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Safety Protocols: The Carotid Artery

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By: David Kent, LMT, NCTMB

Regardless of your modality and whether you perform massage on an outcall basis, in a clinic or spa, or in another setting, it is always important to be aware of circumstances in which massage may not be beneficial for your client or when it might be necessary to take extra precautions during a session. For example, a client enters with cervical pain and limited range of motion, complaining of pain along the length of the sternocleidomastoid muscle, as well as temporal, frontal and orbital headache symptoms consistent with trigger points in that muscle. In this situation, treatment will likely consist of working very close to the carotid artery; therefore, it is extra important to understand the anatomy and the body’s physiological responses around this region, so that you can ensure your massage produces positive outcomes. In this article I will discuss two conditions that require taking extra precaution when working around the carotid artery: plaque build-up in the carotid artery and a condition called Carotid Sinus Hypersensitivity (CSH). Plaque Plaque is made up of fat, cholesterol, calcium, and other materials found in the blood. Over time, plaque hardens and subsequently clogs the arteries, which decreases blood flow through the arteries to the heart and the brain. This is called atherosclerosis. In my full-body dissection seminars, I always remove a portion of the carotid artery; then I cut and peel away the arterial wall to reveal a “tube” of plaque lining the artery. This tube looks like a crudely formed plastic straw that is thicker in some areas than others. When squeezed, the tube makes snapping and cracking noises similar to a piece of plastic braking. I demonstrate this for my students so that they understand why it’s important to administer precise palpation and avoid making contact with the carotid artery during a massage. Palpating an artery that has substantial plaque build-up could pose serious risks to the client. In a worst case scenario, a piece of plaque could break off inside the artery, travel to the brain and cause a stroke. Using appropriate intake forms can help you identify clients who are at risk for plaque build-up. Intake forms should inquire about previous surgeries, health conditions and prescription medications. Some procedures to look out for include carotid endarterectomy:  a surgical procedure for cleaning out the carotid artery and restoring blood flow to the brain. Other related procedures include coronary bypass, stinting or angioplasty. Blood clots are also related to plaque build-up, so look out for medications that include blood thinners and anticoagulants. When red flags come up, heed the warnings—even if a client says he/she has received massage previously. In cases such as these, I will not proceed without a prescription for massage therapy from the physician currently treating the client’s condition. This is a safeguard for everyone involved, and most patients will thank you for your concern and professionalism. If you do not understand something a client wrote on an intake form, make sure to look it up before you proceed. For example, some clients use acronyms to describe their conditions; however, it is important not to assume you know what an acronym stands for. CSH is one such acronym that has multiple meanings. The Carotid Sinus and Carotid Sinus Hypersensitivity (CSH) The carotid sinus plays a key role in regulating blood flow to the brain; it contains baroreceptors that are sensitive to changes in blood pressure. It is part of the internal carotid artery just after it emerges from the common carotid artery, located just above the superior border of the thyroid cartilage (Adam’s apple) at the level of C3; it is attached fascially to the sternocleidomastiod muscle.  SEE IMAGE Carotid Sinus Hypersensitivity (CSH) is an exaggerated response to carotid sinus baroreceptor stimulation. Massaging the carotid sinus stimulates nerve endings, which can cause the heart rate to slow. CSH is the most common reported cause of falls and syncope (fainting) in persons over 65 year of age. In a study of 1,000 people with no history of syncope, dizziness or falls, participants were given carotid massage for an average of 7.3 seconds, in a supine and upright position with beat-to-beat heart monitoring. The study showed that 39 percent of the participants had some form of carotid sinus sensitivity; 24 percent had asystole (absence of cardiac heartbeat) for three seconds or greater; and 16 percent had symptoms, including syncope with carotid sinus hypersensitivity. 1 In rare cases, only 1 percent experiences Spontaneous Carotid Sinus Syndrome: a situation in which the symptoms can be clearly attributed to a history of accidental mechanical manipulation of the carotid sinuses, for example, by taking a pulse in the neck or by shaving. 2 Therefore, it is necessary for massage therapists to be aware of the potential physiological effects when treating in this region. Providing Safe, Effective Massage There are several ways to ensure that you provide safe, effective massage therapy:

