Five Policies Every RMT Should Have In Place

Five Policies Every RMT Should Have In Place

As an RMT one of the toughest aspects of your career will be building your business. Many medical practitioners spend thousands of hours training on procedures, treatments, techniques and patient care yet very few pursue business courses to prepare them to run their practice. Here are five policies you should have in place to improve new client acquisition as well as your reputation:

1. Preparation Policy:  It is very important that you set the mood with a professional atmosphere that reflects your practice. Your office and/or home must be impeccable; clean, fresh and welcoming. Nothing chases away clients more quickly than a massage room that looks like it hasn’t been cleaned in a month. Have a policy in place to ensure the treatment room is properly prepared before each patient and stick to it even if you are running behind.

2. Dress Code: The way you appear is just as important as your massage room. Be certain you are dressed in appropriate, professional attire. Darker coloured scrubs such as navy and black have been shown to instil trust in patients as do white tops such as polo shirts and tan pants. This is a crisp, clean look that will work well in both clinical and spa environments. Have a dress code policy even if it is just your self in the business to set a professional image.

3. Payment Policy: Asking for money  is one of the most difficult aspects of running your business. Think of it like this: You would never walk in to a hair salon, grocery store or restaurant have your hair done, select some groceries or have a nice meal and say, “I’ll pay you next time.” It doesn’t work this way in any of these businesses and it shouldn’t work this way in yours. Being up front about your policies on collecting payment is one of the most important aspects of your business. Post your fees and payment policies prominently so there is never a discrepancy.

4. Mission Statement: As an RMT you are providing a health service to your patients. Even in a spa setting you will be contributing to your client’s state of mind which has a positive impact on their overall health. It is a good idea to look at your options and choose an area in which you would like to specialize. Whether it is sports injury, spa treatments or mom and baby, you can then focus your practice by increasing your modalities and providing the treatments that reflect your chosen area of expertise. You should then write a mission statement that sets policies for the patients you will treat and the services you will provide. This will allow you to establish yourself as a specialist which can lead to a nice generation of referral patients in your community. You can also consider partnering with other practitioners who offer services that work well with your expertise such as maternity yoga classes and lactation consultations if your focus is mom and baby.

5. Booking Policy: Your income is dependent on the appointments you schedule. Therefore it is important you have an effective booking policy. Ensure you outline a treatment plan and book appointments as your patient leaves. This will keep them on track for treatment as well as continue to generate a flow of clients.

Although not all RMT’s intend to go into business for themselves most positions you will hold require some basic business and client building skills. Having these five policies in place will help create a professional tone and keep your business on track.

 

New Patient Do’s and Don’ts for RMTs

New Patient Do’s and Don’ts for RMTs

As a health care professional it is important for you to set the right tone for each patient you see; therefore, the first appointment is the most important appointment as you want to be certain you give the right impression as well as communicate clearly with new patients about policies and their treatment. Here are some do’s and don’ts you should keep in mind when seeing patients at their first appointment:

  • Do inform patients of any cancellation policies as well as fees when they call to book their first appointment. This will establish the value of your services as well as set the tone for the relationship between your patient and your office.
  • Don’t forget to ask new patients to arrive at least 15 minutes early to fill out the necessary forms such as health histories. This is imperative to ensure you can stay on schedule.
  • Do ask patients to bring any relevant information to their health or past treatments to help you establish the best treatment plan.
  • Don’t forget to ensure your massage room has all of the necessary equipment, brochures and supplies prior to a new patient appointment. You want to ensure you appear organized and professional to instil trust and confidence.
  • Do review their medical history in great detail and ask if they have any information they wish to share such as referral letters, questions or even x-rays.
  • Don’t interrupt a new patient when they are trying to ask questions or offer information as this will make it seem that you are aloof or are not going to consider their input when coming up with a treatment plan.
  • Do ask patients how they will be most comfortable fully dressed or clothes removed. This is important as not all patients are comfortable with being exposed. Explain which will work best so they are better able to choose.
  • Don’t forget to provide a sheet to drape over them and ask if they are warm enough.
  • Do prepare them for their treatment and start slow by applying your hands to the area of treatment first before jumping right in.
  • Don’t begin massaging too aggressively right away as a lighter touch will prepare the patient as well as help warm the muscles in preparation for deeper massage.
  • Do explain what you will be doing during treatment and tell them to let you know if they experience pain or concern throughout the massage.
  • Don’t forget to explain when you are about to change what you are doing such as adding oils, using tools or require them to move into a special position. This will prepare them for changes and keep them comfortable throughout the treatment.
  • Do ask if they are comfortable or if areas are sensitive or painful as you are working on them. This will let them know you are concerned with their care and also that you are ensuring you are providing the right pressure and techniques that will be effective for them.
  • Don’t miss your patients’ cues if they seem to tense or sound like they might be uncomfortable.
  • Do finish up gently and consider applying a warm pack to their back to let them wind down from the massage.
  • Don’t forget to explain they should get up slowly in case they are dizzy.
  • Do review the treatment when you are finished and what should take place at their next appointment.
  • Don’t allow new patients to leave without booking their next appointment.
  • Do review possible side effects with the patient before they leave.
  • Don’t forget to provide contact information should the patient be concerned with any side effects they might experience.

