blog the sixth: How often to get a massage...

“How often should I get a massage?”


This is a surprisingly complex question to answer. It would be nice if there was some kind of standardized treatment schedule that works for everyone, but outside of insurance claims, it's impractical to try to impose a set schedule on every person. There are, however, some broad rules of thumb that I like to use to help my patients decide what is best for them.

Usually when someone first comes to see me, it's for an acute injury (sports injuries, sprains, strains and repetitive motion injuries all fit into this general category, assuming the onset is recent). In these cases, the first massage is primarily assessment and symptom management. I recommend at least one follow up for mild injuries. For repetitive strain disorders and for more severe injuries, I recommend an additional two to three treatments to facilitate the formation of functional scar tissue at the site of injury, and the prevention of postural dysfunctions caused by compensatory changes in gait, posture, and hand/arm use. Additional treatments may be necessary, but I find that if I haven't achieved at least an estimated 70% recovery after the 3rd or 4th treatment, then I need to reassess and possibly refer the patient to their doctor.

For chronic musculoskeletal problems (arthritis, tmj, tension headaches, epichondilitis and carpal tunnel are all examples) a longer treatment schedule is most likely necessary, based on the clients response to treatment, financial considerations, and their activity level (patients that can't or won't exercise tend to need more frequent massage treatments). Depending on the condition, this can potentially continue for as long as the patient chooses to come and see me. When the prognosis is for full recovery, I haven't seen many cases where the ongoing treatment plan of the condition continued for more than 3 months.

For both acute and chronic issues, the treatment plan depends on my ability to measure recovery in an objective manner. This involves observing posture, range of motion, inflammation, muscle strength/weakness, and sensory changes (numbness or tingling primarily).

Sensory change does involve a certain subjective experience on the part of the patient, but I think it's sensible to consider it in this category of observation. Once these issues have been resolved, we move more into the subjective experience of the patient.

Subjective experience can involve pain, changes to activities of daily living, stress and mood.

Once we're dealing primarily with these problems (and if it's what they have come in for in the first place), it's fully up to the patient to define their needs. I recommend weekly treatments until subjective changes are significant, and then gradually extending the distance between treatments until a maintenance schedule has been established. By this I refer to the length of time at which symptoms recur. Settling into a treatment schedule of once every 3-6 weeks seems to be the most common.

For management of both pain and stress specifically, I suggest that weekly treatments are optimal. Patients with chronic pain conditions and those living and working in high stress environments seem to benefit from more frequent treatment. Anxiety and risk of depression seem to be reduced (This is one of the areas where massage therapy is well researched. Check here for a good abstract with additional links.).

These guidelines do tend to differ slightly from therapist to therapist, but a quick investigation on Google shows that I'm not out of sync with other therapists. The "Why Massage Therapy" blog is quite interesting to show the similarities and differences between our perspectives.

One last note:

Beware any therapist who tells you that it will take more than 10 sessions to make significant progress! Excepting certain long term conditions where the goal is relief rather than rehabilitation (see above!), you should begin to feel better fairly early on in the treatment process. Even if the improvements are only small, they suggest we are on the right track and can proceed. Anyone insisting you continue treatment when no change is evident could be leading you on, and is almost certainly wasting your money.

Please feel free to add to this or ask questions! As I said above, everyone has a different perspective on this issue and I'm always interested in people's thoughts and opinions.

blog the seventh - The Barefoot Experiment

The Barefoot Experiment – Part I

(This blog was written a couple of weeks ago while helping my friend's out at the new location of their chocolate store. See www.delight.ca for info! Seriously! It's good stuff!)

Today was my second barefoot walk and my first of any length. It felt pretty good.
Now why would I want to go around barefoot in Toronto, you may ask? Well, I've been researching all winter, and hanging out a bit with Barefoot Moe uptown (Check out his website here). Barefoot walking and running is becoming increasingly popular as people try to find new ways to prevent chronic joint dysfunction. If you talk to barefooters (as they collectively call themselves), you'll find that they all believe there's little valid evidence to justify our tendency to wear overpriced, over-supported footwear. I did my own searching on Google Scholar and found several papers on the relationship of chronic ankle and knee injury and footwear (for more info try Thieme eJournals, Medicine and Science in Sports and Exercise, and a particularly good one in which the full text is available: SportScience ).