  • Use intake forms to screen clients for potential risks prior to performing therapy. Make sure that forms are updated on a regular basis, especially if you haven’t seen a client for several months.
  • Thoroughly review your client’s health history on a regular basis. Ask routinely if your client is under a doctor’s care.
  • Clarify the meaning of acronyms.
  • Look up the unknown before you proceed.
  • Make use of resources like the Internet, textbooks, medical books and medical dictionaries to look up information.
  • Educate your clients by using postural analysis photos and trigger-point charts to illustrate their problem areas.
  • Perform muscle tests to ensure that you working on the right muscle and to help avoid critical structures like the carotid artery and carotid sinus.
  • Integrate orthopedic assessments.
  • Continue to expand your knowledge by investing in DVD programs and other continuing-education programs that review the specifics, such as anatomy,  contraindications, precautions, trigger points, safe therapy techniques, etc.
  • Take live seminars to continually hone and refine your hands-on techniques and reinforce anatomy

Treating in the sternocleidomastoid region can be a safe and satisfying experience for the client as long as you take the necessary steps to ensure you are palpating properly and precisely. Always proceed with caution. To share your tips and experiences in the treatment room, please drop me a line at [email protected] And for more information about keeping it simple in your day-to-day practice, be sure to check out my other articles at www.massagetoday.com. David Kent, LMT, NCTMB David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600 for more information. 1Kerr SR, Brayne MS, et. al. Carotid sinus hypersensitivity in asymptomatic older persons: implications for diagnosis of syncope and falls. Arch Intern Med 2006; 166(5):515-20. Institute for Ageing and Health, University of Newcastle upon Tyne, England. www.medscape.com/medline/abstract/16534037. 2 Wijetunga MN, Schatz IJ. Carotid Sinus Hypersensitivity. www.emedicine.com/med/TOPIC299.htm. Click here to download a printable version for this article with photos.

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Questions with Direction – Practice Building Tips

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By David Kent, LMT, NCTMB

One of the most challenging aspects of being a massage therapist is trying to build a thriving practice with repeat clients. So, it’s no surprise that many therapists have felt the crunch with the recent downturn in the economy. And, unfortunately, services like massage therapy are often among the first things to be cut from one’s budget in times of economic crisis.

Therefore, it is now more important than ever to convince your clients to stay the course with their massage therapy sessions. This article will show you how asking some simple questions can ultimately lead to repeat clients, whether you work in a spa, outcall, seated- or clinical-massage setting. Soliciting a client’s feedback by way of asking thorough questions will better help you understand you client’s needs and deliver results. But even more important than asking the question, is listening and responding to the information your client provides.

One way to organize your questions is to make use of the wide-range of forms available for these purposes. In fact, your questions will, to a degree, be directed by the information you obtain using forms. I have my clients complete intake forms prior to therapy; these help me develop targeted questions to clarify my knowledge about their health history, their specific areas of pain, the stresses in their life, the ergonomics of their activities of daily living (ADLs), medications they are taking, and to identify any precautions or contraindications before the session begins. Using intake forms helps me develop goals for the client’s current and future sessions—which is also useful in persuading my clients to commit to ongoing treatment.

There are various types of questions; however, this article will focus on two primary categories: general and those related to a client’s pain. General questions are great for helping you understand your client’s expectations, no matter what kind of practice you have.

General questions:

  • Question: What are your goals for today’s session?

Reasoning: If you don’t ask this question, you won’t know if a client wants a relaxing Swedish massage or a vigorous sports massage that integrates stretching. This is also important so that you are responding to your client’s needs and not responding to your perception of your client’s needs.

  • Question: What areas you would like me to focus on today?

Reasoning: This question also relates to the question above. At one time or another, we’ve all probably had an experience with a therapist that seemingly ignored the very thing that brought us to therapy in the first place. When you ask this question, it is very important to listen closely to the answer. When you listen to the client and deliver results, it increases the odds that your client will reschedule and/or refer others.

  • Question: Have you received massage therapy before?

Reasoning: Regardless of the client’s answer, this is the ideal time to communicate to the client how you will perform the session. For new clients, you might advise the client to disrobe to his/her level of comfort and then discuss draping techniques. For veteran clients, you might ask if they’d like you to do something extra special, such as incorporate essential oils into the session.

  • Question: If you have received massage therapy previously, please tell me where you received it, by whom, and which treatments were the most beneficial?

Reasoning: This information can help you understand how to adapt the session to the types of massage therapy that have produced positive responses for the client in the past. You might also ask the client what he/she thinks makes a great massage—and then do what you can to meet the client’s expectation.

  • Question: What type of pressure do you prefer?

Reasoning: Keep in mind that levels of pressure are subjective for each client; what you perceive as light pressure and what the client perceives as light pressure could be entirely different. It is important that you check in with the client at the start of and during the session.

  • Question: Have you ever had any negative effects and/or experiences from receiving massage in the past?

