Join Dr. Brett Scott in this podcast with Jess Ferrer, a licensed massage therapist as they delve into the various benefits of massage therapy. With expertise in the field, they discussed how massage can positively impact physical and mental well-being.
[00:00:00] Alright guys, welcome back to the Barbell Therapy podcast. I'm your host, Dr. Brett Scott.
[00:00:07] And with me here today is Jess Ferrer and she is a licensed massage therapist by trade but
[00:00:15] is also a certified personal trainer. She teaches yoga and Pilates. She's got a history
[00:00:20] in circus arts as an instructor there. And she's got over 20 years of experience integrating
[00:00:26] all these different things with manual therapy. And so I wanted to have Jess on here today because
[00:00:33] for me and our patients we get a lot of people that want to get massage or they've been to massage
[00:00:38] therapy and most of the time it's something that has temporarily helped them get better but has never
[00:00:45] been the end all be all of their issues that they've been dealing with. And I think there's a
[00:00:52] lot of reasons for that. And so part of my job is what I want to do is make sure people are
[00:00:57] wasting their time and money and really getting a better understanding and a better understanding
[00:01:02] of what massage is, what it isn't when we should use it, when we shouldn't use it. And
[00:01:09] I think Jess here is someone that can kind of play both sides of the ball and as a massage
[00:01:15] therapist knows a whole lot about massage but also integrates it with a lot of other things because
[00:01:19] she knows it's not that we can just make everything a nail and just use a hammer for everything.
[00:01:26] There's different tools in the toolbox we need to have so Jess, thanks for coming on today. And
[00:01:32] yeah so for you I mean what would you say massage is or what people think of when they hear massage?
[00:01:40] Thanks for having me on. Let's see massage what the average person thinks it is
[00:01:49] it's such a range. It could include just a spa visit, a relaxation thing, a thing to do with your
[00:01:58] girlfriends and then you have the other end of the spectrum where it is integrative with conventional
[00:02:06] medicine therapies and even facilitating function and movement just the same as anything with
[00:02:19] in conventional medicine. But it's in the cracks of in between, it could be conventional depending
[00:02:29] on the therapist's knowledge base and approach and then the whole other end of this spectrum.
[00:02:35] And I actually lean more towards how does it help our population get better? And most of the people
[00:02:44] that come to see me come from you know having seen conventional medicine, PT's, OT's,
[00:02:50] all the doctors, all the specialties and then sprinkled in between like all the holistic approaches as
[00:02:56] well. So that's where I'm coming from. And so for you and me there's a lot of people out there that
[00:03:04] think massage is just rubbing muscles and releasing scar tissue and adhesions and unfortunately
[00:03:11] there's still people out there that are working in this field that say these things. So what do you
[00:03:17] have to say to that? That is only a small part, those are things that can be addressed with massage
[00:03:25] therapy but overall it's a whole body if we look at the majority of massage therapists out there.
[00:03:33] It's a whole body approach hands-on manual approach to therapy with a range of modalities that
[00:03:40] we all uniquely train in to help facilitate the client's ability their bodies ability to maintain
[00:03:48] the store-improve function and movement in their daily lives to make it as best as possible for
[00:03:55] wherever they're at. And so with that being said, so you're saying you know because the big thing
[00:04:06] the data we have now shows that we can't break up scar tissue. We can't remove adhesions from tissue.
[00:04:14] Right? So there's a lot of studies that show it's like okay it takes a thousand pounds of
[00:04:19] pressure per square inch to make a deformative change to something like the IT band. So when
[00:04:28] we're looking from a massage therapist point of view, what would you say the best thing we can tell
[00:04:34] our clients is of why we're making change to tissue or how we're making change to tissue?
[00:04:41] Well coming from my approach and you know my knowledge base, let's go back to what I just said
[00:04:49] is facilitating the client's ability to make change so even from a neurological standpoint. When
[00:05:02] you put a hand on a client's body, something happens even if it's an exchange of heat and the
[00:05:10] bodies responding neurologically maybe there's an emotion that comes with that or a settlement of
[00:05:18] pain is a neurological response just from the contact of touch. We're affecting change and from
[00:05:25] those things the brain controls a lot. The brain can start to repatter whether it goes into
[00:05:32] fight or flight or it's like oh this is very relaxing and soothing and calming and I could turn my
[00:05:38] volume down on the pain that's already made it change and then it just it kind of branches off
[00:05:45] from there and I'm not saying that we don't have to apply pressure or techniques or any of that but
[00:05:53] any level of touch and that's what a lot of a lot of people in the field of massage therapy. It's
[00:05:59] about being able to touch appropriately when appropriate and how and why. Let's start with
[00:06:07] when a client comes in, why are they there? Why are they come to see me? What have they
[00:06:14] already tried or who are they already currently seeing what's going on with their body? I mean
[00:06:20] somebody could come in and say yeah I have back pain and then I'll say well what do you want me
[00:06:25] to rust first? And they say well I've had this raging migraine. Well then even though they may have
[00:06:33] started in with complaining about this longstanding back pain, what I got to look at first priority
[00:06:40] for them because it's highlighted is maybe they're migraine and what's affecting that. And it might
[00:06:47] be playing into the main chronic issue. So it's a whole ball of wax.
