Starring in the Role of Client: You

Getting a massage seems straightforward enough—you lie on a table and let a qualified therapist employ massage techniques to soothe your body—but a surprising number of people aren’t entirely sure what is expected of them during a massage. No doubt, differences exist depending on the therapist, the venue, the type of massage, and so on, but there are some general tips that would probably apply to many massage situations. Below are a number of things to keep in mind for your next massage, in order of importance—in terms of resulting a session that you will find effective and enjoyable—rather than in the chronological order of a given massage.

1. Undress to whatever level you feel comfortable. There is no right or wrong; you just want to do whatever is going to allow you to rest most easily. A few things to consider when deciding how much clothing to remove, however, are that (a) by Illinois state law and the training of any reputable therapist, you will be completely covered during the massage except for whatever isolated area is being worked; (b) if women leave their bras on, it is next to impossible for the therapist to do any long flowing strokes; (c) if shorts are worn, the therapist may be impeded from doing effective work in the glutes and/or hamstrings, for instance; and (d) absolutely none of this applies if you are getting a chair massage or a massage in an open space!
2. This is your time to relax! Try not to worry about anticipating what the therapist wants you to do—mostly, what the therapist wants you to do is let your muscles go slack. If the therapist needs your head or a limb to be in a different position, she will move it for you. There may be times when the therapist will want your assistance—for example, when it’s time to turn over—and at those times, she will explain what she needs you to do. Otherwise, just try to be. Forget about thinking, forget about moving: just feel. Of course, we are not all equally skilled at letting go, but that’s the goal.
3. Communicate. As with any good relationship, clear and honest communication is a key component. Before the massage, take time to speak with your therapist about what you are looking for in terms of outcome and about what you want your massage experience to be. In general, talking during the massage is not expected—and can actually detract from your being able to fully relax—but if the massage is not proceeding the way you had hoped or if anything gives you pain or otherwise makes you feel uncomfortable about the massage, let your therapist know. Massage therapists are knowledgeable about a variety of techniques, but each of us experiences them differently. Because everyone’s level of sensitivity is different and because our preferences are unique to each of us, it is difficult for the therapist to know what feels good and/or effective for you and what doesn’t—unless you tell him. This also applies to temperature: if you feel too warm or too cold during the massage, let your therapist know so he can take steps to make you better able to enjoy your massage.
4. Following the massage, ask the therapist for self-care tips if she doesn’t provide them. Are there stretches that would be helpful for relieving or preventing particular muscles issues? Are there things you can do at home to alleviate remaining muscle pain? What tools are effective for addressing recurring muscle pain?
5. While not required, a clean “work surface” is much appreciated by the therapist. It’s not always possible, of course, to arrive at your massage appointment sweat- and odor-free (I’m thinking, for instance, of Chicago’s notoriously hot and humid summers), but whatever efforts you make along those lines will be beneficial to the therapist and, therefore, ultimately to your massage.
6. If you have long hair, consider putting it up in some way that will keep it out of the way. Doing so not only keeps your hair from getting oily, but it also allows the therapist to focus on the work at hand rather than on repeatedly trying to move your hair aside.

In sum, your main responsibility as a client is to help make it possible for your therapist to give you the best massage of which she is capable. In the unlikely event that you find yourself in an unredeemingly unpleasant massage situation, remember that you always have the option to end a massage early if it seems you and the therapist are just not on the same wavelength. However, when you keep in mind the above points, you are giving both yourself and your therapist a fair chance at achieving a satisfying outcome.

The Heated Debate: Hot? Or Cold?

Among massage therapists, physical therapists, trainers, and medical professionals of all stripes, one of the most contested topics is whether sites of soreness or injury should be treated with heat or cold. It turns out that at least some of the divergence can be resolved based on what the cause of pain is and how long the area has been painful—although as the Merck Online Medical Manual points out, “Whether to use heat or cold therapy is often a personal choice.” Consequently, the decision of which to use may always be open to question.

The first thing to consider, though, is what each type of treatment does to tissue. According to the University of Chicago Medical Center, for instance, the application of heat brings more blood to the area, reduces joint stiffness and muscle spasm, and helps resolve inflammation. Merck adds to this the fact that heat makes connective tissue more flexible and reduces the buildup of fluid in tissues. Cold, in contrast, relieves pain by numbing the affected area, reduces swelling and inflammation, and reduces bleeding. Already you can see that the issue gets a little muddy in that both cold and heat help reduce inflammation.