Reasoning: People respond to massage in different ways. Some people get ill or are sore for several days after they receive a deep massage. This is where intake forms and questions can be very useful. Some questions might include what medications the client is on, if he/she bruises easily, what the client’s diet is like, as well as questions related to general health and exercise.

  • Question: Is there anything else that I should know?

Reasoning: I intentionally keep this question open-ended so that the client can add additional information at their discretion. It is up to me to connect the dots. I am frequently amazed by how many clients will tell me about a traumatic accident and/or major surgery in the past that they didn’t mention previously.

Questions about Pain:

 

  • Question: What other healthcare providers have you seen recently and for what?

Reasoning: This question immediately informs you if your client has seen a doctor or if the client has self-diagnosed. I can then quickly perform a postural analysis (See my article, “Getting Comfortable with Postural Analysis” in the July issue of MT), check range of motion, and perform relevant muscle tests and orthopedic assessments to determine if it is appropriate to proceed or if the client needs to first follow up with a physician.

  • Question: Have you tried different healthcare practitioners over time? If so, which one(s) provided the most relief? What did they do and how long did the results last?

Reasoning: Understanding more about the treatments a client has sought for pain relief will give you insight into how you can best help him/her. For example, if the client sees a chiropractor on a regular basis, you might suggest that he/she schedule an appointment with you immediately before the appointment with a chiropractor for maximum results.

  • Question: What do you do for pain relief?

Reasoning: I am always surprised by how many people buy topical pain relievers at a drug store. Why should the drug store get the money? Consider selling topical ointments in your practice. Integrate a topical into the therapy session and then send the client home with a sample. The next time the client buys a topical ointment, it might just be from you.

  • Question: What aggravates your condition?

Reasoning: If the client reports increased back pain when standing or straightening after bending down, it might indicate lumbar and hip flexor or extensor involvement. A muscle-movement chart can help you determine exactly which muscles to assess. Trigger point charts are useful for educating clients about referred pain. Additionally, using the postural analysis information combined with photos helps show the client how stressed or shortened muscles have contributed to the formation of trigger points. This further leads into a discussion of how a series of treatments can be beneficial.

Asking the right questions can help your practice tremendously. I am looking forward to learning how the questions in this article worked for you. I encourage you to read my other articles that can help during these challenging economic times.

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Muscle Movement Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealth.com or call (888) 574-5600 for more information.

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First Aid Tips For Your Patients – Practice Building Tips

A simple acronym that reminds you how to treat injuries.

By David Kent, LMT, NCTMB

By David Kent, LMT, NCTMB

As a practicing massage therapist, I’m exposed to a variety of clients every day, some of whom suffer from debilitating pain brought on by soft-tissue injury. Sometimes, clients wait weeks, even months, to see me after sustaining a soft-tissue injury because they think that the pain will go away by itself; however, more often than not, by the time they do finally see me for treatment, the pain has progressed to the point that it has impeded on their daily activities.

Depending on the extent of one’s soft-tissue injury, there are steps that can be taken at the time of injury to minimize damage, reduce pain, and help aid in the healing process until the client can make it in for treatment. This article will discuss self-care first aid tips that your clients can apply when they sustain a soft-tissue injury.

Emergencies don’t occur every day, but when they do, there are simple and swift actions that can help improve the odds of a speedy recovery. There is no question that your clients will need this information at some point for either themselves or to help a friend; however, the question is: When they need the information, will they remember what to do?

The answer is yes, and it starts with the acronym R.I.C.E:

  • R – Rest the injured region or limb. Pain is the body’s way of signaling that something is wrong and needs attention. Rest will prevent further injury by not using the affected muscle(s) or joint(s).
  • I – Ice the area as soon as possible after the injury. Cold packs or ice baths will limit swelling. When using ice, be careful not to use it for too long, as this could cause tissue damage.
  • C – Compress the area with an elastic wrap or bandage to reduce swelling.
  • E – Elevate the injured body part. Elevation works with gravity to help reduce swelling by allowing fluid and blood to drain toward the heart.

However, our clients will only remember the acronym R.I.C.E. and its significance if we, as massage therapists, put into practice another acronym: R.E.S.T.