[00:06:57] And there is still something we're doing at the level of the tissue though for the patients too
[00:07:03] right? So we're getting more hydration, we are creating some type of we can create
[00:07:08] synovial fluid exchanges within our own joints. So what things are happening?
[00:07:12] Circulation. Yes so just tell me take me through like what things are actually happening
[00:07:18] at the level of tissue and on a physiological perspective.
[00:07:24] From massage therapy point of view, there's the contact you know every every time I have an intention
[00:07:34] to make contact with a client's body whatever whatever part of it is, there's going to be
[00:07:45] assessment from every second of contact. That could be heat, that could be vibration,
[00:07:51] that could be watching other signs like increased respiratory rate. All the while I'm trying to
[00:07:58] start leaning I call it leaning into the tissue to address whatever problem. Say it's a
[00:08:08] yeah low back pain and they sit 90% of their day so they have a sitting stationary job,
[00:08:15] they don't necessarily work out but they're constantly in a hinged position in the chair.
[00:08:21] So I might be working their quads checking out their anterior hip flexors and I'm assessing the
[00:08:28] the quality of the muscle and it's going to be quality of his assessment of their quality of muscle
[00:08:33] tissue based and relative to them because working with a performance athlete, their tissue might
[00:08:41] feel like butter and then the areas of tension that present might feel rigid stiff and maybe
[00:08:48] they have a certain quality of dehydration versus like the everyday gen pop person who
[00:08:54] have a seated job whose you know desk job five six days a week that doesn't move their tissue is
[00:09:04] not like butter but I have to evaluate what is the area the side that they're not complaining about,
[00:09:11] say it as the legs. I'm going to check out the quality of all the tissue of the unaffected or
[00:09:18] uncomplained of leg and then compare it to the one that seems to be the issue so that I have a
[00:09:25] base of reference. And you know the other thing is too it's like what things,
[00:09:38] what is the hardest part about being a massage therapist for me as a PT sometimes and maybe
[00:09:44] it's the same but and you are more than just a massage therapist too, but I see a lot of people go
[00:09:51] in and get massages recurrently and kind of chronically for the same thing and it just feels
[00:09:56] better temporarily and it doesn't last so like nutrition hydration strength conditioning like these
[00:10:03] are all things that people need to address that maybe they don't want to because they're harder
[00:10:08] and massages is easier just oh I'm going to go lay on a table and I'm going to feel better
[00:10:11] temporarily. So do you ever feel maybe not you per se but some massage therapist feel handicap of like
[00:10:18] I know you could get better if you address all these other things in your life too.
[00:10:24] What I'm about to say a bunch of massage therapists are probably not going to like me for saying this
[00:10:29] but they do get caught in a loop or they get caught in a sequence or a pattern and they just hear
[00:10:36] back pain so then they're going to do a certain protocol and it's almost the
[00:10:43] it's their agenda when they hear a complaint instead of working with the clients.
[00:10:51] I say because I practice as described by some iteratively where I am always it might seem repetitive
[00:11:02] but I'm always making changes so from session to session and there are clients that I've been
[00:11:08] seeing for almost my entire career. They may have similar complaints there's always a primary
[00:11:15] complaint and you know aging has a process to that too or contributing factor
[00:11:21] and also however you know how spaced out they come to see me and how many other things they do
[00:11:26] and you know maybe they decide to sky jump and then land on their legs so there's a lot of things
[00:11:31] that change what how they come in and I always start with what is your status now and that is really
[00:11:39] where I feel anybody who is trying to help somebody be better whether it's a massage therapist or PT
[00:11:46] we want to meet them where they're at when they come in because that's the that's the health
[00:11:50] status that we're going to work from. When people do go to the I'm going to say average massage therapist
[00:11:59] if their therapist has an agenda of just getting through you know it's kind of like an order you order a burger
[00:12:07] you don't know how to make the burger but they probably make the burger the same way
[00:12:11] but if you actually sit down and ask you know because you have somebody who has a lot of
[00:12:16] restrictions and say well you want the burger but if you can't have nice shades you can't have this
[00:12:23] you know you start customizing it and then it is really what works for that person.
