Four Seasons, Two Wheels, One Great Massage

When I first bought the bakfiets, a.k.a. the cargo bike, I thought I would get five, maybe six months of the year out of it for massage transportation. But this week—after riding through a minor snowstorm to get to the Dutch Bike store (http://www.dutchbikeco.com/), some seven miles from my home—I had studded tires put on the bakfiets. And now, I’m a two-wheeling massage therapist for all seasons.

No one is more surprised about this than I am. When I left my tomboy childhood, I also left behind any semblance of daring. The thought of riding a bike on snowy, icy streets has always horrified me. What if I slipped on the ice and fell into traffic? This is not the kind of attitude that has gotten Mount Everest climbed or Antartica discovered, that has sent snowboarders hurtling over cliffs or motorcycles sailing across ravines. Of course, I’m not trying to conquer great forces of nature—just Elston Avenue. And now, when I need an intact body to earn my living, risking life and limb for fresh air and a greener form of transportation seemed downright foolhardy.

But then some sort of weird confluence occurred where it seemed like everyone I knew was talking about studded tires for bikes. Okay, so it was Alex at Roscoe Village Bikes (http://www.roscoevillagebikes.com/) and Vince at Dutch Bike. But they were very convincing. And Vince said the bakfiets was great in snow. Because of its weight, it could just plow right through. And then I was thinking about how much I enjoy riding the bakfiets and how much I was missing riding my bike, and the next thing I knew, I was trundling through snow clogged streets to get studded tires. Several guys on road bikes zipped by me, as though the snow was hardly an inconvenience for their skinny tires, but I hardly gave them a thought, amazed as I was that I—scaredy cat me—was riding a bike through the slushy, slippery streets. New flakes pelted my face and eyes, making the trip even slower going, but speed was not the point of this excursion anyway.

Today, I go pick up the bakfiets, with its new studded tires. With these tires and with my new goggles—those flakes felt like little darts zinging my eyes—I am hoping I will become even more intrepid. There may be days yet when the weather interferes with my bringing massage to clients by bike. But there will be far fewer of those than I ever imagined.

No Offense but That’s Offensive; or, What’s in a Name?

A massage therapist by any other name . . . might be a prostitute. Although technically “masseuse” and “masseur” are legitimate terms for a person who provides massages—albeit dated in their gender-specificity (“masseuse” being female and “masseur” being male)—“masseuse,” in particular, has come to be associated with not-so-legal practices.

When massage was first “imported” to the United States from Europe by two American brothers, physicians who had studied in Sweden, it was not a regulated profession. Therefore, the French terms for someone who practiced the “friction of kneading” could legitimately be applied to anyone who offered massage. And from the 1850s, when the Doctors Taylor introduced massage to address their clients’ health issues, until mid-twentieth century, massage therapy was viewed as a valid medical practice in the United States. It was even used to treat World War I soldiers suffering from shell shock (what today we’d probably call posttraumatic stress disorder). But as medical advancements were made, massage—along with other natural healing methods—fell out of favor. At that juncture, massage became a luxury that only the wealthy indulged in. This contributed to one view of massage, still held by many, that massage is a form of pampering.

The other persistent image of massage originates with the advent of so-called massage parlors, which had become a cover for illegal sex trade. This connection began, actually, with public baths during the Roman Empire. According to Noah Robert Calvert, author of The History of Massage, “Massage was an established part of the ancient public baths, and it was part of the growing historic relationship between bathing and prostitution as well.” In the early part of the twentieth-century, however, cities started clamping down on prostitution, notably with the passage of the Mann Act in 1910. Technically, the Mann Act targeted forced prostitution in response to the “white slavery crisis” that had been engendered by the sensationalized stories of muckraking journalists about innocent girls kidnapped off the streets by swarthy foreigners. The Mann Act, however, was so broadly worded that courts often used it to prosecute all manner of consensual sex. Individual states also passed antiprostitution laws. With this crackdown, bathhouses and other places where prostitutes were known to practice their trade were under scrutiny by authorities, and thus massage parlors were created as legal fronts for the protection of prostitution.

Because prostitution became so firmly associated with massage parlors and because those working at these parlors were termed “masseuses,” the negative connotation of that term became fairly firmly entrenched in the public imagination in this country. Around 2007, in fact, when I was in massage therapy school, I would still get snickering questions about “happy endings.” One reason this connection has been able to persist is that while prostitution was regulated and/or closely monitored in most states, massage was not. In fact, even a late as 1985, only ten states had passed laws regulating massage statewide. It was therefore relatively easy for those with less-than-altruistic intent to set up a massage business that had very little to do with addressing health issues. Consequently—because of the impropriety enduringly suggested by “masseuse”—just as most of us would no longer use the word “cripple” to describe someone who, owing to a disability, is unable to walk or move properly (even though that’s exactly what the word means) because it is now seen as offensive, so the use of the word “masseuse” (and, consequently, “masseur”) should be avoided.