  • R – Repetition is necessary if we are to teach our clients about the importance of self-care.  Most people need to see and hear the information, as well as perform the task, numerous times before it becomes routine. During my sessions, I ensure that my clients have all the information they need via handouts, books, Web sites, and anything else that I think will be helpful. During follow-up phone calls to the client, I review the actions that I would like them to take to expedite and maintain their recovery.
  • E – Education and training are the keys to preventing and treating soft-tissue injuries.   Most clients will take appropriate action once they know what to do, when to do it, how to do it and why they are doing it. Whenever possible, I teach using as many senses as possible, including visual, auditory, kinesthetic, olfactory and gustatory. For example, when I teach a client how to use ice, instead of just talking about it, I demonstrate how to do it so that the client can feel and see the process. Then I allow the client to ask questions as they do it to themselves so they are confident with the process.
  • S – Stretching is another useful aid. (Raising your arms and yawning after getting out of bed in the morning doesn’t count!) When it comes to stretching, it is very important to describe the reasons why it is important, most notably, for injury prevention. Create a stretching routine for each of your clients depending on his or her physical condition and abilities; then demonstrate how to perform each stretch. Taking photographs while the patient stands in front of a postural analysis chart is very useful to show clients distortions in their body. This helps clients understand the stresses being placed on their joints and soft tissues.
  • T – Topicals can help by creating a cutaneous (skin) distraction, which reduces pain intensity and helps the muscles relax during stretching. I hand out trial samples to my clients for their use, and I use topicals to promote my clinic by asking my clients to give samples to friends, family and coworkers. Topicals like BioFreeze and other devices, such as the TheraBand, can also produce additional income for you if you choose to sell them in your clinic.

The educational process empowers clients on many levels. It also elevates your reputation as a highly knowledgeable massage therapist. These self-care skills are practical and will help clients who have sustained a soft-tissue injury get some instant relief from their pain. Thanks to your first aid tips, your clients will know how to help themselves and others when soft-tissue injuries arise, and they will sing high praises about the therapist who taught them.

Got some great first aid tips? Are you selling a fantastic product in your clinic? Drop me a line and share your tips!

David Kent, LMT, NCTMB

David Kent, LMT, NCTMB, is an international presenter, product innovator and writer. His clinic, Muscular Pain Relief Center, is in Deltona, Florida, where he receives referrals from various healthcare providers. David teaches Human Dissection, Deep Tissue Medical Massage and Practice Building seminars, and has developed a line of products, including the Postural Analysis Grid Chart™, Trigger Point Charts, Personalized Essential Office Forms™, and DVD programs. Visit www.KentHealtht.com or call (888) 574-5600 for more information.

David Kent – Massage Today: First Aid (08/2008)

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Taking Action to Improve Your Massage Practice

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BY: David Kent, LMT, NCTMB

In my May column, I talked about how to empower your clients using simple communication skills. It doesn’t matter whether you work in a clinic, a spa, or as an outcall massage therapist; chances are, you have encountered one or more clients who experience feelings of hopelessness and depression because of their physical pain. Keeping an open dialogue and educating your clients about their bodies, as well as maintaining a positive attitude in the treatment room, is as essential to a client’s well-being as the bodywork itself. Sometimes, however, this is easier said than done—especially when you are in the midst of your own challenges.

As massage therapists, we are often so focused on helping our clients that we neglect our own professional, financial, personal and spiritual lives. So how does one go about creating balance in all of these areas? In this article, I will walk you through five steps that can help you balance and produce positive changes in any area of your life.

If you’ve listened to the news in the last couple of months, chances are you’ve heard the buzz about the economy. Prices for basic goods, services and gas continue to rise, and many of the experts are predicting some tough times ahead. Obviously, some things—like the economy—are outside of our control. And it’s not healthy to expend large amounts of energy over the things that we can’t control. Rather, what we need to do is to focus our efforts on those things in our immediate lives that we can control; then evaluate the challenges and take steps to overcome them.

In addition to running a massage practice, we all perform various juggling acts. I am on the road several weeks a year teaching seminars, as well as running a clinic and continually working to develop new and improve existing products. This doesn’t take into account trying to maintain a social life and my relationships with friends and family. Perhaps you are dealing with similar issues: running a massage practice, trying to devote more time to yourself and your family, and a host of other personal and professional obligations. So, here is rule number one: It’s easier to deal with the stresses of life when you are flexible. There is no doubt that challenges will be constantly thrown your way. Maintaining flexibility and a willingness to adjust your plans will make dealing with these challenges much easier. You can start with the following five steps.

Five Steps to Positive Change

1. Acknowledge that something is out of balance and needs your attention. No one ever improved a situation by looking the other way. No matter how painful, scary or unpleasant the circumstances, it is generally best to face it squarely. 