[00:12:31] So when somebody just says okay well their PT will recommend a massage which can it offers a lot
[00:12:38] more time I think one of the things we have discussed in the past is the difference between
[00:12:44] a PT massage and what somebody could obtain from working with a massage therapist that is you know
[00:12:52] it's their job is oftentimes what I hear is that when they go to a PT to get massage there isn't much
[00:13:01] time it's about 10-15 minutes at the most maybe five but it's also and I'm going to take this part
[00:13:08] because you're a PC but you're direct access when it's under insurance they're limited to the amount
[00:13:13] of time that can be spent for that modality and usually I think it's increments of five minutes or
[00:13:19] 10 minutes or 15 and then it's filled that way but when you come to a massage therapist oftentimes
[00:13:27] you can choose the length of time and there is another massage therapist that work with insurance
[00:13:35] but because we are and always have been primarily direct access you pay for the time now when
[00:13:40] you come to see me this is the way my business model it is you pay for the time
[00:13:47] that you are visiting in my office with me and your evaluation my evaluation of you my assessment
[00:13:55] of you every single visit starts from the time that I visually see you come in the office because
[00:14:00] I'm already assessing and all that stuff and seeing how you come in and then there's always interview
[00:14:07] and then education pieces and sometimes the hands on the hands on is never really going to be
[00:14:14] for a one hour massage 16 minutes on the table unless you're walking in naked
[00:14:20] when somebody goes to an average massage therapist and the massage therapist is not really meaning
[00:14:25] you wear your hat and they're like okay low back pain I know what to do
[00:14:30] you are getting a routine and everybody's pressure scale is different
[00:14:37] um if you're just going there but uh it's also the knowledge base of that therapist I can't speak
[00:14:45] for everybody I know what I like to fill my library with and and the library in my brain it helps me
[00:14:54] provide better therapy so to speak to my clients and I I feel comfortable and confident
[00:15:04] that I can uh backed by science and the knowledge and education um of what modalities can work
[00:15:14] what can't what I know what I don't do I know how to refer out when it's out of my wheelhouse
[00:15:22] or helping them find resources to get education educated in certain things or more information
[00:15:30] but um going to any massage therapist I don't know it's uh it's a it's a slippery slip I mean there's
[00:15:41] a whole range of people who are calling themselves a massage therapist yeah um same with personal
[00:15:48] trainers and PT's I like to you so my question too is in school for massage therapists
[00:15:55] how much time is spent on assessment depends on the school depends uh yeah depends on the
[00:16:04] school there is for every state has a certain minimum requirement that meets accreditation form
[00:16:11] massage schools that um pop up and exist in the country uh my program was unique in that it was
[00:16:18] 900 hours and it was very thorough it included um mental health components on therapeutic
[00:16:25] relations so we understood how how to work with clients when they come up and even the mental health
[00:16:31] aspects of being a there yeah building trust and actually you know working on yourself how important
[00:16:37] self-care is for the therapist because you may be working with somebody and something like
[00:16:43] anxiety anxiety depression or um somebody who is a senior like over 70 comes in and that might
[00:16:55] trigger a memory for a therapist and they might be so wrapped up in their head and then working with
[00:17:02] that person just because they remind them of their grandmother can actually create an um
[00:17:09] that like a a hiccup or just a block and how to provide objective therapy to that person
[00:17:17] but i mean those are every program is different um assessment i know a few that do spend a lot
[00:17:23] in orthopedic assessment at least educating them on what it looks like
[00:17:27] what it does actually um teach them how to do it whether or not the therapist graduating for those
[00:17:34] programs that do provide that education implement those is kind of you don't know until you get there
[00:17:41] um as far as the national certification exam that um
[00:17:47] that massage therapist have to complete in order to get licensed across a country
[00:17:52] um that is usually required by a lot of state licensure boards um i believe it doesn't
[00:17:58] it doesn't ask those things like what is this test and what's that test and how you know
[00:18:02] what what assessment you use um usually it is like um you know most people would just walk in and
[00:18:11] it's going to be all subjective so whatever information you give as a client
[00:18:16] it or none that's yeah that's what they're gonna go off of unless you know like me i ask a ton of
[00:18:22] questions my intake form is about five pages long and every
[00:18:27] the most people will say wow this is like a bible like you're asking a lot of information which a lot
[00:18:35] of people don't think why am i giving you all this information because you're just a massage therapist
[00:18:40] but it's all relevant because even though they might just think that it's all oh it's muscle
[00:18:46] muscle pain sometimes i could find an assess with my hands and and um movement and you know
[00:18:53] passive movement range of motion limitations and such that along with some of the pathologies that they
[00:19:00] pathological conditions that they have some of their muscular issues are not because of their muscles
[00:19:07] it's because of the other things going on and coming to a massage service that is an example of why
[00:19:13] at that moment massage may not be appropriate yeah and so
