, signage, advertising, Yellow Pages, business cards, brochures, towels, massage table, furniture etc to pay for or pay off, if you’ve borrowed the money to get things underway, are you managing to cope? People who get themselves into this situation often give up and go back to what they were doing before, which is a great loss, both to them and the community that could have benefited from their skills. What should they have done? Planned things out and taken one small step at a time. Students contemplating practice need to carefully research exactly what it’s going to cost them to set up a successful massage practice. Rather than going straight into rented premises it may be more useful at the outset to work part-time from home so that you can still feed yourself and your loved ones while the business builds up and then, once you’ve got a reasonable client base on the books, investigate the transition to full-time practice in commercial premises. If it’s too late to do that, you obviously need to do one or both of two things- get more cash or get more clients. For the latter, see the next paragraph. More cash, unless you can liquidate some of your assets, can legally only be acquired through borrowing it or taking on a partner. You can read more on both of these options in the book mentioned below but in brief, the cheapest way of getting long term finance is by extending the amount of a home loan if you have one, or, in the short term, negotiating an overdraft with your bank. Taking on a partner can be slightly more tricky and this again is elaborated on in the book mentioned below, but either option will be made easier if you produce a business plan that clearly explains what you need, why you need it and how easy it will be for the business to repay the loan or enrich the investing partner. Formulating things into a business plan will also help you to clarify your goals and ensure that they’re achievable.
Not enough clients
Not enough clients obviously means not enough income and a lack of this is the most common reason for a business to fail. But how many clients is enough? We can look at this using “break-even” calculations. Say for example that your weekly business costs total $500. If the average client brings $50 into the clinic you’ll need 10 clients ($500 divided by $50) to keep your door open. If you’d actually like to make some money out of your practice, say $1000 per week gross, you’ll need to see 30 clients per week ($500 + $1000 divided by $50). The magic word here is marketing. Unless you have some form of effective marketing strategy in place it’s going to be difficult to keep your appointment book full. The Yellow Pages and referrals from existing clients are the two most useful sources of new clients. However, these will normally only take on some level of significance after you’re been in practice for a while and even then, may not be bringing in the number of clients you need. Marketing is all about letting the community you work in know who you are, what you’ve got that they need, and motivating them to ask you for it. Successful marketing has a few essential elements.
- Research – you need to find out what the community’s needs are and the best way to reach them with advertising.
- Competitive advantage – you need to know what you have, that no-one else has, that will meet the needs of the community.
- Advertising – you need to be able to:
- Communicate your competitive advantage to the community in a way that will attract their attention.
- Identify their needs.
- Offer a tangible solution to those needs that they’ll understand.
- Have some means of stimulating them to contact you.
Clients don’t come back
If a client you’ve treated doesn’t return to the clinic, in most cases it’ll be because you’ve done a good job and the original problem you treated hasn’t returned, so no further treatment was required. However, if the client has a recurrence of the problem and they fail to come back to you for treatment, there may be a problem. If this situation occurs often enough you’ll mostly be seeing new clients and while these are necessary for growth, it’s the regular clients who’ll enable you to stay in business. There could be a large number of reasons why clients don’t become regular clients. The best way to find out what’s going on here is to conduct an external audit of your business. The critical point here is to ensure that this audit is done from the view of those outside the business looking in, not those inside the business looking out. You may think your business is healthy and functioning properly but your view of it may be slightly biased and may well be different to the view taken by clients and potential clients. One method often employed by those conducting external audits is to ask past clients, current clients, suppliers and anyone else dealing with your business one simple question- how can the clinic improve its current operation? It helps to have someone other than you ask this question and the responses to it should be anonymous. After you’ve allowed enough time for this process to occur, collect the responses and group them into categories relating to each separate issue that’s raised. For example, you may have 75 responses and 50 of these relate to perception that your clinic is untidy, 10 may relate to difficulties in parking near your clinic, 8 may relate to the way you communicate with people and 7 may relate to your pricing. If you prioritise these into those causing the most concern to those causing the least concern and dealing with these in that order of priority, and through your marketing let the community and specifically past clients know that these issues have been addressed, you should find that the situation improves. As a final point here it’s useful to bear in mind that businesses that do the little extra things for clients that they don’t need to do are the ones that prosper.