 

Professional Challenges. Are you worried about increasing volume or just maintaining your massage practice in this unsettling economy? Try one or more of the following:

  • Visit businesses, gyms, and other health care professionals in your area to establish new referral sources.
  • Offer discounts and incentives for regular and repeat clients.
  • Educate your clients so that they will continue therapy and refer friends, coworkers and family.
  • Learn new treatment techniques so that you can specialize in a particular area of bodywork.
  • Sell products to generate additional income.
  • Check out my article, “Building Raving Fans,” in the April issue of Massage Today for a host of additional practice-building tips.

Financial Challenges. Are you making a decent living or barely making enough money to get by? Hire a financial planner who specializes in small business money management. A financial planner can help you create a reasonable budget that you can stick to; help you plan for retirement and unexpected financial emergencies; and help you get organized so that you can see the bigger financial picture down the line. Can’t afford to pay a financial planner? Consider trading services with one. Or check out your local bookstore—there are plenty of great books that specialize in financial planning and small businesses.

Personal and Spiritual Challenges. You won’t be much good to your clients unless you are taking care of your mental and physical health. Exercise, eat healthier, and take time out to recharge your brain and do the things you enjoy.

2. Ask empowering questions that include a specific positive outcome. Ask yourself what you can do right now to immediately improve your situation.
Professional Challenges. Empowering questions would include:

  • Are there mentors or other professionals that I can turn to for advice?
  • Are there sources of information online or elsewhere where you I can learn more about how to handle this problem?
  • Should I take some educational seminars?

Financial Challenges. Empowering questions would include:

  • Do I have a functional accounting system?
  • Do I understand the finances of my business? If not, you may need specialized computer software or other practice-management options, such as customized business forms.
  • Should I take a financial class or tutorial?
  • Should I update my business tools? Perhaps you own charts and tools, but they are outdated. For the price of one or two treatments, you could pay for updated materials that increase your volume. That’s an investment in your business (and a tax write-off).

 

Personal and Spiritual Challenges. Empowering questions would include:

  • What do I need to do to stay personally and spiritually balanced?
  • What physical activities do I enjoy doing that work with my schedule?
  • What can I do for myself that has a positive influence on all the areas of my life?

3. Implement change by taking action. The empowering questions you asked in step two will help determine the actions you need to take. There is a saying that goes, “The journey of a thousand miles begins with the first step.” The key is to start and then constantly move in the direction of the outcome. Don’t get frustrated if things don’t happen right away. Most things take time to come to fruition—and patience is a virtue.

4. Assess and modify your plan to achieve your outcome. This is where flexibility comes into play. Always prepare for unexpected challenges and try not to get overwhelmed when things don’t go exactly right. Instead, ask yourself, “What did I learn today?” When you hit a wall, start at step one above, and repeat the cycle. Realize that there will be occasional bumps in the road. For more about achieving your desired outcomes, check out my article, “The Power of the List,” in the January 2007 issue of Massage Today.

5. Maintain a positive outlook. It is important to see the silver lining with everything we do. Most people will never completely understand the challenges we face as massages therapists, but you chose this profession because you wanted to help people. No matter what challenges you are facing, there is always a light at the end of the tunnel. Stay positive. Take the lemons in your very capable hands, and make lemonade.

Join me again next month for more valuable information, until then stay focused, be positive and enjoy the process.

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Simple Answer, Positive Results

Finding the source of your clients’ pain

By David Kent, LMT, NCTMB

Addressing the pain and discomfort associated with trigger points is one of the most common complaints massage therapists deal with in the treatment room. It’s not uncommon, for example, to palpate a trigger point in the upper trapezius, sternocleidomastoid or suboccipital muscles that produces a referred phenomenon to a completely different area of the body, such as the head. When trigger points refer into the head the phenomenon is often described as pain, a headache, pressure, tingling and/or numbness. Although clients are often surprised at this phenomenon, most are thrilled when I am able to isolate and treat the trigger point. Occasionally, however, a client might show distress at this discovery and say something like, “I’m all screwed up,” “I’m wired wrong‚” or “I’m weird.” In this article, I will share simple solutions for addressing these types of comments in ways that will help empower your clients to have a positive attitude and take a more proactive approach to their health care.

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David Kent – Massage Today: Simple Answers Create Results (05/08)

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Building Raving Fans: Practice Building Tips

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By David Kent, LMT, NCTMB

In my March article, “The 80/20 Rule: Maximizing the Return on Your Investment,” I talked about how to use the 80/20 rule to produce a better return on your investment of time and money in  your clinical, chair, outcall, or spa massage practice. I discussed focusing 80 percent of your efforts on the 20 percent of the tasks that matter most, and I stressed the importance of thanking your clients for their business. I also touched on the importance saying thank you to those professionals and others who refer new business. This month, I’d like to expand on this idea with a few simple “20-percent actions” that will set you apart from your competition and help you build “raving” fans.