Following these do’s and don’ts will help provide the best possible first appointment while setting a strong foundation for ongoing relationships.

Joint Pain, Joint Disorders and Massage Therapy

I often hear many people complain about achy joints, especially hips, knees, hands and wrists.  These conditions are especially problematic as they can deter normal activities affecting our work and play.   Some joint issues may fall under the category of regional affectations, whereby some activity was undertaken and swelling, inflammation, and achiness became temporary.  Or the condition might fall under the category of degenerative joint disease, such as rheumatoid arthritis or osteoarthritis, whereby irritation, inflammation, and general deterioration have been long term with no improvement.

Many of our joints are weight bearing and most are confronted with repetitive motions from work or sports activities.  The tough and tender components of our joints are bathed in fluids to keep them moving freely and to keep nutrition flowing to the cells.  Several factors can lead to the breakdown of these internal joint structures, such as inadequate dietary nutrition, overwork, overstress, excess weight, especially on hips, knees, and ankles, strained musculature pulling on tendon and ligament attachments or even lax musculature that puts a strain on surrounding structures creating imbalance and misalignment.  Ruth Werner in her textbook, A Massage Therapist’s Guide to Pathology, third edition, informs us that hormone deficiencies, dehydration, allergic reactions creating inflammation that often settles in joint capsules, or improper metabolic absorption, as well, can all lead to compromises in joint capsules. (p.111)

Massage therapy can be highly effective for alleviating the pain and swelling of arthritic conditions. The warmth, touch, and gentle movements become a welcome nurturance to areas plagued by chronic pain.  It is important to note, however, for therapists as well as patients, that arthritic conditions have subacute and acute stages, and massage may not be helpful during the acute stage, also referred to as the flare-up stage, as it is too painful oftentimes to touch or manipulate.  When a patient is in the subacute stage, a state that may be uncomfortable, but not inflamed, massage can be helpful in alleviating any strained, cramped, or spasmed musculature creating pressure on the joint capsules.  Gentle manipulation working inner structures may begin to improve normal ranges of motion and may be helpful in restoring synovial joint fluids and creating spaces for nutrients to enter especially if one is taking nutritional supplements assisting joint repair.  This may reduce stiffness and lower pain sensations.

For both the client with arthritis and the massage therapist treating the client, it is important to work with the health care team to determine any other associated underlying medical conditions that might exist.

by Krystle Shapiro
Source: http://www.sandpointwellnesscouncil.com/2011/09/joint-pain-joint-disorders-and-massage-therapy/

Tips For Working On Trigger Points

Tips for working on Trigger Points

You are certain to encounter patient after patient with complaints of “muscle knots”. Muscle knots are trigger points believed to be created by a contracted muscle but in a small patch of muscle tissue. There is also the theory that with the contraction the muscle tissue may also contain waste metabolites due to the lack of blood circulation in the area. This means there is a build up of toxins in the trigger point. When there is more than one trigger point it leads to Myofascial Pain Syndrome (MPS) and whether they have one muscle knot or a series of them the resulting pain can prove to be quite troublesome for patients.

Three Results of Trigger Points

Trigger points can affect a patient in three ways. First it can cause pain, second it can complicate an existing condition or issue and third they can mimic other problems. A trigger point always causes pain in theory, but when you have a muscle injury the addition of muscle knots can amplify pain and in some cases end up being worse than the original injury. The third affect is perhaps the most troubling as it a trigger point is misread it can then be mistreated. Therefore it is important to take caution when working with a patient to determine the causes of pain to ensure a trigger point is not misdiagnosed.