Poor financial management
Along with a lack of clients and subsequent income, this is one of the main reasons for business failure. The kinds of things that can trip you up here are:
- Failure to allow for regular expenses such as tax, rent etc. If you know when regular expenses are due, bank the money for these into a separate account used solely for expenses so that you have this available when the expense is due. It may be that you need to bank half of the income from every treatment to achieve this.
- Failure to allow for unexpected expenses such as equipment repairs or replacement. You should also maintain a slush fund that allows you the flexibility to cover any unforeseen expenses.
- Failure to charge appropriate prices for your services. The appropriate price in one that the market will bear, isn’t too far from the community average for your type of services and isn’t prohibitive for those on low incomes. Don’t be squeamish about raising your prices if your costs increase, as they will naturally do.
- Failure to maintain enough funds to allow you to stay afloat while the business builds up to a break-even point. For most businesses it’ll take anywhere from 3 to 12 months before the business breaks even, i.e. can fund its own existence. This is before you start to draw a wage from it. You should have enough funds behind you or regular income coming in from other sources while the business builds up to the point where it can support you.
- Failure to monitor your finances generally but particularly rising expense levels and falling profit levels. Profit is obviously what’s left after you subtract expenses from income. Many practitioners who find their cash flow is occasionally a little tight, might not be aware that during these times they’re actually paying to treat their clients rather than the other way around. This is because their expense levels have risen above their income levels. Unless you’re hit with some form of extraordinary expense, monitoring income and expenses on a weekly and monthly basis will enable you to see this problem coming before it strikes. Being forewarned of the trend, you should be able to do things such as boost your marketing activities to attract more clients into the clinic to avoid the problem.
Robert Medhurst is a South Australian naturopath, homeopath, former lecturer in therapeutic massage who has been a teaching business management to non-medical healthcare therapists since 1994. He is the author of the book, The Business of Healing.
Article by Bruce Stark
Touch is an essential part of our work as hands-on practitioners. Research continues to show that touch is necessary for our sense of vitality and well being. Yet from the perspective of Somatics touch is only one component of the therapeutic dynamic between the massage therapist and the client. The experience of “contact” is equally important to facilitating healing and structural change.
Through touch we become aware of our physical boundaries – what happens at the level of the skin. “Contact” moves beyond the boundary of the skin. It is the experience of everything outside of and within that boundary. Contact invites our clients to be present, thereby enabling them to access more physical and emotional resources to respond to the daily stresses and events of their lives.
Many Somatic practitioners have looked at ways to understand how the differentiation between touch and contact affects our work with clients. Gerda Alexander (1908-1994), a dancer and movement therapist who developed a form of bodywork in the 1950’s called Eutony – eu meaning good or well, and tonus meaning tension – found that by interacting with the motor and autonomic nervous systems she could help individuals become more self aware and experience themselves as a unified whole. Using touch and movement with presence and awareness clients felt “contacted” thereby able to change postural and structural imbalances in addition to increasing their emotional responsiveness.
The body’s receptor systems are highly sensitive and responsive to touch, but what is equally important is how the body perceives the quality and sensitivity of the touch it experiences. When we touch without a sense of receptivity the client can experience it as mechanistic, superficial or invasive, regardless of whether the touch is firm or gentle, or the type of techniques we are using at the time.
By contrast, contacting our clients requires that we as massage therapists become sensitive to what is happening both within the tissues and structures of our clients as well as what is happening externally in the relational dynamic between our clients and us. Instead of just noticing a tight or relaxed muscle we can differentiate it further. Is it rigid or is it flaccid (lifeless, non-responsive, “dry”)? Does it resist movement or is there some spring or “give” in the tissue? Does it feel solid or vitally relaxed (buoyant, enlivened, flexible)?
At first these distinctions may seem subtle to us, but with practice they become more obvious and dynamic. As we pay attention on this receptive and observational level our clients’ sensory nervous systems are stimulated and become more responsive. Contact then becomes a type of “conversation” between us – as we notice more going on within our clients they have the experience of noticing more within themselves. We create a physical and energetic space which facilitates self awareness and self reorganisation. We support our clients’ ability to access their bodies’ inherent wisdom to choose structurally efficient patterns thereby making our work with them deeper, more effective and truly profound.
In combination, touch and contact are our primary tools for helping our clients – whether for specific injuries or imbalances or for a general sense of relaxation and well being. The more we explore the experiences of boundaries (touch) and the movement in relationship to these boundaries (contact) with our clients and within ourselves as practitioners the more resourced our clients will become and the more effective we will be as massage therapists.
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