So when do you use which? The August issue of the Mayo Clinic Health Letter advises cold first, to soothe inflamed muscles, and heat later, per Medical News Today. So if you have injured a muscle or ligament, having sustained a sprain, strain, or pull, the application of a cold pack or cold compress will act like a local anesthetic, numbing the area, thus relieving the pain. Cold will also slow the flow of blood to the area, which helps reduce bruising. Because of this reduction of blood flow, though, cold should not be applied to areas where the supply of blood is already compromised, such as where arteries are narrowed by peripheral arterial disease. Cryotherapy (treatment using cold) should also be avoided for areas with trigger points (tight bands or knots in a muscle) since chilling activates them owing to decreased circulation.

In contrast, heat therapy is in order once the pain and swelling of an injury have decreased or for chronic pain, such as when muscles are simply tight or sore but haven’t sustained an injury, per se, or for arthritis. The increased blood flow brought about by the application of heat helps soften the connective tissue. If you imagine connective tissue to be like taffy, think about how rigid and inflexible it becomes when cold versus how pliable it is when warm. Furthermore, since blood helps eliminate the chemical by-products produced during exercise that make muscles tight and compressed, the increase in its flow will aid in this elimination.

If all else fails, use your head. Not as a compress! But, rather, to think about this: you already know that cold makes your muscles stiff, right? So why would you treat stiff muscles with cold? Certainly cold will numb the pain of, say, a tight back or shoulder. But unless an area was just injured, the use of cryotherapy won’t promote the relaxing of the tissue to which it’s applied. So for stiff, chronically achy muscles, I recommend heat. That’s a “personal choice,” certainly, but it’s one I’ve come to after careful examination of research and based on logical extrapolation of the findings of that research.

Gimmicks, Gimcrackery, and Goodness

The most important consideration about a massage is whether it is good. But what constitutes a “good” massage? The short answer is that it does what you, the client, want/need. The longer answer requires answering in the affirmative to questions such as the following. Were the techniques, modalities, and level of pressure appropriate for what you hoped the massage would accomplish? Did you feel like the therapist had really listened to you and did what you’d asked? Did you feel better (more relaxed, experiencing less discomfort) not only immediately after the massage but in the day or two following? Did your therapist do everything she could to make you comfortable?

Beyond such considerations, there are a variety of extras that may enhance the massage for you, everything from the overall environment of the massage space to the kind of linens used. Such so-called extras can even be therapeutic in the hands of someone professionally trained to, for instance, use essential oils for aromatherapy. The trick is to distinguish between tools that are used with professionalism and knowledge and those that are mere gimcrackery—for instance, the application of tuning forks by someone not trained in sound therapy.

Gimmicks should also be viewed with caution. All too often, the word “gimmick” bears greatest resemblance to the part of its definition delineating it as “a concealed, usually devious aspect” of a deal—for instance, “massage” parlors that offer 24-hour service. But a gimmick doesn’t necessarily have to be a bellwether for something subpar. A gimmick that is “an ingenious or novel device, scheme, or stratagem” used to increase the genuine appeal of a service or product or that incidentally draws attention to something of real value doesn’t warrant the same sort of caution as its less respectable counterpart. In other words, a gimmick can also be an honest means to a good end.

For example, my recent venture of delivering massage to clients in their homes via bicycle could at first glance be construed as a gimmick. And in the sense that transporting a massage table via bicycle is a novel way to do so, it is, in fact, a gimmick. But the motivation for buying a Dutch WorkCycles bike so that I could haul a massage table was not to bring attention to my massage business—though doing so would without a doubt be a happy by-product. Further, it is the quality of my massage—not the fact that I ride a crazy-cool massage-table-carrying bicycle—that persuades people to schedule with me.

So if not primarily for the publicity, why have I embarked on this enterprise? In the main, I have done so because (1) I love bicycling, (2) I hated having to burn fossil fuels in order to go just a few miles to a client’s home, and (3) I work with a lot of athletes and so I feel using my own power to move about adds to my credibility with them. As it turns out, the bakfiets (pronounced bahk-feets and translated as “box bike”) is also incredibly fun to ride!

