Posted on

Getting Comfortable with Postural Analysis Practice Building Tips

Download a printable version or this article with photos

By: David Kent, LMT, NCTMB

We all recognize the importance of getting our cars serviced regularly so that they run at their optimal level. Not surprisingly, the same is true of the human body. In fact, there is a very useful car-related analogy we can use when it comes to describing postural analysis: a front-end alignment and wheel balance.

The word “posture” is derived from the Latin verb “ponere,” meaning “to put or place.” The word “analysis” comes from the Greek word “analyein,” meaning “to break up.” Therefore, postural analysis is simply the process of “breaking up” the body to determine where it should be “put or placed.” This article will review the body positioning for the purpose of taking a standing (static) postural analysis so that you can custom design your clients’ therapy sessions.

When a vehicle’s alignment is off, it manifests as uneven tread wear and loss of tire life. Likewise, when a car’s tires are not properly balanced, ride quality is diminished, tire life is shortened, and bearings and shock-absorber performance suffers. When one’s posture is off, the human body also experiences a range of problems: restricted range of motion; pain; organ dysfunction; and joint, tendon, ligament and muscle stress, to name a few.

The body, like tires, has an ideal position. It, too, must be balanced to run smoothly and last a long time. For a mechanic to assess and adjust the front end of a vehicle, he must first check wheel positioning for deviations from the norm. To do this, he sets the wheels in a standard position and conducts an evaluation. In massage terms, this is the equivalent of taking a postural analysis. A mechanic’s objective findings are also reported in terms we can relate to the body. For example, the mechanical term “toe-in or toe-out” is what we would call “internal or external rotation.” And what a mechanic calls “camber,” we call “tilt.”

When we report to a mechanic that the tire tread on our vehicle is wearing unevenly and the steering wheel vibrates, we have given our subjective complaints. The mechanic hears this complaint frequently and knows exactly what needs to be done. Before he can conduct his evaluation, however, he needs to use the proper equipment to access and design a repair plan, according to the car model’s specifications.

In the same way, clients often make subjective complaints to us about headaches and neck and back pain. These are common complaints we hear frequently. Just like a mechanic, we need to use the proper equipment to access and design a customized therapy session to meet each individual client’s needs, focusing on both short- and long-term goals.

The “manufacturer specifications” for the human body include the anatomical planes that show us the ideal positioning of joints and bones. While individuals are not expected to be perfectly positioned, we want to facilitate the best posture possible through massage therapy. According to Muscles: Testing and Function” “Ideal skeletal alignment…involves a minimal amount of stress and strain, and is conducive to maximal efficiency of the body.” Moreover, “the intersection of the sagittal and coronal midplanes of the body forms a line that is analogous to the gravity line. Around this line, the body is hypothetically in a position of equilibrium. Such a position implies a balanced distribution of weight, and a stable position of each joint. When viewing a posture in a standing [position], a plumb line is used to represent a line of reference…Since the only fixed point in the standing posture is at the base where the feet are in contact with the floor, the point of reference must be at the base,” or the foundation of the body.[1]

Whether you work in spa, clinic, medical office, fitness center, or some other venue, there are certain things you must do to conduct an effective postural analysis.

Postural Analysis Checklist

[Graphic designer: please insert check boxes next to each entry]

o      Hang a plumb bob approximately 3 feet in front of a postural analysis grid chart. The plumb bob should be approximately a ¼ inch off the floor.

o      The client should be:

o       in bare feet

o      wear clothing that allows for visual observation of body contours.

o      Standing between the postural chart and the plumb line, but his/her body should not be touching the plumb line or chart.

o      Client should place the hair behind the ears as the external auditory meatus is an anatomical landmark that is used as a reference point.

o      Position the feet in relation to the plumb line:

o      For anterior and posterior views, the heels are equally spaced from the plumb line and posture chart. See images #1 and 2

o      For a lateral view, the plumb line is immediately anterior to lateral maleous. See images # 4 and 5

Now, stand a few feet back from the plumb line. Using a digital camera, move from side to side (right to left) until the plumb line is lined up with the center line of the grid chart. Take a photo of the client and make any necessary notes for your objective your findings.

We all know the saying “A picture is worth a thousand words”. In images #1 and 3 it is easy to see how the right shoulder is higher then the left. We see the torso and head are to right of the midsaggital plane. In images 4 and 6 it is easy to see the forward head posture and the right shoulder being posterior to the coronal plane. These “deviations” have numerous origins. A muscle movement chart will help quickly determine which muscles are shortened and which ones are lengthened helping you design a customized treatment plan.