Saying “thank you” to someone for referring a new client isn’t just the polite thing to do—it’s a means of maintaining relationships and building new business. When was the last time you got a “Thank You” from your health care provider or from a patient that you referred to another health care provider? It doesn’t take much to say thank you; yet, simply acknowledging someone’s efforts on your behalf can go a long way.

Get clients involved. When new clients are checking out, I hand them a blank note card and ask them to write a simple thank-you note to the person that referred them. The message is quite simple: “Dear ____, Thank you for referring me to David Kent’s Muscular Pain Relief Center. Today I received my first treatment and I already feel much better! Sincerely, ___.” This simple action only takes a few minutes, and most clients will be more than happy to write a thank-you note, especially when they have just received a treatment that has relieved their pain. This simple gesture makes everyone involved feel good and strengthens the relationships. Make it easy on the client: Provide the envelope and the stamp, and mail it for them.

Send personal thank-you cards to first-time referral sources. It’s not just up to your client to thank the referral source, especially if you want that source to continue sending clients your way. Create or buy some massage-specific thank-you cards, and send them every time you receive a referral from a new source. Make sure that you personally sign the card, too. I sign every thank-you card to new clients, referral sources, and people that have inquired about or ordered my products.

Make a statement. While it’s probably not necessary to send a thank-you card every time you receive a referral from the same source, you should make a point of consistently acknowledging that person’s contribution to your practice. Do special things throughout the year for your referral sources—not just on holidays or special events. They will appreciate and rewarded your actions with more referrals. I stand out by thanking my referral sources in unique and personal ways. Some ideas include

  • Offering chair massage for everyone at the referral source’s office or business;
  • Dropping off a basket of healthy snacks, fruit, nuts and bottled water (with several business cards attached, of course);
  • Offering discounts for sessions;
  • Giving away samples of topical analgesic and lotions; and

A word about samples. Everyone loves free stuff, and free samples are an easy way to build raving fans while producing extra income. I use certain topical applications on my clients during treatment; then I show clients’ how to apply them for self-care between sessions. I explain how these topical aids can work in conjunction with stretching, rest, ice and exercise. I also make the analgesics available for purchase at the clinic. Clients often ask for samples to pass out to family, friends and coworkers, many of whom later become my clients. One large company offers two samples with your name and telephone number printed on a product brochure. They’ll even ship it to you for free.

Office visits, distance and timing. To maintain my relationships with the referral sources in my area, I make occasional personal visits. Some of my referral sources have relocated over the years, but they still refer clients to me from time to time. A doctor who was once very close to my office is now almost an hour away. But I still take the time, on occasion, to drive out to see him. Just because a referral source has moved away doesn’t mean he or she will stop referring. Remember, the world is still a small place!

 

While making personal visits is a good method of maintaining your relationships, it’s also important to time your visits with discretion. Some referral sources may work odd shifts or weekends, such as a walk-in clinic. I work those visits into the different 20-percent parts of each day during the week. My sources often appreciate that I took the time to stop in and say thank you.

Personalize your visits. Each meeting is an opportunity to strengthen your professional relationship. If, for example, I am stopping in to a doctor’s office, I will take some time to learn about the doctors, nurses and staff members so that I can personalize my visit. During one visit, I learned that a doctor only ate organic food. On my next visit, I brought in some organic fruit and snacks. He appreciated that I took the effort learn about his eating habits and then responded with a customized gift.

Become a support system for your referral sources. When people need help, they call the people they know and trust. Many clients call our office asking if we can help people they know. And they want to know whom we recommend if we cannot help. Take care of the referral sources that take care of you.

Maintain consistency. Rarely will a single conversation, meeting, personal gift or thank-you note build a relationship or produce long-term results. Plan some 20-percent time every week to say thank you so that you can maintain your current relationships and build new ones. For more ideas, check out my past articles at www.massagetoday.com. For more practice building visit www.KentHealth.com, and drop me a line with your great ideas.

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The 80/20 Rule: Making the Most of Your Limited Time

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By: David Kent, LMT, NCTMB

Lets examine the 80/20 rule, which is also called Pareto’s Principle or Pareto’s Law, after Italian economist and sociologist Vilfredo Pareto.[1] Pareto’s original principle applied to land ownership and wealth distribution when, at that time, 20 percent of the people owned 80 percent of the land; however, I’ve discovered that the general theme of Pareto’s Principle can be loosely applied to other circumstances. In fact, the 80/20 rule has saved me valuable time, energy and money, while helping me improve my practice and produce a better return on my investment.