On the bakfiets, you sit much lower than on a “regular” bike, similar to someone riding a chopper. It is a position that makes me feel relaxed and incapable of hurry, as though I were piloting a ship. And though I’ve not carried as much as the 300-pound load limit, for the most part, I haven’t felt especially burdened by whatever I’ve carried in the box so far. (I’ve taken my five-year-old nephew for rides and used it to carry nearly a hundred pounds of groceries, as well as having transported my massage table.)

In addition to the physical pleasure of the ride, there is the added pleasure of reaping oodles of positive attention and admiration. The day after my partner Kathy and I purchased the bakfiets, I rode it about five miles to the Trader Joe’s grocery in Park Ridge, IL, with Kathy accompanying me on her own bicycle. Though I wasn’t aware of it, Kathy tells me I “turned a lot of heads.” I couldn’t help but notice, however, the things people called out as we passed by. “That is the best bike ever!” “Awesome bike!” “Where did you get that bike? Did you have it specially made?” “Did you build that bike yourself?” I even drew amused chuckles from an elderly woman waiting for her bus. At stoplights, I was engaged in lengthier conversations with nearby motorists. At Central Avenue and Northwest Highway, a Vietnamese man told me the bike reminded him of a kind of bike used in his homeland, and at Raven Avenue, a pale man with dreadlocks quizzed me about where to purchase such a vehicle. There were also questions about what I used the box to carry. The latter sort of question has mostly ceased since I mounted my banners on it, with my logo and the declaration “Pedaling massage to you,” but passersby are no less amazed by the vehicle itself or by its purpose.

When I first used the bike for its intended purpose, I received surprisingly little notice. First, it was near rush hour on a weekday, and not on the weekend as when I’d ridden it otherwise, and so people were more in hurry (hence the rush in “rush hour”!) and less inclined to stop and marvel. Second, I took more residential streets to get to my client’s home so there were simply fewer people out and about. When I arrived at my destination, though, the eleven-year-old boy who lives there was rendered nearly speechless by how “cool” my mode of transport was.

Since that first trip, and since affixing the banners, in addition to the comments about the bike itself, I’ve gotten many comments from strangers on the street and in parking lots about what a neat thing I’m doing and what a great way to advertise. The banners have even generated some networking. In the parking lot of the Trader Joe’s in Wrigleyville, a musician who composes music for massage and relaxation, Michael Strening Jr. (www.msj-music.com), approached me to pass along his business card and ask for mine. Now he’s spreading the word about me and I am buying his CD of piano compositions to use in my massages and to sell.

Even at this early stage of my latest endeavor, it’s clear that the “gimmick” of this strange cargo bike is generating a little buzz for me. And that’s nice. But in the end, what will really matter is whether I give the people what they want: a darn good massage.

Massage and Weight Loss

It may seem too good to be true that massage can help you with a weight-loss program. There are many ways, however, in which massage therapy will indeed support your exercise and weight-loss goals. Massage is unlikely to have a direct impact on weight loss, such as physically bursting fat capsules as some have claimed. This doesn’t mean, however, that the benefits are not real.

To begin with, massage will improve your flexibility by loosening tight muscles. Muscles that are therapeutically manipulated will experience an increase in blood flow, which helps lubricate muscle fibers that are sticking together. And an added benefit of loosening tight muscles is that you will be less stiff and sore, making it easier for you to stay on track as you work toward achieving your objectives. In short, because massage increases oxygenation of muscle tissue, it can shorten recovery times and prolong endurance.

Massage can also help reduce your risk of injury, especially as you increase your level of activity, putting greater stress on muscles that have been less active. By stretching and manipulating the connective tissue that enwraps all muscle tissue, massage can help reduce adhesions, or scar tissues, which are common with muscle injury.

Further, research has shown that massage will increase metabolic rate, thereby allowing your muscles to burn more calories. This improved metabolic rate is a result of the endorphins released during massage. Endorphins, as you probably know, make you feel better, too, and will help you remain motivated and active.

Another frequent factor in weight gain is the production of cortisol, a hormone that is released in response to stress and has been shown to increase appetite and cause fat to be deposited in the abdominal area. Exercise is the best way to reduce cortisol levels, but massage can reduce it as well by lessening your stress level.