Referred Pain

Not only can trigger points mimic the symptoms of other common issues they can also be at the root of referred pain. A common complaint your patients might have such as sciatica is often believed to be a result of referred pain from piriformis or other gluteal muscles as opposed to the nerve itself. Other common referred pain caused by trigger points include tinnitus, tension headaches, TMJ pain, lower back pain and a decrease in range of motion in the legs and sometimes arms (due to shoulder pain). Fibromyalgia (FM) is often confused with MPS due to the tender points associated with FM which differ from the trigger points of MPS.

Diagnosing Trigger Points

With all of these challenges how is it possible to diagnose trigger points? Many would argue it is not an exact science but there are some commonalities you will see with a true trigger point issue. In general, the physical finding of a trigger point is feeling a hardened nodule with palpation of the area. Palpation should also result in pain directly in the area of the nodule which can also radiate out from the nodule and in some cases cause twitching.

Treating Trigger Points

When treating trigger points the lack of circulation in the area plays a key role. It is important to return blood circulation to the area and sustained pressure can be effective in urging the blood flow to resume as well as in releasing the muscle fibres. Deep stroking is also effective especially in assisting returning blood flow. Deep tissue massage can also be used as it can aid in removing metabolic waste believed to build up in trigger points. Trigger point therapy can be the saving grace for patients who have suffered from chronic pain that has not been diagnosed properly and therefore never resolved.

 

 

Slide Matters and Other Fascial Significant Paradigm Shifting Considerations


– Interview with Antonio Stecco, MD, on Fascial Manipulation Courses

According to Hankinson & Hankinson (2012) Musculoskeletal Disorders are more prevalent than all chronic disease types, making musculoskeletal [soft-tissue] pain and dysfunction the most pervasive health afflition.

Myofascial pain is estimated to be the most commonly experienced musculoskeletal pain (Srbely 2010). Meaning, that although the condition is often termed/diagnosed as musculoskeletal – fascia, this may be [at least in part] the pain generating tissue in such cases.

85% of patients receiving care at specialized pain management centres are experiencing myofascial pain (Gerwin 2001) and Myofascial pain syndrome (MPS – aka fibositis and myofibositis) is one of the most common disorders encountered by physicians in clinical practice (Rachlin 1994). Yet, given all of this, no standard, universally accepted biochemical, electro-diagnostic, diagnostic-imaging, or physical examination criteria exist for a diagnosis of MPS (Annaswamy et al. 2011) and therefore it is most often an under-diagnosed or misdiagnosed condition (Cummings 2007).

Recovery following musculoskeletal injuries has traditionally focused on restoration of strength [muscular force generation and tendon/ligament tensile capabilities] and joint range of motion.

Until recently, little attention has been given to restoration of “glide” within the fascial system’s sliding mechanism, likely because up until recently little was known about the sliding mechanism. And indeed fascia in general, has been largely overlooked within the sphere of conventional diagnostics and treatment interventions.

Throughout my massage therapy career, fascia has fascinated me, understandably a career highlight has been attending the Fascia Research Congresses (FRCs). Dr. Antonio Stecco’s presentation at the 1st FRC was a principal accelerant for my fascial obsession that has exponentially heightened since then. A Stecco FRC3 highlight was the fascial system’s sliding mechanism.

In the human body, available movement and coordination of movement involves more than “the joint(s)” and the central nervous system. Although traditionally, “synchronisationof movement was exclusively attributed to the nervous system components, at a certain point, neurophysiologists began to question how the brain alone was able to control all of the variables involved in a motor gestures. The control of movements in the periphery had to be more complex than initially thought” (L. Stecco). Glide between the interfascial planes, endofascial fiber, endomuscular fiber all factor into movement potential and any impediment in the gliding of the fascia could impact available movement and alter afferent input resulting in incoherent movement.

A primary aim of Fascial Manipulation (FM) [aka: the Stecco Method] is to restore unimpeded gliding within the fascial  system’s sliding mechanism. We will explore this topic with renowned fascia expert, Dr. Antonio Stecco.

Hello Dr. Stecco, thank you for taking the time to speak with us and welcome to Massage Matters Canada.

AS: Thank you for inviting me.

CR: Dr. Stecco, can you provide us with a general anatomical/physiological overview of the deep fascia (DF) and the fascial system’s sliding mechanism?