I first understood how I could make the 80/20 rule would work for me when I realized that I was spending far too much time on a specific project without any positive return. Although I was dedicating an exhaustive amount of time and effort to this project, it was costing me money, and my business was also suffering because I wasn’t focusing on other areas that needed my attention. To utilize the 80/20 rule in this new way, I determined that I would have to focus 80 percent of my efforts on 20 percent of the tasks that matter most to me.

Consider that it is 20 percent of the actions we take that produce 80 percent of our results; however, it is learning to tap into that 20 percent that is pivotal to making this philosophy work. What 20 percent of tasks can you focus on to have the biggest positive impact on your practice?

Let’s start with clients: Do 20 percent of your clients produce 80 percent of your income? If so, work on nurturing those relationships by making follow-up phone calls or offering occasional treatment discounts. Do 20 percent of your referral sources send you 80 percent of your clients? If so, what 20 percent of your actions can you take to help maintain and improve those relationships while producing new ones? Do you apply 20 percent of your techniques 80 percent of the time? Then become a master at utilizing those techniques in your practice. And remember: No matter what type of massage practice you have, the 80/20 rule can work for you.

 

 

 

Saying “Thank You”

One of the easiest actions you can take is to send a thank-you card to new patients, as well as the person or business that referred them. Include your business card with each thank-you note, and consider also sending a gift certificate for a complimentary treatment. Each week, I strive to make contact with current referral sources. Usually, I deliver a healthy snack when I visit, so that I can demonstrate how valuable these relationships are to me. Likewise, send your new clients a thank-you card for giving you the opportunity to be of service. Let them know that you will do everything possible to merit the confidence they have shown in you.

New Business

Don’t dismiss the importance of spending a portion of your 20 percent researching potential new leads. To obtain referrals from the medical community research physicians in your area to determine who would be a viable resource. Seated massage therapists may want to research various professional office buildings to determine where seated massage might be a good fit. I will be discussing more about showing gratitude to your referral sources and generating new business in my April column—you won’t want to miss it!

Education

To avoid spending too much time on less-than-quality educational and supplemental training materials, look for programs that give you more bang for your buck. DVD programs are very popular and have multiple benefits. And some DVDs may double as educational tools for your clients to demonstrate trigger-point locations or stretching techniques. Select programs with clearly indexed menus and supplemental materials that complement the DVD, such as manuals or workbooks.

The dissection lab is another great place where I can apply the 80/20 rule because the amount of knowledge I gain from the time I spend in the lab is invaluable, and it gives me more confidence in my hands-on abilities. Just ask Edgar Moon, a blind massage that I wrote about in my second article for Massage Today, “Feeling is Believing.” Edgar, who “sees” with his hands, attended a dissection seminar and said that it helped enhance his kinesthetic skills tremendously.

Employment Opportunities

As everyone knows, we never get a second chance to make a good first impression. And it doesn’t take much to be prepared: dress professionally; have all of your paperwork with you, including copies of your massage license, liability insurance and certifications; and do a little homework to learn everything you can about your potential employer. Does the clinic provide a certain type of therapy that matches your skill set? Do you already have the proper training and experience? What current skills do you have that can benefit your future employer? The most important 20 percent of this exercise will be during the interview, so make it count! Prove that you are ready to work!

Recognizing the importance of and focusing on that 20 percent will make a huge difference in your life. It will revolutionize your practice and give you maximum return on all of your investments of time, energy—everything, really. Review your goals every day, plan your outcomes, and then ask yourself, “What items on my list are the 20 percent that really count?” I invite you to read my previous articles at MassageToday.com, such as “The Power of the List” or “The Power a Minute,” for more practice-building ideas. Each article supports the other, so make sure you check them out.

Additionally, visit www.KentHealth.com where you can listen to free audio clips that provide additional tips to keep you focused on the 20 percent that counts. (I recently interviewed a CPA who is also an LMT, and she shared the 20 percent of things that will save you money at tax time!)

Drop me a line at [email protected] to let me know how you are applying the 80/20 rule to improve your practice. Next month, I’ll expand on the idea of thanking referral sources and generating new business. See you then!


[1]http://en.wikipedia.org/wiki/Pareto_principle

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Charting Success: Effectively Treating and Retaining Patients

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By David Kent, LMT, NCTMB

Whether you perform massage in a medical, clinical or spa setting, it is important for clients to feel they are benefitting from treatment. Using visual aids is an excellent way to chart and evaluate a client’s progress. Charting allows you to show a client his/her progress. It also helps you and the client stay focused on which course of treatment to pursue.