It isn’t only the long-standing link between “masseuse” and “prostitute” that makes using this term problematic, either. As I alluded at the start, there is the issue of gender specificity, something that is generally avoided in this day and age—much as terms such as “policeman,” “stewardess,” “male nurse,” and “comedienne” have fallen out of favor. No doubt some would chalk this up to political correctness, but the real point is that professionals should be judged by how well they do their job and not by their gender. We don’t refer to our physicians as “doctors” and “doctoresses” because anyone with an ounce of intelligence knows that what really matters is how knowledgeable and skillful that physician is and not what his or her anatomy might be. (Well, that and the fact that “doctoress” is not an actual word!) Along these same lines, I’m not particularly concerned with the comeliness of my doctor or any other health care provider, for that matter. Just the other day, however, on a morning run through my neighborhood, I spotted Pretty Girls Massage Spa. Attractiveness is not the feature by which a massage therapist should be selected. Rather, what counts most is whether he or she is an educated practitioner who knows how to apply their knowledge in the skillful easing of muscle aches. I suppose it’s possible that the name means to imply it is a massage spa for pretty girls rather than one staffed by pretty girls, but frankly that doesn’t make me feel much better! And need I mention that it is entirely possible that “massage” might be at least partially beside the point?

In addition to concerns about illicit sexual associations with the word “masseuse” and its gender specificity, there is the fact that “masseuse” can rightfully be applied to any woman who does massage, with no training inherently implied. The term “massage therapist,” in contrast, not only connotes the therapeutic value of this treatment but also alludes to some measure of training for the person who goes by that title. Most states (43 out of 50 plus DC), in fact, now require purveyors of massage to be licensed, further ensuring that legitimate massage providers are properly educated. Sticklers for absolute accuracy might insist that massage therapists be identified as licensed massage therapists or certified massage therapists—terms that specifically reference the legitimacy and education bestowed on these professionals by their state or local governments and by their professional organization. Personally, though, I would be happy simply to be called a massage therapist since that acknowledges not only that I manipulate a client’s skin and muscle tissue but, more important, that I do so in a manner that draws on my study of anatomy, physiology, and kinesiology.

When someone refers to me as a “masseuse,” I don’t immediately assume that his or her intention is to denigrate me in some way but, rather, that he or she is unaware of the nuances of that word choice. Consequently, I don’t berate them for their word choice—although I do cringe a little inside. Ultimately, I would like to find a way tactfully to educate such people—in a way, that is, that will neither embarrass nor belittle. That’s the nurturing nontechnical side of the massage therapist in me.

How'd I Get That Pain? Part I, Head and Neck

If you’ve just run a marathon or spent time tossing your six-year-old into the air and catching him, you have a pretty good guess, afterward, as to why you have that pain. From time to time, however, you’ll find yourself with muscle pain that is a complete mystery to you. “I must have slept funny” is a common guess about the source of neck pain. And sometimes, that’s exactly what it is. But other times, there may be factors at work that could be avoided in the future. While it’s my job, as a massage therapist, to help you alleviate that pain, knowing whence it came can possibly save you from having that issue from making a return engagement.