There are many advantages of taking postural photos, including

• Documenting posture before and after a series of treatments;

• Educating clients about their postural distortions and demonstrating causes of pain, muscle weakness, etc;

• Showing clients, physicians, and other relevant parties a client’s treatment progress;

• Presenting clients with clear treatment solutions;

• Recording and documenting the client’s postural changes;

• Customizing treatment plans; and

• Confirming your objective findings via trigger point charts. (See my article, “Charting Progress: Visuals for Success” in the February issue of Massage Today for more about this.)
When you take the time to administer a precise posture evaluation for your clients and devise a customized treatment plan, you will gain their respect and earn a reputation as a top massage therapist. Your clients will also appreciate how you utilized the information to educate them.

Don’t let the idea of conducting a postural analysis intimidate you. There are many things we do every day that we needed to learn to do for the first time. Once you get comfortable with posture, it will be easier to think about each client as an individual and know how to develop special treatment plans for each person. Over time, posture analysis becomes easy—second nature. You just need to start doing it.

For more information about posture analysis, as well as several tools to get started, visit KentHealth.com.

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.


[1] Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function, 4th ed. Williams & Wilkins, 1993: pg 71.

Download a printable version or this article with photos

Posted on

Practice Building For Massage Therapists: Consistency Breeds Success

Printer friendly version of Practice Building For Massage Therapists: Consistency Breeds Success

By: David Kent, LMT, NCTMB

The current economic slowdown is stressful to everyone. Business is slow, treatments are down, and both are affecting the bottom line. During these challenging times, however, there are things you can do to consistently to breed your success. Instead of getting frustrated and discouraged, use this extra downtime to your advantage. Following the tips in this article will help you achieve ongoing success in your practice, whether you are in a clinical, spa or outcall setting.

Getting Out There

Marketing professionals know how important repetition is to “imprint” a product in the mind of the consumer. This same concept applies to massage therapy and your ability to imprint your services on potential referral sources. Each week, I visit specific locations that have become my best referral sources. If you aren’t getting the number of referrals you would like, it’s time to get out there and introduce yourself. Here are just a few places to start:
o      Medical and chiropractic clinics

o      Acupuncturists and homeopaths

o      Hotels and salons

o      Personal training centers and gyms

o      Tennis and golf courses

o      Yoga studios

o      Health food stores

o      Gymnastic and dance studios

o      Business centers

Talk it Up

You took the time to get out there; now you need to make it count! Your goal is to attract business by educating your referral sources about the importance of massage therapy.  Advertisers use test markets and focus groups to refine their messages. But before you begin pitching your services, you will need to practice and refine your “commercial” with your “test market,” which is located in the next community over.

That’s right. You need to practice your selling skills before you officially launch your marketing campaign with your “real” audience in your own community. Practicing gives you the opportunity to build your confidence while simultaneously getting comfortable with introducing yourself to strangers, telling them what you do, and answering commonly asked questions. But don’t let yourself off the hook with your practice sessions. Make sure that you are as professional and courteous with your test audience as you plan to be with your “real” audience. The following tips will help you get comfortable in this newfound role as salesperson.
o      Introduce yourself. Let people know who you are, what you do, and where you practice.

o      Talk to everyone you come into contact with—everyone! From waiters and waitresses to the FedEx delivery person to your mechanic, dentist, or insurance agent.

o      Never assume that people know what massage is or how it can help them.

o      Following each encounter, reevaluate your performance and ask yourself the following questions: What did I learn?  What will I do different next time? What other strategies could I try in the future? Answering these questions will help you do a better job each time.

o      Finally, ask your clients and referral sources what they think is important for you to tell others when marketing your services. You’ll be surprised at how helpful their feedback will be.

Show and Tell

Explaining the basics helps others understand how massage therapy can help with headaches, sciatica, neck and back pain, and more. Additionally, using “props” can help educate your clients.
o      Carry a trigger point flip chart with you. Explain how trigger point patterns are often the cause of severe pain.
o      Take a moment to examine the posture of the person you are speaking with. Educate your contact about how each individual’s unique postural pattern can be treated with massage therapy. Then describe your ability to custom tailor your treatments accordingly.

Mutual Benefits

Discuss how you can be of mutual benefit to each other.
o      Can you send them business?

o      Take some of their business cards to pass out, and ask them to do the same.

Leave Treasures

Do something unique so that your referral sources remember you.

o      Give a helpful tip. If you are talking with a secretary who complains of neck pain, suggest that he/she try a telephone headset, or adjust the height and angle of the computer monitor or chair.

o      Teach simple stretching techniques.

o      Leave healthy snacks. I know people who are always on the run and rarely stop to eat. Sometimes, I’ll drop off an apple, nuts, and a bottle of water, along with my business card.

o      Leave samples of topical pain relievers.  