Digestive health is another critical factor if you are going to achieve your target weight, since the digestive tract supplies your body with the fuel it needs for energy and eliminates waste products. Abdominal massage not only promotes digestion, it also reduces constipation, bloating, and flatulence, all of which are factors in belly size. Abdominal massage should therefore be given serious consideration if you are intent on decreasing your body size.

Finally, although losing weight and regular exercise are rewards in themselves—improving your health, your self-esteem, and so on—the results are not instant and it can be easy to feel discouraged. Therefore, if you are working hard, it’s important to find healthy ways to reward yourself regularly to maintain your motivation. Massage is an excellent way to do that because not only does it feel great but it can also be an important adjunct to any exercise and diet plan.

Exactly What Is a Knot in Your Muscle?

Clients often come to me with a “knot” in their back or their necks. And occasionally, one of them will ask me the question I’ve just posed above: “Exactly what is a knot?” I swear that they’re picturing a nice little half hitch or slipknot in their muscle fibers. But a knot, in this context, is less like something you learn in Boy Scouts, with loops and twists, and more like what you find in a piece of wood: a hard place.

In reality, a knot in the muscle occurs when a section of the muscle becomes constricted (or compressed). The scientific term for this state is a myofascial trigger point, with myo meaning muscle and fascial referring to the connective tissue surrounding the muscle. Knots can form when some event generates a reaction in which the muscle never relaxes, which leads to a muscle spasm. The spasm creates a sense of chronic tightness—a.k.a. “a knot.” The word spasm might seem to suggest a sudden series of muscle contractions and relaxations—a jumpiness in the muscle—but a spasm can also be a single prolonged involuntary muscle contraction, or abnormal tightness.

Muscle constriction can also occur as a result of small amounts of scar tissue developing through an injury or even just repetitive motion, from microscopic damage to muscle fibers. Scar tissue is an inflexible collagen fibrous material that, once created, can adhere to muscle fibers, preventing them from sliding back and forth over one another as they should, as well as to connective tissue, reducing muscle flexibility. Muscle fibers can also adhere to one another as a result of, for example, dehydration.

One of the reasons that massage is so effective at treating knots is that it helps loosen such adhesions, allowing the muscle fibers to slide over each other again, and it also helps reintegrate the scar tissue into the muscle, reducing its inelasticity and thereby restoring the muscle to a more flexible state.

In Defense of the Relaxation Massage

Given that I am a massage practitioner who thoroughly enjoys doing therapeutic work with clients—releasing “knotted” muscles, alleviating aches and pains, and so on—it is probably not surprising that a fairly high percentage of my clients come to me exclusively or nearly exclusively for therapeutic work. Some, I would venture to say, feel they can only justify coming in for a massage, in fact, when they are hurting.

There are other reasons, of course, for relegating massage sessions solely to times when pain relief is the goal, but one of those reasons should not be that relaxation (or Swedish) massage is just pampering and, therefore, a luxury expense. Because in its own way, Swedish massage can be just as therapeutic as deep tissue and trigger point massages.

Though definitely more gentle in its application, Swedish massage reduces anxiety levels, lowers blood pressure, reduces heart rate, increases range of motion, and improves mood. It also reduces the stress hormone cortisol, about which I’ve written previously.

If you are still thinking to yourself, “Well, that’s all nice, but I wouldn’t call any of that essential,” consider for a moment how heart rate affects both your athletic performance and your daily life. A lower resting heart rate keeps stress levels in check, improves heart health, and allows quicker recovery after strenuous exercise. In addition, the reduction in cortisol production is huge. Reduced stress levels have been shown to increase one’s sense of happiness, promote weight loss, protect against cancer, make your sleep sweeter, help you live a longer life, improve your memory, and, gosh darn it, just give you a better outlook on life! Now I’m not saying that if you get a regular relaxation massage, you’re not going to get cancer and you’re going to live to be 120. But anything you can do to reduce your stress level is bound to enhance the quality of your life.

Those of you who are athletes have probably heard that sports performance is 80 percent mental. If, in fact, “a lot of performance is psychological based,” as researcher Michael Tschakovsky and others say, then it stands to reason that “if you feel better, if you feel you’re in a better situation to do something, [massage] probably has the ability to affect performance.” Furthermore, if science is still at a bit of a loss to explain just how massage does work, at the same time, research hasn’t proven that massage in any way hinders performance and recovery. In short, there is no downside to getting a massage that will help you feel rejuvenated both physically and mentally.