AS: Throughout much of  the body the DF is a multi-layer presentation consisting of 2-3 layers of dense connective tissue (CT) and 1-2 layers of loose CT (e.g. fascia lata, brachial, & antebrachial fascia). A loose CT layer is also often present between the deepest most layer of the DF and the underlying layer of epimysium. The dense layers are constructed of parallel bundles of collagen fibers(type I & III). In the loose layers we findcollagen, adipose cells, glycosaminoglycans (GAGs) and a rich supply of Hyaluronan (HA). The dense layers transmit force and the loose layers augment gliding/slide between the layers [i.e. constitute the sliding mechanism].

CR: Can you provide us with a general pathophysiolgical overview? What goes wrong and why?

AS: Pathophysiological processes [within the sliding layer] are not completely understood. Current hypotheses suggest that increased resistance within the sliding layer — likely due to changes in viscosity — warrants valid consideration.

It is known that ground substance (GS) can change its viscosity and that HA, a component of GS, plays a significat role in viscosity changes. HA is a primary component of the loose CT/sliding layer. Mechanical stimulation (e.g. exercise, movement) triggers increased production of HA in the various sliding layers. If over-stimulation of abnormally high volumes of HA occurs, HA will tend to aggregate a transformation into a super-molecular structure that changes its ‘normal’ configuation. Aggregation results in increased viscosity, which in turn increases friction or resistance in the sliding layer. Another consideration is that a shift in pH toward acidity tends to instigate HA aggregation as well (e.g. 6.6 – 6.9 pH; possibly associated with an increase in lactic acid following hard exercise or overuse).

CR: What types of impairment/dysfunction can be attributed to ‘slide mechanism’ interference or dysfunction? What might the patient experience?

AS: As the sliding mechanism plays a significat role in movement potential; conversely interference with sliding can impact available range of motion (ROM), so a patient might present with movement difficultie (e.g. quantity and quality of available movement, stiffness). Additionally, slide/glide resistance incites friction, which in turn can provoke neural hyperstimulation (irritation). Neural-irritation can lead to hypersensitization of mechano and nociceptors and as such correlates with a patient’s experience of pain, allodynia, paresthesia and abnormal proprioception and subsequently altered movement/postural patterns. Generally speaking, pain is the most common reason for a patient to seek treatment and pain can occur with or without ROM limitations/difficulties

CR: Regarding glide interference, what kind of observations/indicators might the clinician note?

AS: The patient’s account of pain — location and referral pattern — is a key indicator: this is furthered by palpation and movement verifiction. In the FM model specificlocalized areas — approximately a 1 inch segment — of densifiction increased viscosity and fibosis correlate with the patient’s pain presentation – however, the sites of densifiction are not located at the site of pain. From a biomechanical point of view, these specificpoints — referred to in FM as centre’s of coordination (CC), centre’s of fusion (CF) — are of greater significane than say that of adjacent or other areas within the sliding layer. It is the clinician’s palpation of resistance to glide/slide and the patient’s notable increase in CC/CF point tenderness that denotes a malfunctioning/densifiedCC or CF. The FM model movement assessment differs from traditional ROM testing – this model takes into consideration myokinetic chain/sequences of movement. To recap, location of the patient’s pain, observable movement limitations and the clinician’s verifiction of painful points are the key diagnostic indicators of interference/dysfunction within the sliding layers.

CR: The advancement in Massage/Manual Therapy research is being aided by various imaging and measurement tools that can be used to identify biomarkers and denote differences in normal\abnormal tissue presentations, and thereby track pre\post treatment changes.

What kind of imaging/diagnostic tools are you currently using in practice and research, and what are some significat pre/post FM treatment changes you are seeing?

AS: Ultrasound is one commonly used diagnostic tool in practice and research. Changes in viscosity/tissue thickness can be viewed via ultrasound in some regions of the body. The region of the SCM and Medial Scalene are one of the more ‘viewable’ areas and thicker than normal areas in the correlating DF can be seen in patients presenting with chronic neck pain. Subsequently, thickness changes following FM treatment can also be viewed. Ultrasound is also being used to look at glide/slide differences (e.g. Langevin’s research comparing LBP sufferers to a non-pain group). The use of ultrasound to view moving tissue still presents some limitations (e.g. complexity and expense of computer software, resolution quality and depth of the tissue). There is currently no ‘gold standard’ in this area of diagnostics and research. EMG, DynaPort and robotics (providing computer generated movement animations) are also being explored as means by which to better understand fascia’s biomechanical role, monitor/measure tissue changes, identify normal and abnormal presentations and denote changes post treatment.