Contact Information
You’ve invested your time and energy marketing your practice. Now make sure that your referral sources can find your name and number when it counts. Be sure to leave
o      Business cards

o      Magnets

o      Flyers

o      Pens

o      Notepads

o      Any other tool you think will leave an impression.

Education
Clients often want to understand and learn more about their condition, so put your education to good use.
o      Continually educate and re-educate your clients.

o      Show them how to stretch and maintain themselves between sessions.

o      Explain the importance and benefits of regular exercise.

o      Use visuals, such as anatomical models, textbooks, trigger point charts or other charts to show the musculoskeletal origins of their condition.

o      Review the effects of poor posture and explain how it contributes to pain. Since a picture is worth a thousand words and many cell phones have cameras, taking postural analysis photos on the road is easier than ever. Read “Getting Comfortable with Postural Analysis” (Massage Today, July 2008) for more tips on using postural analysis photos.

o      Discuss the uses of ice, heat, and topical analgesics for pain.

Say “Thank You”

o      Place follow-up calls to new clients.

o      Send thank you notes to clients and referral sources.

We typically avoid the things that we are uncomfortable doing; however, with practice, you will quickly realize that certain thoughts and actions consistently focused in positive directions will ensure your success. And if you practice your selling skills consistently, you will improve each time you sell your services to somebody new. Remember: practice makes perfect! Hang in there and don’t get frustrated. Results don’t always happen overnight. Just invest the time and keep a positive attitude. You’ll be amazed with the results!

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 is President and Founder of Kent Health Systems which 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.KentHealth.com or call (888) 574-5600 for more information.

Printer friendly version of Practice Building For Massage Therapists: Consistency Breeds Success

Posted on

Blind Massage Therapist Takes Dissection Seminar

Full Body Dissection Seminar June 19-23, 2013

  • For more information call 888-574-5600 M-F 9-4 EST.
  • Blind Therapist Takes Full Body Dissection Seminar

    Feeling Is Believing – Improve Your Massage Therapy Skills

    By David Kent, LMT, NCTMB

    I recently took an online survey and was interested to discover that of the five senses, 76 percent of men and 72 percent of women feel that vision is the most important. But while “seeing is believing” to many, Edgar Moon, a blind certified massage therapist from Philadelphia, believes that “touching is seeing and understanding.” Edgar, who primarily is a kinesthetic learner, “sees” with his hands.

    Edgar became a massage therapist after he lost his sight serving our country in Vietnam. A couple of years ago, he joined me in the dissection lab for a week of training. Following the experience, Edgar expressed both appreciation and excitement for his newfound knowledge, “Now I understand exactly what I am treating on my clients. This experience has been so enlightening and a dream come true.”

    The level of enthusiasm in the dissection lab truly is amazing. I’ve seen faces light up with excitement in anticipation of embarking on this incredible exploration of the human body. Yet, at the same time, each person is extremely respectful of the process. All of the participants honor these “silent teachers,” since it is through their foresight and planning that we have been given this ultimate gift and learning experience. Additionally, we in the anatomy lab recognize that performing an outstanding dissection and then using that knowledge to benefit our clients is the most respectful way we can honor these exquisite souls.

    While Edgar did not use a scalpel to perform the dissection, he did use his hands to palpate every layer, separate the fascial planes, and feel the fascia, muscles, nerves and organs. Additionally, Edgar and his dissection team continually palpated the same structures on 11 different cadavers to compare the shapes and sizes of each. Edgar maneuvered around the dissection lab with confidence. As he approached each cadaver, a team member would place his hands on a bony landmark so that he could identify his starting point. Working with Edgar in the lab reminded each of us how fortunate we are to have the gift of sight. We were all proud that we had the opportunity to “loan our eyes” to a fellow massage therapist so he could follow his passion.

    In my last column, I discussed how most of us learn and experience life through the five senses: visual (sight), auditory (speech), kinesthetic (touch), olfactory (smell) and gustatory (taste). While most of us are fortunate enough to have the full use of our senses, each person typically is more reliant on one or two of the senses; these are referred to as the dominant senses. Since the senses affect how we interpret and interact with the world on a daily basis, it is easy to understand how the dominant senses could guide us into a specific profession.

    Edgar Moon, a blind certified massage therapist from Philadelphia, says “touching is seeing and understanding.” he is a kinesthetic learner, and “sees” with his hands.