Of course, not all relaxation massages are created equal. I have heard complaints about the light touch used some relaxation massages being “too tickly” or so feather light as to leave muscles relatively unchanged. Though even a very light massage, depending on the person’s needs and wants, can be psychologically and physically valuable, it is helpful to know that the basic strokes used in traditional Swedish massage—kneading, gliding, circular pressure, and so on—can be applied more firmly for those wanting something gentler than deep tissue or trigger point massage but also wanting to feel as though they’ve actually been massaged and not just brushed with butterfly wings.

So as they used to say in the sixties, if it feels good, do it. Let your Puritan ethic relax a little, set aside your no-pain, no-gain mentality, and get a massage for the pure enjoyment of it. (But feel free, if you must, to remind yourself of all the suspected and proven therapeutic benefits of a “nontherapeutic” relaxation massage!)

Circulating Rumors?

Virtually every document promoting massage contends that massage improves circulation. It’s what I was taught in massage school, it’s what I read in countless other sources—it’s what I put it in my private-practice brochure. An article that recently appeared in the New York Times, however, calls this claim into question, reporting that a study by Michael Tschakovsky published in the June issue of the journal Medicine and Science in Sports and Exercise found that not only did massage fail to increase blood flow to tired muscles—it actually decreased it.

Does this mean that I, and every other massage therapist, have been misleading our clients, albeit unintentionally? Yes and no. It depends, it would seem, on where and how that blood flow is measured. An earlier article, published in that same science journal (August 2004), determined that while massage did not increase blood flow to the femoral artery in the quadriceps it did increase blood flow to the skin. The latter effect is, in fact, easily verifiable with the naked eye: look at anyone’s skin after a vigorous massage, and you can see the redness brought on by the increased circulation of blood to the surface. So massage does increase circulation.

But—but—that same article concluded that any increase in blood flow to the skin “is potentially diverting flow away from recovering muscle. Such a response would question the efficacy of massage as an aid to recovery in postexercise settings.” That seems fairly clear, right? But yet another article published that same year, in Medical Science Monitor, concurred with the findings about increased blood flow to the skin but also detected increased blood flow to the muscle and a decrease in muscle fatigue, as subjectively evaluated by the experiment’s subjects.

So how is one to reconcile all of this conflicting information? And what does it mean for the efficacy of massage for relieving muscle soreness? To begin with, according to an article by Whitney Lowe, LMT, in Massage Today (September 2009), “rarely do these studies investigate circulation through small capillaries in muscle tissue and skin. Increases in small capillary blood flow bring fresh oxygenated blood to muscle tissue.” The study reported on in the New York Times, for instance, measured blood flow by “catheter inserted directly into the deep vein that drains the muscle”—that is, not in the capillaries. So perhaps there are, in fact, circulation benefits to massage as has been claimed.

In any case, massage provides other benefits that aid in the reduction of muscle soreness. A 2005 study in the Journal of Athletic Training, for instance, suggests that massage can help reduce delayed-onset muscle soreness (DOMS) and swelling associated with certain kinds of high-intensity exercise. Massage also clearly can release very tense muscles. I have felt this happen in my own work, with muscles that were once tight as piano wire becoming soft and pliable. In addition, recent studies indicate that massage may “improve the rate of healing in damaged tendons and reduce the symptoms of tendonitis.”

Scientists concur that there is much yet they don’t understand about how and why massage works and that more research is needed. And even as more data is released concerning the efficacy of massage, it will likely take time before the results of such findings are incorporated into the practice of massage. As Lowe notes, “A recent study investigating knowledge translation in medical practice noted that it takes about 20 years for advances in medical knowledge to be incorporated into clinical practice.” Plus, the sheer volume of work being published and the difficulty with understanding scientific jargon make this task even more formidable.

It may be that in the long run I and other massage therapists will find it prudent to strike “improves circulation” from the list of massage’s benefits. Or we may find that we can let that claim stand. But in the meantime, it bears keeping in mind that, as Tschakovsky stated when he presented his findings at a May sports medicine meeting, massage “feels good, that’s the truth of it. A lot of performance is psychological-based so if you feel better, if you feel you’re in a better situation to do something, it probably has the ability to affect performance.”