Muscle	Location	Stressors of That Muscle
Sternocleidomastoid	Side of neck, toward front	Lying on side while reading; poor eyesight (leading with the eyes); prolonged automobile driving; too-tight collars and neckties; drooping shoulders; chronic cough; whiplash injuries; structural faults (short leg or small hemi-pelvis); overhead painting, carpentry, wallpapering; horseback riding; front-row movie seats; working for long-periods with head turned to one side (“word-processor headache”)
Semispinalis capitis	Along the ridge of the cervical and upper thoracic spine	Sustained neck flexion while reading, writing, playing, or working; whiplash or trauma resulting in postural imbalance; improper adjustment of prescription eyeglasses; lack of lumbar support when seated
Splenius cervicis	Back of the neck to upper part of the spine	Use of the dominant eye; cold air blowing on neck, such as reading under a drafty air conditioner or riding a motorcycle with head forward with a cold wind whipping around the edge of the helmet; bird watching through binoculars
Splenius capitis	Back of the neck	Cold air blowing on neck; whiplash injury; excessive hyperextension; painting a ceiling; computer use or other reasons for sitting with head held forward and turned to the side
Trapezius, upper	Along each side of cervical spine and into the top of the shoulder	Sitting with head protracted; writing at a desk that is too high; cold weather; cradling telephone between shoulder and ear; chronic anxiety (with raised shoulder response); carrying a should bag, luggage, or heavy purse
Suboccipitals	Below the skull under the other muscles at the back of the neck	Sustained upward gaze with head tilted up; sustained awkward head positions; maladjusted eyeglasses; use of bifocal or trifocal lenses; prolonged typing while reading copy from a flat surface; watching TV lying with chin propped on hands
Temporalis	Side of the head above the ear	Cold draft over the muscle; clenching and grinding of the teeth; excessive gum chewing; ill-fitting dentures
Masseter	Connecting upper and lower jaw	Tension, unresolved anger (clenching teeth); bruxism; pipe smoking, chewing gum; ill-fitting dentures; crushing ice or nuts with teeth; an uneven bite; Prozac and related anti-depressants such as Paxil specifically cause tightness in this muscle
Scalenes	Side of the neck	Coughing; carrying shoulder bags; upper chest breathing, asthma; reading in bed; whiplash
Levator scapula	From the top of the cervical spine to the top of the scapula	Looking sideways for long periods of time; cradling telephone between shoulder and ear; using crutches that are too long; tense or aggressive postures; falling asleep with head tilted backward or to one side

Lactic Acid Trip

Remember when the sun was good and wine was bad? If you’re like me, the constantly evolving research that alters our understanding of health and fitness can be daunting. The temptation is to believe what you want to believe because, eventually, research will come out to support that belief! Who would have thought, for instance, that there would be health benefits to eating dark chocolate? Well, besides chocoholics. But recent research has shown clearly that our old hackneyed beliefs about lactic acid—that it’s bad for you and must be removed from your muscles—is not only wrong, it’s really wrong. So what does lactic acid do?

As you probably know, increased levels of lactic acid in muscles have long been believed to play a role in muscle fatigue, cramping, and reduced performance. Such beliefs about lactic acid also led to the notion that if you reduce you exercise activity slowly—that is, cool down following a workout—you would give lactic acid a chance to leave your muscles. In fact, however, thirty years of research by George Brooks at the University of California at Berkeley have shown that lactic acid is one of the most important energy sources for high-intensity muscle activity. Before I get any further into discussion of this research, though, two other issues need sorting out.

First, “lactic acid” is a misnomer in any case. What the body actually produces is lactic acid minus one proton, or “lactate.” If “lactate” sounds like something a pregnant woman might do, that’s because, when the acid was first discovered by a Swedish chemist in 1789, he found it in some sour milk. Since “lactic” means “relating to milk,” Carl Whilhelm Steele named his newly discovered acid “lactic acid,” though in fact lactic acid is not confined to milk but can also be found in meat and blood. And again, it is not lactic acid that is produced in the body—it’s lactate. Lactate is the product of a side reaction to glycolysis, which is a process in which the energy stored in glucose is converted to a form the body can use.

The second issue I wanted to address is, if lactic acid (or lactate, as I’ll refer to it here on out) isn’t the culprit in muscle soreness, why have we all—including fitness professionals and educators—believed it was for all these many years? This prevailing understanding of the role of lactate came about because of incomplete observations of cell metabolism made by Nobel Prize–winning researchers Otto Meyerhoff and Archibald V. Hill in 1922. As noted exercise physiologist Robert A. Robergs puts it, the “research showed that lactic acid was produced during conditions of low oxygen content (hypoxia), and that muscle contraction also became impaired. This research led to the assumption that lactic acid production caused decreases in cellular and blood pH, which in turn caused the symptoms of muscle and body fatigue during intense exercise. This evidence was not cause-and-affect, but rather guilt by association [emphasis mine].” This incomplete description of acidosis—the low pH in body tissues and blood that arises when cells receive too little oxygen—then continued to appear in fitness and biochemistry textbooks, leading to our ongoing misconceptions about lactate and exercise.

That said, what actually does happen in the muscle during exercise? Without getting too technical, it has become clear that lactate production is not the cause of cellular acidosis but, rather, a consequence of it. But more than that, elevated levels of lactate—which occur when people exercise regularly and/or during high-intensity workouts—lead muscle cells to make adaptations that give them the ability to use lactate as an energy source rather than a mere waste product. It turns out that interval training, with its short bursts of intense activity, is particularly effective in causing spikes in lactate levels that increase the number of molecules in mitochondria that transport lactate. (The mitochondria, as you may recall from biology classes, is considered the “powerhouse” of the cells in your body because of its role in breaking down sugars into basic chemicals that the cell can then use for energy.)