    For example, someone whose dominant sense is taste probably would enjoy being a chef, a food taster or a wine connoisseur; a speech-dominant person might gravitate toward a profession in acting, music or politics; and a sightdominant person might prefer a career as a graphic designer, architect or painter. So, it makes perfect sense that a touch-dominant person would lean toward a career in massage therapy. In fact, when massage therapists are in the process of learning a new technique or structure of the body, it often is necessary for them to see (visual) it, hear (auditory) about it, and, of course, use touch (kinesthetic) to feel or perform it.

    It was beautiful to witness Edgar as he began making all of these connections in the lab. Occasionally, while palpating, he would say, “I see.” I remember thinking how much more sensitive Edgar’s hands are since they play such a dominant role in his life.

    As you know, the largest organ in the body is the skin. It provides:

    • Protection for the body from injury, fluid loss (e.g., in minor burns), and invading organisms;

    • Heat regulation through sweat glands and blood vessels; and

    • Sensation (e.g., pain) by way of superficial nerves and their sensory endings. 1

    Additionally, it’s common knowledge that one square-inch of skin contains about 65 hairs, 100 sebaceous glands, 650 sweat glands, 78 heat sensors, 13 cold sensors, 1,300 nerve endings that can record pain, 9,500 cells, 19 yards of nerves, 19,500 sensory cells and 165 pressure apparatuses for stimuli (touch).The fingertips are very sensitive, making them powerful tools for any massage therapist, particularly someone with an enhanced sense of touch, like Edgar. But, how does the dissection experience help heighten one’s sense of touch and subsequently make one a better massage therapist? Well, with or without the use of one’s vision, palpating during dissection provides the therapist with a more thorough understanding of each individual structure, as well as how these structures interconnect to form the whole. A therapist who has received the gift of knowledge thanks to these special “silent” teachers can’t help but function in the treatment room with a heightened appreciation and understanding of the human body. And developing these skills takes little more than a heartfelt desire to learn and a willingness to see with your hands what your eyes cannot. Just ask Edgar.

    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 is President and Founder of Kent Health Systems which 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.KentHealth.com or call (888) 574-5600 for more information.

  • For more information call 386-574-5600 M-F 9-4 EST.
  • Posted on

    Subscapularis: Overlooked and Under Treated

    Click here for a printable version of this article with photos

    By: David Kent, LMT, NCTMB

    The subscapularis is often neglected and/or undertreated as a cause of posterior shoulder pain with restricted range of motion (ROM). According to Travell and Simons, “differential diagnosis of subscapularis TrPs includes C7 radiculopathy, thoracic outlet syndrome, adhesive capsulitis and ‘impingement’ syndrome.”[1]In this article, I will review how to determine when the subscapularis muscle is responsible for causing shoulder pain and restricted ROM, as well as review its anatomy, function, trigger-point patterns and treatment options.

    Intake and health history forms will help you identify some common factors that may contribute to the formation and perpetuation of trigger points, as well as the shortening of the subscapularis muscle. According to Travell and Simons, some of these factors include the following:

    • Repetitive movements that involve medial rotation, such as swimming the overhead stroke, playing tennis or pitching a baseball;
    • Repeatedly lifting boxes or other objects overhead with both arms extended;
    • Reaching backward to break a fall;
    • Soft-tissue stress when the shoulder joint is dislocated;
    • A fracture to the proximal humerus or trauma to the shoulder joint capsule;
    • The immobilization of the shoulder in an adducted and medially rotated position over a long period of time, such as when the arm is in a sling; and
    • Prior surgeries and procedures.[2]

    Taking a photo of your client in front of a postural analysis grid chart is an effective method of evaluating, documenting, educating and ultimately showing a client his or her postural progress over a series of treatments. For example, a constant slumped, forward-head, adducted-scapulae posture will perpetuate trigger points and the shortening of muscles, like the subscapularis, by continually keeping the humerus in a position of medial rotation.3 [Photo 1]

     

     

    Symptoms

     

    Trigger Points: When trigger points are present in the subscapularis muscle, they produce referred pain “in the posterior deltoid area…down the posterior aspect of the arm, and then skip to a band around the wrist.”4 [Photo 2] Remember that referred pain is a symptom; we want to address the cause. So intake forms, postural analysis evaluations, range-of-motion and orthopedic assessments, and being familiar with trigger point patterns are all helpful to designing and implementing a customized therapy plan. But treating a trigger point is only part of the solution. We need to avoid a recurrence in the future. It is therefore necessary to demonstrate to your client which muscles need more lengthening and which ones need more strengthening so that all of the joints are properly aligned and moving through their full range of motion.