[00:19:20] so when would you say massage is inappropriate because i can think of plenty of times when it's not
[00:19:26] appropriate and this is this is the question you really wanted to answer here i think
[00:19:30] uh partly um if somebody is an active
[00:19:39] uh if within six months of somebody being hospitalized for anything cardiac
[00:19:47] um outside the post-op protocol provided by a physician surgeon so um now i know you do a lot of
[00:20:02] orthopedic PT and i'm sure you've seen your fair share of post-op stuff especially joint replacements
[00:20:11] two people two patients can go to the same surgeon and they'll still come out and they'll get
[00:20:15] the same appliance for a hip replacement same exact type of appliance and the surgery is have a little
[00:20:25] difference between the two of them and the post-op protocol and how they should treat their new
[00:20:30] hip is going to be different so um a knowledgeable massage therapist would ask to have a copy of that
[00:20:40] if they're going to be seeing them also probably medical clearance a note from their doctor
[00:20:46] and um like for me i would ask a permission to communicate with their healthcare team
[00:20:53] that they're actively being followed especially if they had had their first follow-up
[00:20:57] uh or their physical therapy the physical therapists they're currently working with
[00:21:03] so that there isn't overlap or contradiction and maybe sometimes you know partnering up with
[00:21:10] physical therapy um team if they can't get to doing a certain thing within the certain time frame of
[00:21:18] the visit and it's something that they could just simply ask hey can you possibly do this the next
[00:21:25] time you see Mary then i could say yes or no so there's just open communication to again facilitate
[00:21:34] and improve the wellness of of the patient um speaking of improving wellness of a patient so for me
[00:21:45] uh i got a 90-minute massage a few months ago it was like a gift and again that's why i was asking
[00:21:52] about assessment too because i've only gotten massages they've been like gifted to me because basically
[00:21:59] my whole family mother goes regularly because she doesn't want to work out and she feels pain and
[00:22:05] she doesn't want to listen to her son that's a PT sorry mom uh but like i'd be all stressed out she's
[00:22:13] a care coat take my massage or whatever so i got one and it was a 90-minute one and like it felt
[00:22:20] good and everything it didn't hurt like she used the adequate amount of pressure which i also
[00:22:25] want to talk about too but i don't get them regularly and i don't know what it is and i hope you can
[00:22:31] tell me maybe i was sore for like a week and not even just sore my workouts were like crippled
[00:22:42] for like a week like i like my nervous system was just like done like i could not push any type of
[00:22:48] weight for like a week and i was like what is this all just from the massage like what happened to
[00:22:52] me there well i'm gonna ask you this first why do you think it came from the massage
[00:22:59] because it was the last thing you had done yeah i mean there was a correlation between like i was
[00:23:06] sore for like two days after um so i think i'm not blaming the massage directly maybe with something
[00:23:13] with my nervous system like down regulating out of like sympathetic to parasympathetic nervous system
[00:23:19] activity um because i don't i'm not good at relaxing usually and maybe that was the first time i
[00:23:25] figured out what that was um well one of the things would be one of the things would be um then you know
[00:23:32] i you don't have to say it here if you know but um i'd be curious to know what your
[00:23:40] what your experience was like um yeah neurologic like what was what was coming up sometimes
[00:23:48] like i'll use this as an example people will come and they're like yeah i need this you know just
[00:23:55] like going to the gym i need this but they're really not ready for it they don't mentally they're not
[00:24:02] they don't have they're not in the headspace to receive it and they're guarded and in an initial like
[00:24:09] this was the first time if you're going into to a massage therapist for the first time
[00:24:14] in your garden they don't know because it's the first time that they've seen you and they start to
[00:24:19] work on your like they do feel the rigidity but they have no idea that this is you guarded
[00:24:26] yeah and then they're working with that and you don't know or you know when you're not communicating it
[00:24:34] um or just not body aware or you know sometimes clients might even check out because they're like
[00:24:40] yep i'm only doing this because i got to give certificate and if i don't use it because it expires
[00:24:45] next week they're going to kill me that i just wasted it um there's a lot of those those mental
[00:24:53] factors that play into it and then because it is more or less like the basic massage therapy session
[00:25:01] is a circulatory thing and the nervous system either it um it tonifies or it upticks it
[00:25:11] depends on also the technique she used um i would even for me i would even wonder which direction
[00:25:19] she went as far as the strokes um because there is research out there that if more downstrokesness
[00:25:28] has nothing to do with you know pushing the blood towards the heart all strokes need to go towards
[00:25:32] the heart that's that's not even a really thing anymore unless that's the intention um so if we
[00:25:39] move make um technique movements away from the brain down the spine towards the fingertips down
[00:25:49] like away um to the lateral from medial to lateral um it calms the system down
[00:25:56] okay and everything stimulating is up towards the brain so it it depends on her technique too and
[00:26:06] uh maybe even where she worked um i just wonder too like from a physiologist standpoint could
[00:26:13] it just be like there was a lot of metabolic damage built up when we just put it back into circulation