In my last article, “The Power of the List,” I presented my goal-setting questions and Power List to help you kick-start the process of identifying and achieving your goals for your practice and all areas of your life. In this article I will share tips for using visual aids for your client’s benefit, no matter what type of massage setting you work in. I also will describe how I use visual aids in my own practice. These tips will help you gain, maintain and increase the momentum you need to attain your professional goals while you subsequently help your clients.

Few goals are ever achieved in one step, and one massage therapy treatment is rarely going to resolve the core cause of a client’s stress, pain or dysfunction. Many clients want instant gratification—the “magic bullet” or the one-treatment fix that will immediately solve their problem; however, it is incumbent upon us to educate our clients about the accumulated benefits of a series of treatments versus a single treatment here and there. Clients who make a commitment to regular treatment often are quickly amazed at the positive impact it has on their quality of life.

Here’s a brief quiz. Imagine you are driving down the highway and the “low oil” warning signal displays on the dashboard. You take the next exit and drive to the nearest gas station where you check the oil level and see that the engine is low by two quarts. Should you:

  1. Buy just enough oil so that the warning light will turn off; then drive the car until the warning light comes on again, only to do the same thing again. This is the human equivalent of taking over-the-counter (OTC) medication.
  1. Pull the fuse so the warning light doesn’t annoy you. This is the equivalent of seeing a doctor for prescription medication that masks the pain.
  1. Locate the wire that connects the light to the dashboard and cut it so it can never send the warning signal again. This is the body’s equivalent to surgery.
  1. Add one quart of oil and drive until the warning display lights up again; then add one more quart of oil. This is the equivalent of a client with headaches, neck and shoulder pain scheduling an emergency massage therapy session. Upon completion of the session, you recommend follow-up sessions, simple stretching techniques, ergonomic changes, and other methods of self care; however, the client doesn’t follow any of your recommendations and the next time you hear from the client is when his/her pain is at the crisis level and he/she needs to “get in as soon as possible.”
  1. Immediately add two quarts of oil at the gas station and then schedule an appointment to have your car serviced as soon as possible. Think about it. Maybe there is an oil leak or maybe something is drastically wrong with the car. Over time, the oil in the car breaks down. This is what the experts call “loosing oil viscosity.” Could that be similar to loosing range-of-motion?

Obviously, the best answer to the question is “E”.  You need to schedule the car for service – not only for a filter and oil change, but for a complete checkup. You make this decision on simple information that would be obvious to any person. It’s not too hard to see that the car in this scenario is a stand-in for the human body. And this valuable machine needs attention and care to run correctly and last for the long run. Ultimately, it’s cheaper to maintain the body’s health than to “pay” for a complete “breakdown” in the long run in the way of lost work, doctor bills, medication, pain and a reduced quality of life.

The point of this exercise is to demonstrate the importance of gathering information the right way at the right time. For example, a client complains of headaches that occur three to four times a week and require prescription medication; however, even with increasing medication, the client frequently misses time off work. This client also has secondary complaints of neck, shoulder and upper back pain that disrupt sleeping patterns. In this example, my short-term goals are to reduce the headaches and the neck pain intensity, frequency and duration, as well as to improve sleeping patterns.

Here is where I start collecting my visuals to create my starting point of reference so that I can measure the client’s progress from this point forward. To begin, I have the client fill out intake forms, questionnaires and a pain-scale chart before and after treatment. Other aids I use to establish a baseline include documenting range-of-motion; conducting muscle and orthopedic assessments; using trigger point charts; taking postural analysis photos; and evaluating gait.

Depending on your massage therapy setting, you will probably adjust which visual aids you use in your practice; however, most clients, regardless of the setting, find it both useful and comforting when the therapist uses charts and models to describe their condition and note their progress.

Lastly, we all need a little encouragement to produce the results we want in our lives. Often, however, we have no one around to motivate us. Every day, I list the things I am grateful for, as well as the things I did to move myself closer to my goals. I also ask my clients to do the same. A client with chronic headaches might be grateful for finding you, the massage therapist, and—thanks to continued treatment—he/she might be grateful for missing less work and sleeping better at night. This client might be following your recommendations and stretching and exercising every day as a means of reducing the frequency of the headaches.

As for me, I am grateful for my health and my practice. And whether it’s learning a new skill, following innovative practice-management techniques or using visual aids, I make a point of doing something every single day that will help me reach my professional and personal goals.

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