The general idea is that wearing shoes inhibits the foot's ability to actively absorb shock as we step or stride. The muscles and joints of the foot are thought to work best when allowed the freedom to operate individually and freely (think independent suspension). This is particularly true on hard surfaces like asphalt and concrete. By walking barefoot we allow the small support muscles to strength, and retain full proprioceptive sensation (proprioceptors are the nerve endings in our joints that communicate the position of the joint to our brains, giving us a more complete mental image of our position in space. The more active our proprioceptors are, the more detailed and accurate is our sense of position in our environment.). The larger and more movement oriented muscles don't have to do as much work maintaining our balance and can be left to their main job of propelling us forward. At the same time, shock is absorbed through many more joints rather than just the ankle and knee, diffusing the impact and reducing overall wear on the joints (Think arthritis prevention!).

The reaction most people have to the idea of going barefoot in the city is “Ewwwwww!”. Sanitation is a primary concern. The answer to that is quite simple if you really think about it: We don't tend to lick our feet, or eat with them, or touch any surface that our food is likely to come in contact with. The risk of infection through the skin is limited as pathogens have difficulty passing through the thickened sole of the foot.

The next reaction is “But aren't you afraid of cutting your foot?”. Well, I don't particularly like cutting myself no matter where it is, but for the most part, glass and sharp stones can be avoided. I don't know about anyone else, but I don't like walking through glass even in my shoes! (That also applies to feces, spit, vomit, gum, discarded food and any other noxious substance one might encounter on the sidewalks of Toronto.). Watching one barefoot jogger explain himself in a youtube video, I had to agree with his reasoning (and I'm paraphrasing here.): Which is worse? A small cut that heals in a couple of days, or arthritis that's with you forever?
I know which one I'd take!

Now as for the risk of infection through that little cut, for that reason, barefoot runners in particular carry along with their normal running gear, a pair of tweezers, some antiseptic, and dermabond/crazy glue. I'd also like to point out that we bleed out, not in, so unless a cut is allowed to become septic, the risk of internal infection is very low. Ask your Doctor for more qualified advice on that side of the issue. (Barefoot Moe asked his, and I'm again paraphrasing the response.)

Both times I've been out for a barefoot walk, I've been pleasantly surprised by how good I felt during and after. My legs and feet were actively tingling after this one! And the sore back I had (from carrying a duffel bag of sheets home... Massage therapists share my pain!) felt much better.. It's really quite difficult to walk barefoot without erect, dynamic posture. It does get quite tiring towards the end as I'm not quite used to walking for long periods with my forefoot. It feels a bit slower than heel striking, but ultimately more satisfying (and it hurts less).

Some things to consider if you decide to give this a try:

Pick a warm day. It'll put you off walking in the rain, or the cold.

Don't walk for too long. Depending on your skin type, it may take some time before you can do more than get the mail. You don't want to get blisters.

If you're testing your limits, take a pair of sandals or thongs with you. Also handy if you're going shopping, or out to eat. Most commercial establishments are going to either treat you like you're crazy, no matter how good you are at explaining yourself, or they're going to be worried about the potential liability of injury.

If you're really grossed out by walking on urban sidewalks, try Vibram Fivefingers. I haven't tried a pair yet, but they certainly look ideal for wet weather and skin protection on long outings. Plus they'd be a conversation starter I'm sure!

Keep a towel by the door. That way you don't dirty your floors (or get nasty looks from your girlfriend! And on that note NEVER get into bed without cleaning your feet first...).

Check back here for more. I'm going to try running soon. Once I've done a few of those, I'm sure I'll have some thoughts for part II...