[00:26:18] my body was sore for a week that's the other part if you had i you know and
[00:26:24] we're not gonna say lactic acid is metabolic waste it depends on what what you did previous to the
[00:26:30] massage um even you're in nutrition as we kind of touch on that a little bit if you're nutrition
[00:26:38] or lack thereof if you were just like starving yourself um or taking in other things like
[00:26:47] supplements can also like you know camping out the the the components of supplements can be
[00:26:53] just sitting because they need more you know engagement of the body and then you have somebody who's
[00:27:01] you're lying on a table passively and you have a massage therapist more or less um putting
[00:27:06] you putting your body through a passive workout you're gonna feel you can feel sore like i've said
[00:27:15] to some of my clients like if they're sedentary individual and i'm doing something full body
[00:27:20] total body and they're asking for like i don't really move and i want more movement and sometimes
[00:27:26] that will involve some vigorous um massage techniques to open up the range of motion for their joints
[00:27:35] i tell them they're gonna feel sore like they worked out for two days
[00:27:39] and if it goes beyond two days then it was too much for their system not too much pressure
[00:27:45] just too much maybe a little overwhelming kind of being drunk on the sash
[00:27:52] yeah and speaking of that too so pressure is another big thing i want to talk about uh
[00:28:01] you know all my my meatballs that i trained in everything my bodybuilders crossfitters whatever
[00:28:07] they just wanted to dig in so fucking hard and it's like
[00:28:11] so so this is a two part thing though too because yes we know scientifically that the
[00:28:19] mechanoreceptors for muscle tissue most of them lie superficially right under the skin
[00:28:24] so it doesn't take a whole lot to stimulate a response or change in most people uh where we can
[00:28:32] improve mobility improve muscle tissue extensibility yada yada right um but people don't feel that
[00:28:40] they want to feel something right they want to feel like they got to work out although we don't need to
[00:28:45] now there's a whole bunch of things to that too with patient preference and patient outcomes
[00:28:51] based on their preference so like if they don't feel like they got enough
[00:28:54] pressure they're probably not gonna think that the massage did anything therefore their outcomes
[00:28:59] kind of a wash um right but the thing i want to get across it's like i just need someone to like
[00:29:06] re-verify this for me here if you're on whether you're on a table whether you're using a lacrosse ball
[00:29:11] you have um i used to be at a gym we called it the x-wife it was this big like titanium steel rod
[00:29:19] that donny Thompson um do you know donny Thompson body tempering um body temperance basically take
[00:29:25] this like hundred pound steel rod and roll it on your quad and make it feel better uh
[00:29:32] uh yeah that's a thing okay um but it's like we don't need to do that i could
[00:29:39] i remember i took a course and it was all about like getting away from that because we don't
[00:29:44] necessarily it was like the instructor basically took a a grassing tool and it felt like there was
[00:29:51] a cat just licking me on my neck slow and just steady like not much pressure and um you know rapid
[00:29:59] changes and range of motion i was like huh that's weird okay like it says something so
[00:30:05] you can go harder and i think there are people that are kind of nearly dense where they don't respond
[00:30:11] until they get some deeper level of pressure but you shouldn't be and correct me from wrong here
[00:30:18] but like you wincing on the table when your toes and fingers are curling up and your your shoulders
[00:30:24] are raising and you can't breathe we're not doing anything there that's helping us relax any bit more
[00:30:32] we're actually jacking the nervous system up more exactly but all of you all of that that you just
[00:30:37] described what what do you think is happening it's all you're you're contracting so you're just
[00:30:44] you're uh zeroing out exactly what you're creating more of a barrier so you're building a wall
[00:30:54] ahead of is it's ahead of actually receiving what you may need um you're right most of the a lot
[00:31:04] of research is finding that um a lot of the a lot of things that that help our helps our body change
[00:31:12] is at the superficial layer we don't necessarily need to drive so deep that we're at the bone
[00:31:18] we also have to be mindful of the tissue that we are affecting so how much
[00:31:24] poundage and the quality of the person's muscle and is it an area that we're going to be smashing a
[00:31:30] nerve um sometimes that want and that quote their perceived need to have the shit kicked out of them
[00:31:41] is a need for that endorphin rush you know that you know just like the high of winning a competition
[00:31:52] it's it's practically I would say biochemically the same thing um but there are individuals that do
[00:32:02] like you mentioned do need that deeper pressure to have change affected because of
[00:32:08] um the way their physiology their makeup is and um you had touched on a while ago we kind of
[00:32:16] had a brush with this and it is a whole nother topic that could be discussed in us uh it's
[00:32:22] its own podcast is hypermobile people and there are various various there's a whole spectrum
[00:32:29] of hypermobility um at the deepest root um don't absolutely just say yep just said this and this is
[00:32:38] you know the the law or whatever um hypermobility often has that component of the deeper
[00:32:47] connective tissue around the joint um that is compromised in some way and then the body's
[00:32:55] reliant on the muscle tissue which is the external of the bigger structures to provide the stability
[00:33:03] and when that's the case you got you know you don't have the internal you don't have the i-beam