CR: On the topic of alignment: I am not an anti-structuralist, but I am not a predominantly structural-istic driven clinician [meaning, perfect alignment is the key to pain free functioning]. The scoliosis case that you shared at the Level I course in Vancouver last fall comes to mind. The  X ray image you showed us was of a dramatic spinal deviation (87 degrees), yet following FM treatment your patient has been able to function by returning to work, resumption of activities of daily living and sport/recreational activities with significatly less pain.

Dr. Stecco, how much did the actual curvature of her spine change post FM treatment? And from your perspective how imperative is ‘perfect’ alignment with regard to pain-free functioning?

AS: There was no significat change in the degree of her scoliosis following treatment. Scoliosis [spinal deviation] is not necessarily correlated with pain.

With this patient, there are three important components to look at: the scoliosis, hyperkyphosis and hyperlordosis. The impact of the spinal deviations essentially present as ‘overuse’ type syndromes in the paraspinal and other associated musculature’s sliding mechanism, which appears to be the predominant source of the presenting musculoskeletal pain and dysfunction. This patient still experiences some low back pain but not at the debilitating degree she experienced prior to FM treatment (e.g. missing time at work, stopping all activity). Occasional use of paracetamol (mild analgesic) (2-3 times a month) manages her back pain well, while FM treatment 2-3 times a year effectively addresses her compensatory neck pain. Following treatment she experiences no neck pain between treatments and her episodes of neck pain are occurring less frequently and are quicker to resolve.

CR: Regarding a couple of dosage considerations – Direction and Duration:

CR: Are there specific direction considerations and if so what are considerations for determining the direction of the FM technique? Cyriax (fractioning) for example is applied cross-fiberin reference to the underlying muscle/tendon – but articulating fascial layers are not parallel (oblique arrangement at a 78 degree angle). Does this arrangement have any bearing on the direction of FM application? Or are there other factors within the sliding layer that are taken into consideration?

AS: Direction of the FM technique is not specificto underlying fiberorientation. Where you feel the restriction is the most significat determinate factor pertaining to the direction the technique is applied, which sometimes can be multi-directional. There are some site-specificconsiderations (e.g. accessibility and proximity of sensitive anatomical structures; limited space between bones or anterior neck muscles and close proximity of vascular structures).

CR: What about duration? How long is FM technique applied for and why? What are the changes that you are listening for or  feeling for — indicating a productive change in the sliding layer?

AS: Knowing when to stop the technique is a combination of patient feedback and what the clinician is feeling. It takes an average of 3.14 minutes for a patient to report a 50% reduction in what was their initial level of tenderness/pain (e.g. if the patient reported that upon initial contact with the site [CC or CF] their pain level was a 7 on the NRS, it would take approximately 3.14 minutes for their pain to drop to 3.5).  What the clinician is feeling for is a decreased resistance to glide in the direction where resistance was initially strongly felt.

From a treatment perspective there are three important factors to consider: disengagement of collagen cross-links, restoration of normal HA presentation and restoration of normal GS/HA fluidit. Our hypothesis is that FM, a provocation-type technique, catalyzes a sequence of chemical events culminating in the restoration of normal quality/quantity of ground substance (GS) constituents (e.g. HA) within the dense collagen layers of deep fascia. Tracking changes poses some difficult, as post-treatment tissue biopsy is not reasonable. However biochemical measurements can track inflammtory mediated changes, which typically occur over a 48-hour period.

CR: What research are you currently working on? What might we expect to see you presenting on at the FRC4 in 2015? AS: Current studies include FM efficacyrelated to Spasticity associated with neurological disorders and Musculoskeletal Pain and Dysfunction. We are conducting various clinical trials: neck, shoulder, carpal tunnel syndrome and using various instruments/diagnostic technologies (e.g. EMG, DynaPort, Robotics) to assist with these studies and further our understanding of sliding layer pathophysiology and effective treatment interventions. We are also exploring a new pharmascopic track.

by Cathy Ryan RMT
Source: MTO: http://www.massagetherapy.bc.ca/news-events/magazine/magazine-article/slide-matters-antonio-stecco