So what does cause your muscles to be sore if not lactic acid? During high-energy exercise, our muscles use adenosine triphosphate, or ATP (a form of energy), which results in the release of hydrogen ions or protons that then accumulate and stimulate pain receptors. This is the “burn” we sometimes get during exercise. (In contrast, if you are doing low- or moderate-intensity exercise, you will seldom experience this burn because the protons are absorbed by other chemical reactions taking place.) This burning sensation generally disappears as soon as exercise is stopped or shortly thereafter. As for delayed onset muscle soreness, which generally occurs a day or two after a period of heavy exercise, it is partly caused by structural damage to muscle fibers, which causes an inflammatory response. This response factors into muscle soreness in two ways: (1) it produces a buildup of fluid (that is, swelling) that results in pressure being exerted on the muscle fibers and (2) the body’s defense system kicks in, producing white blood cells that “enter the muscle fibers and secrete chemicals that activate pain receptors,” according to fitness expert Deborah Riebe.

The short and sweet of all this? The production of lactate during exercise actually provides the muscles with fuel and is not the bad seed we always thought it was.

If you’d like more detail on the science of all of this, here are some websites you can check out:

o http://www.unm.edu/~lkravitz/Article%20folder/lactate.html

o http://running.competitor.com/2010/01/training/the-lactic-acid-myths_7938

o http://findarticles.com/p/articles/mi_m0675/is_2_17/ai_54286949/

Lights! Camera! Massage!

As you might imagine, going from being an in-house manuscript editor for the University of Chicago Press to becoming a massage therapist involves quite a number of changes. One of the toughest adjustments for me, though, has been to promote myself to potential clients. At the Press, someone put work on my desk, I did it, and then I got more. But since no one is depositing clients on my doorstep, it’s up to me to find them. No one likes a pushy massage therapist—it’s anathema to our image of the nurturing, mellow, healing soul that is the massage therapist. But it’s also a fact of business that if no one knows you exist, no one can take advantage of your services.

I am, therefore, always on the lookout for creative ways to bring myself—or, more to the point, my special therapeutic abilities—to the public’s attention. In the growing field of massage therapy, which is becoming increasingly accepted as a therapy, it’s not always easy to stand out from the crowd. But when I decided to start using the bakfiets, or Dutch cargo bike, to deliver my services to clients, table and all, I knew I was doing something that set me apart and would give me the opportunity to show clients what really matters: my skill as a therapist.

After sending out a dozen or more press releases to local media, I was contacted by the Chicago TV show 190 North for inclusion in a segment they were doing on “bring-it-to-me services.” The host of the show, Janet Davies, had recently done an interview with my friend, the photographer Barbara Karant, about her book Small Dog, Big Dog for the 4 o’clock news on WLS TV (http://karantcanines.com/blog/?p=22). Barbara warned me that they were relatively low budget in that I’d be responsible for my own hair and makeup. This is not good news for someone who goes for what we’ll kindly call the natural look. Barbara strongly advised that I find someone to do makeup for me in order to avoid looking washed out on camera.

Having a shortage of cosmetology friends in my life, I decided to contact the Aveda Institute to see if someone there could do makeup for me. When I called for an appointment, the receptionist made a point of telling me they were low on their “seasonal colors” and suggested that if I had any makeup to which I was partial I bring it along. This compelled me to admit that I have no makeup: the last time I wore makeup was probably my sister’s wedding—some three decades ago! Aveda did a nice job of creating a very natural look, but despite their assurances that I would not sweat away the makeup during the two-mile bike ride—with massage table on board, of course—to where the 190 North segment would be shot, I’m not sure how much lip gloss and blush made it there with me.

The filming itself was a lesson in self-consciousness, which I actually already have a lot of experience in—feeling self-conscious, that is: I have very little experience being filmed. First, they had me ride around the corner and down the street on my bakfiets, all of which they filmed. They had given me the instruction not to look at the camera, which made me develop a sort of amnesia in which it was as though I had never ridden down a street where there was not a camera filming me! Where was I supposed to look, if not at the camera? I looked at the houses across the street, up into the trees, at the road underneath my wheels.

That extremely taxing activity completed, they next filmed me pushing my bike up the curb, parking it, taking off my helmet, unloading my massage table, carrying everything up the stairs, and setting everything up. I couldn’t imagine they would use much, if any, of that footage, riveting though it was to see me perform these mundane tasks.