[00:33:09] holding the house up you have the external drywall trying to hold up the house and um
[00:33:15] you know those people have to learn a different way of finding stability and sometimes
[00:33:22] you know for hypermobile i'm not going to get into this because this is going down another radical is
[00:33:28] hypermobile uh people who have hypermobility and connective tissue disorders um needs specialist
[00:33:36] in the field of massage therapy if they're going to um want to include a massage therapist they
[00:33:44] need people who are knowledgeable in those conditions um because there is a lot of times that
[00:33:52] certain massage modalities applied pressure and techniques should not be implemented
[00:33:58] with those types of individuals um because taking away their stability because yeah
[00:34:05] because taking away their stability because their muscles are trying to make up doing the job
[00:34:10] that doesn't exist at the deepest core level closest to the joints and that's just one type of
[00:34:16] hypermobility um is is is crypto it's going to cripple them and it's going to make them warrant
[00:34:23] risk for injury um even just getting up off your table could um not be a good thing once somebody
[00:34:31] is hammered so thoroughly into their body not understanding what what that pathology really is
[00:34:37] or what it is to that individual so um and then also being knowledgeable to be able to identify
[00:34:44] signs and symptoms that you know a lot of clients don't this isn't uh I wouldn't say it's a new
[00:34:49] thing it's just newly surfacing into mainstream that hypermobile um hypermobility is a condition
[00:34:56] of connected tissue disorders it's those testing but it's not something that is commonly tested
[00:35:00] for right when you're born yeah people find this out years later so are you talking about just
[00:35:07] people that have like general hypermobility or you're talking about someone that has like an
[00:35:11] L. L. Stanlow syndrome or like true connective tissue disorder like that uh all of it
[00:35:17] because even even somebody like a gymnast just an average gymnast you're saying could yes yeah okay
[00:35:24] yeah um so so take that gymnast right so um you know every gymnast that I know thinks they have
[00:35:33] tight hamstrings and tight hip flexors and we know they're not well here's the thing
[00:35:41] the hamstrings and hip flexors can feel tight I understand that they can feel that way but that is
[00:35:47] just a sensation that is not a state of being right now the problem we face I think clinically
[00:35:56] in something I've thought about more recently too is the context of which we test in
[00:36:02] makes it hard to say yes or no to some of these things because um A you have patient preference
[00:36:07] too but if I lie you on the table right you're flat there's no control you don't have to do anything
[00:36:15] and I put you in what we call a Thomas test and okay yeah negative like you don't have tight hip
[00:36:23] flexors but what happens in standing what happens if I put you in a crop is it her half kneeling
[00:36:28] position or I throw some demand at the upper and lower quadrants all at the same time or have
[00:36:32] you do some high level skill we don't know contextually there if the hip flexor is actually hypotonic
[00:36:39] or not or if there is more demand placed on it so that's kind of the hard part of some of these
[00:36:44] things of so as a massage as a massage therapist what is your viewpoint on um
[00:36:51] you know performing massage on something like a so as where it maybe it's presenting as a
[00:36:57] teninopathy symptom wise but it tests that it's you know it's strong enough and it's mobile enough
[00:37:04] what are your thoughts on that uh I actually do more um visual
[00:37:11] postural and functional testing like just I don't put names to it I just okay well
[00:37:20] as like as a gymnast all right let's let's talk about the gymnast here I would actually look at
[00:37:26] what her posture her natural standing posture her casual and where things actually lie where it
[00:37:36] you know is it a um where does that where do the where does the pelvis tilt um how straight or
[00:37:46] um hypo like the curves of the spine where's the position of the neck um where are the shoulders
[00:37:54] how how much tone are like is she locking her knees all the time is it you know
[00:38:02] hyper extended where it would there's a lot it a lot for me at least as a massage therapist when
[00:38:09] somebody comes to see me I look at all those things and also um uh if we're talking about like
[00:38:18] a school aged kid also like what how does she carry her things to and from school
[00:38:26] like the active posture stuff um
[00:38:32] yes I'd ask her for her active range of motion as I have her or him um show me their flexibility
[00:38:42] and watch how the body um compensates to some of those things because I don't I don't just even
[00:38:49] know the complaint is that one joint like area there's other things that start moving
[00:38:57] yeah so let's say we have one finding here right everything is normal
[00:39:03] and let's let's go let's go with hamstring just to make it a little less complicated I guess
[00:39:07] passively more than enough range actively they're limited they can't do a straight leg raise
[00:39:15] you know past 70 degrees to save their life which is basically adequate right so say we're missing
[00:39:21] 50 degrees of from active and passive range of motion okay would you would you do any type
[00:39:27] of massage on that tissue to facilitate it in some way or would you just leave it alone
[00:39:33] I would slightly palpate it with it not so much actively massage it I it would be more of a
[00:39:44] palpate and see how the how okay let's see where the the quads are are they are the heads working as one
[00:39:52] like one unit because they're all stuck together um or an core engagement the other part to it which
[00:40:03] um is not within my scope of practice Nordic and area that I would ever want to I mean it's a PT