    Anatomy: The subscapularis is one of four muscles that make up the rotator cuff, along with the supraspinatus, infraspinatous and the teres minor muscles. In my dissection seminars, I always highlight the subscapularis, which is the most anterior of the rotator cuff muscles. [Photo 2] It is a thick triangular muscle that attaches medially on the anterior or costal surface of the scapula on the subscapular fossa; it forms part of posterior wall of the axialla. Laterally it attaches on the lesser tubercle of the humerus and the lower half of the shoulder joint capsule.

    Actions: The subscapularis is primarily responsible for medially rotating and adducting the arm. It also helps to hold the humeral head in the glenoid cavity. To check for shortening in the subscapularis it is necessary to evaluate both abduction and external rotation.

    Abduction: According to Travell and Simons, when evaluating a shoulder with restricted abduction, it is first necessary to determine if the restriction is being caused by the inability of the scapula to move on the rib cage, the humerus to properly articulate in the shoulder (glenohumeral) joint, or a combination of the two. The difference can be easily determined by placing your hands on the client’s scapula to prevent its movement while asking the client to abduct his/her humerus. [Photo 3] When the subscapularis is involved, it restricts glenohumeral movements like abduction and lateral rotation, but it does not restrict scapular movements on the rib cage. If scapular movements are restricted, it is necessary to evaluate muscles that run from the torso to the scapulae like the pectoralis minor, serratus anterior, trapezius and the rhomboids.5

    Lateral Rotation: When checking lateral rotation at the shoulder, adduct the arm by placing the elbow at the side. Bend the elbow 90 degrees to show the amount of rotation at the shoulder joint. [Photo 4] The arm should be able to laterally rotate 90 degrees. In addition to the subscapularis, other synergistic muscles like the teres major, latismus dossi and pectoralis major also adduct and medially rotate the arm. These muscles must also be evaluated and treated. Keep in mind that the antagonistic muscles are weak and over lengthened, so they need strengthening. Muscle movement charts can aid in quickly identifying the muscles involved and show the normal range of motion for the muscles and joints being evaluated. [Photo 5]

    Treating the subscapularis: While there are many different approaches to treating the belly of the subscapularis muscle, I find one particularly effective; however, with this method some clients may only be able to tolerate static pressure versus movements, such as with-fiber or cross-fiber techniques.

    1. Place the client in a supine position.
    2. Stand facing the client at level of client’s shoulder.
    3. In the palm of your non-treating hand, cradle the scapula while using your fingertips to secure the vertebral border of the scapula; abduct the scapula.[Photo 6]
    4. Position the fingers of the treating hand against the belly of the subscapularis muscle. [Photo 7]

    NOTE: Some clients may be ticklish, but this is easily overcome by using the client’s hand during the treatment. Have the client place his/her hand on the ticklish region while you treat the area between his/her fingers. [Photo 8]

    1. Drape the client’s arm across his/her chest (adduction) to shorten the muscle. [Photo 9]
    2. Press the fingers of your treating hand down toward the table and into the subscapular fossa.

    Before the session ends, advise your client that he/she will receive the most benefit from your therapy session by actively engaging in self-care stretching techniques, such as the doorway stretch, which will further help improve muscle length, and create and maintain balance in the shoulder. [Photo 10]

    You have now identified several factors associated with subscapularis pain and discomfort with the help of assessment aids and tools like intake forms, charts and postural analysis photos. Continue to study and broaden your skills with hands-on seminars and DVD programs. And to share your tips and experiences in the treatment room, please drop me a line at [email protected]

    For more information related to this month’s topic, check out “Charting Your Progress: Visuals for Success” (February 2008) and “Getting Comfortable with Postural Analysis” (July 2008) online 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.KentHealth.com or call (888) 574-5600 for more information.


    1-5 Simons DG, Travell JG, et al. Myofascial Pain and Dysfunction: The Trigger Point Manual, volume 1, 2nd ed. Williams and Wilkins: 1999.

    Click here for a printable version of this article with photos

    Posted on

    Safety Protocols: The Carotid Artery

    Click here to download a printable version for this article with photos.

    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.

    Posted on

    Questions with Direction – Practice Building Tips

    Click here for a printable version of this article with photos

    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.

    Click here for a printable version of this article with photos

    Posted on

    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)

    Posted on

    Taking Action to Improve Your Massage Practice

    Download a printable version of this article.

    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.

    Download a printable version of this article.

    Posted on

    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.

    To read the full article, click here:

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

    Posted on

    Building Raving Fans: Practice Building Tips

    Click here to download a printable version of this article with photos.

    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.

    Click here to download a printable version of this article with photos.