The table now set up in Janet Davies’s living room—for it turns out we would be shooting in her home and I would be demonstrating my massage skills on the hostess herself—Ms. Davies proceeded to interview me while I perched on the edge of the blue-flowered sheets I’d put on the table. I wasn’t nervous about the interview because I knew all the answers to her questions, since they were about me, and I wasn’t worried about putting myself in jeopardy with the law as, say, a suspect to a crime might be. Perhaps I ought to have worried a little more than I did, though, since natural doesn’t always equal appealing. However, the only portion of the interview that actually made it to the air was my answer to a single question that highlighted my strong suit without making me seem totally self-aggrandizing, since I was quoting from my clients.

The interview was followed by the main attraction: a massage. But the massage was anything but typical. To begin with—and this may surprise you—I’m not usually under bright lights being filmed while I work. Ignoring that aberration, though, there was also the fact that Ms. Davies was nearly fully clothed under the sheet, allowing me access to about 4 or 5 inches of her back—which was akin to a pilot having a short runway for take off. My gliding strokes, consequently, were truncated, so I moved rather quickly from warm up to demonstrating my trigger point work. Finding trigger points, or knots, and releasing them is essentially my calling card, so showing off that part of my massage made some sense. But I’m pretty sure on camera it looks like I’m merely using Ms. Davies for a leaning post since the camera can’t capture either the knot or its release. Like a host of a cooking show, however, I will need to trust that viewers will be able to imagine how delicious the outcome is.

After some compressions, muscle stripping, and myofascial release work on her arms, I got to spend a short amount of time massaging her neck before the producer announced it was time for Ms. Davies to do the lead-in for the next segment of the show, which would be filmed elsewhere. First they tried a camera angle over her head as it lied cradled in my hands. (“Don’t just hold her head—do some massaging,” the producer directed. “I’m doing tractioning,” I objected, but that, of course, is about as visually interesting as watching Jello set, so I complied with something more active.)

After moving the sheet up closer Ms. Davies’s neck, having her turn her head to the side, and another variation or two, the producer decided this camera angle just wasn’t working. So they had Ms. Davies turn over. The cameraman toyed with shooting through the face cradle, but that was a short-lived idea. I didn’t get to see what the shot looked like, but I can imagine her face looked rather squashed and pruney, viewed from that angle. Probably not the sort of view of their star they wanted the audience to take away from the episode.

Finally, they decided she should fold her arms in front of her with her head propped on them. By the time we got that far, I knew her line by heart and could have said it myself, but they suggested I continue to massage her while she spoke, so I inanely kneaded her shoulders while she delivered the line. Inanely, I say, because it was a rather poor representation of how I would actually conduct a massage—beginning with the fact that Ms. Davies, in that position was far from relaxed, especially given that her neck was crooked so she could look up at the camera. I found myself hoping that any massage therapists viewing this would understand that what they were seeing was not how I would have staged the massage. But I wasn’t the director of this production, only a bit player.

After we packed everything up—me, my table and oils; the crew, their cameras, sound and lighting equipment—we went outside to shoot the lead-in to my segment. Ms. Davies was going to say a line or two, and then I was to ride onto the scene, into the camera’s view. Now, having taken to heart their earlier exhortation not to engage with the camera, when I pulled up on the bakfiets, I simply stopped at the curb next to Ms. Davies. “You could smile!” the producer said. “And maybe reply to the question.” So we did another take in which I grinned my way to the curb and gave a hearty “sure thing” to the question, “Hey, Knot Whisperer, can I get a massage?” Though they felt that was a good take, they decided to do another “just in case,” but this time I didn’t brake early enough and bumped my way onto the curb. We all laughed, and they said they’d use the earlier take, but on later viewing they must have spotted something amiss with it because they ended up airing my ungainly bumping into the curb.

I hoped this faux pas, like the inane shoulder kneading, would be overlooked by viewers. But when the segment aired, a client’s eleven-year-old son said to me, “I saw you on 190 Nor-orth. Way to bump into curb.” And then he acted out my wheel banging into the curb before he dashed off to another room. Can’t put anything over on an eleven-year-old!

Though inquiries have been slow to come in, following the segment’s airing, I’m fairly certain it’s not because of my less-than-balletic bike riding. People will continue to see the 190 North segment online and I’m definitely on people’s radar: visits to my Knot Whisperer Facebook page were up more than 200 from the previous week. So now, when viewers do need a massage, the Knot Whisperer will ride again in their minds’ eyes and up to their doorsteps—which I will take care not to run into with the bakfiets!

If you’d like to see the finished product, you can find it at http://dig.abclocal.go.com/wls/podcast/101010190northvodcast.m4v. The Knot Whisperer starts her “star” turn at the 6:33 minute mark.

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.