[00:40:11] thing is pelvic floor health yeah and I do have a lot of a lot of clients that come to see me and I
[00:40:20] I'll palpate their areas if they think are a complaint like anterior hip and hamstrings
[00:40:26] and or even back pain and my the tissue is just fine like it's equal across the board I wouldn't do
[00:40:33] massage on that and and I would ask uh second the secondary interstitial
[00:40:40] questions that may seem more intimate but um also make a referral to the appropriate physicians
[00:40:49] that cover those areas and inform the client because they're coming to me for that muscular
[00:40:56] issue and I'm I'm knowledgeable in the muscular aspect of pelvic floor I would tell I might do
[00:41:03] some education in my office because I can't guarantee that they're going to get that from the other
[00:41:11] professionals right off the bat but so they understand it may be muscular and this is why I'm
[00:41:17] thinking that I need to refer you out if these are the muscles in here they are um and you are
[00:41:24] telling me you have problems paying or pain with pooping or um you know and with sacs hemorrhoids
[00:41:33] all these things yeah um that even you know trying to yeah another issue that is not
[00:41:44] something that I that's in my scope and these are the specialists that you may need to see
[00:41:50] and this is probably where these are the people that can do direct work and that would be
[00:41:56] a pelvic floor specialist in physical therapy yes not just a physical therapist don't come
[00:42:01] to me with these issues not just any PT but I've even you know I've even said well it's not me saying
[00:42:08] but I've had a client who I actually did a phone consult and they refer to me by another um
[00:42:13] colleague of mine who does the same work and it was low back pain and her client called me and said
[00:42:18] I don't know why she's sending me to you but apparently she's she's done what she could and I said
[00:42:24] okay so it's back pain and she's done what she could I don't think there's anything more so I
[00:42:28] asked her those next level questions and I told her it sounds like you have pelvic floor issues
[00:42:35] with the muscles of your pelvic floor and she said well you're a massage therapist can't you do it
[00:42:39] she trusts you I trust you I'll let you do it and I sit absolutely not out of my scope I don't
[00:42:45] have a license to it and um not an area that I want to get involved with yeah I don't know if I
[00:42:53] want to tell people what pelvic floor therapy always and and and there's either um there's things
[00:42:59] that there is there is approaches that don't involve interpelvic anything and that is not limited
[00:43:06] to women I'll just make it very clear yes men too um I've sent some men for some some pelvic floor
[00:43:14] issues because men then so that's the thing too is men have these same issues um and people don't
[00:43:19] realize there's a pelvic floor it's like yeah do you have muscles and tissues and tendons like
[00:43:23] they can get overstretched overwork they can be like botanic they can be weak they can do all these things
[00:43:30] they could also they could also develop trigger points secondary to external issues that that
[00:43:36] weren't addressed such as so as issues and iliacus issues and hip issues that were not addressed
[00:43:43] or you could just could not get treated and then they become more of an issue in the body decides
[00:43:50] that they're gonna tighten up everything else and lock down yep so yeah patient a while ago when he
[00:43:56] came back and he was not pleased that the type of massage he received but he did get better so
[00:44:02] men put your ego away if you need to do it and I think the other thing too is like this just
[00:44:08] brings up a good thing we just made an Instagram post about this too of like don't be a friend
[00:44:13] to tell your provider of these things that are going on like we hear them all the time
[00:44:17] every single back pain patient I have that comes in I ask about your poop your pee your sex life
[00:44:23] in very like does it hurt or not and yeah plenty of other questions do you have
[00:44:28] have really clinical it's not personal no it just helps us it helps us understand and it
[00:44:36] it gives us vervage that that helps you understand what we're trying to ask you versus you know
[00:44:41] hey how's your you know your deeper tendons and ligaments down you know low yeah so
[00:44:49] and the thing is too it's like people don't realize with anything too and this is where like
[00:44:54] questions and interviewing stuff is really important is if you don't tell us these things
[00:44:59] and this is kind of my problem with some massage therapy clinics or spas or whatever
[00:45:03] is like you just go in and lie on the table it's like my shoulder it's like all right let me hammer it
[00:45:07] um more it's like well you didn't look at my thoracic spine or how that rotates or my head rotates
[00:45:13] or like when and why it like activist has of all these different pieces like is there motor
[00:45:19] controls the village is like no just lie on the table and I'll take care of it's like okay but
[00:45:24] if you have these underlying things especially with pelvic floor going on like we can hammer your
[00:45:28] back all you want we can grind needle it we can manipulate it we can do all these things
[00:45:32] but yeah I'm not looking down there to see what's going on I can only ask questions and refer out
[00:45:37] but if you don't tell me these things and you you want to hide it because you're embarrassed
[00:45:41] you're gonna waste your time with us sometimes right and it's like you know five weeks in it's
[00:45:46] like hey you're not getting better it's like do you have anything else to tell me it's like oh actually
[00:45:49] yeah like this is a problem okay well right I can't really help you with that you need to go somewhere else
[00:45:54] exactly and we're not trying to get rid of you we're trying to get you the right professional
[00:46:00] that can address it more directly than we can yeah and I tell my patients all the time
[00:46:06] I love money I will gladly keep treating you as long as we have the same you know we're on
[00:46:11] the same page that the expectation of like some people just like coming in because it's an hour
[00:46:15] away from their kids or whatever and it's like but we're not yeah we're not trying to fire you
[00:46:20] because we just want to make sure you get what you need uh and then I know massage therapist
[00:46:26] all hear it is like well I don't know what's going on they'll ask like what's going on today they're
[00:46:31] like I don't know but you'll find something and well then they know that they're gonna go I'm gonna
[00:46:38] put them through the e-vail process and then I might have them do a couple of moves and
[00:46:43] watch their mobility you know that's why I know you uh one of the things is um frequency of massage
[00:46:51] sessions there are pluses and minuses um sometimes uh there is there is such a thing as too much massage
[00:47:05] really um for various reasons um what I like to tell my clients if I see you I hope I'm doing
[00:47:14] such a good job that I don't see you that often for the same thing um there may be instances where
[00:47:21] as you know they're limited on time and they want to they only have half an hour and I can't really
[00:47:26] address but I'm gonna pick the most important things for a half hour to address but I might have them
[00:47:32] come in two days later because well I could show you how to tape we could do this by video
[00:47:39] I need to shape your knee but you need to get the swelling down on this and blah blah blah whatever
[00:47:44] you know kind of they want to put it in parts and the only time they can come into short bursts then
[00:47:49] that's what we're gonna do and you're gonna come in a little bit more frequently but I try to taper
[00:47:53] people off if it's just for the same problem but there are people who are they they do so much they
[00:48:01] try to stay active and there's always something coming up and every time that they come in
[00:48:07] what's going on how are you doing and it sounds like a casual conversation but I'm really looking for
[00:48:13] what's the story today and what's going on like you should be um aware of your body you might not be
[00:48:22] very good at being body aware but you should have an idea of how you feeling because you should
[00:48:32] have a better sense of feeling you know after a session of anything you should feel better
[00:48:42] all right and uh do I have anything else here
[00:48:50] I think that was about it I think the last thing I wanted to throw out there just is
[00:48:55] yeah um
[00:48:57] um
[00:48:59] yeah so I guess it's like we said like we don't want to just send you to a massage therapist that's
[00:49:04] working at like an element massage where it's just come in get on the table leave like what should
[00:49:10] people people be looking for and and finding if they go good a massage I will start with this
[00:49:17] depending on what what it is that you're looking to accomplish with a massage therapist of why are
[00:49:24] you going there and what are you looking to get out of it out of the session um if you're an athlete
[00:49:31] I'm gonna say this and please hear me you want to make sure you're going to see somebody who
[00:49:38] can understand the athletic mindset and um the actively engaged body like an athlete's body
[00:49:46] I have had clients come from out of state like drive all the way from New York City to see me in my
[00:49:52] new Hampshire office all because um they had a procedure and they were a junior hockey player
[00:50:04] collegiate also collegiate hockey player drove all the way he had a hip procedure done by a
[00:50:11] I'll say general population orthopedic surgeon and it wasn't with a sports focused orthopedic
[00:50:20] surgeon and the procedure that was done was not appropriate for a performance athlete
[00:50:27] and he thought that I could do something to fix it externally um I explained to him um what could have
[00:50:36] what what I could have done but given whatever was done internally to the hip that that was
[00:50:42] that was it that's all the range you got like based on the procedure um but I I reminded him and
[00:50:50] I referred him to other athletic based um performance orthopedic massage therapist closer into New
[00:50:58] York City like go see these people because they will understand your schedule your demands on your
[00:51:05] body training schedule when to rest when to you know make sure to kick your ass to rest and make
[00:51:13] changes and how to work with your athletic coaches and strengthen conditioning people um and also have
[00:51:22] access to the modalities um that help you with recovery and and improve performance um if you're
[00:51:32] an orthopedic like you just had different replacements if you're a senior um there are massage
[00:51:39] therapists that specialize in geriatric and I don't want to use that word for people who have more
[00:51:44] life experience and there are things that the aging process does to the body that make it completely
[00:51:53] different um it requires a different approach I'm not saying that you have to be feathered and that's
[00:52:01] the only type of massage that you'll ever get when you're a senior um I had a senior who was like
[00:52:07] still black double diamond uh skiing in in Austria he was like a bird of a different kind at
[00:52:14] the scene at the retirement community and he wanted deep tissue and that's all he's he's ever
[00:52:19] gotten and we discussed all his medical conditions and I said but there's nothing that that tells me
[00:52:26] that I can't do the pressure or the style or the techniques that you want but if they presented
[00:52:35] with a condition that says nope you can't work the upper quadrant with any kind of moderate pressure
[00:52:41] of more than five grams then I'd explain why and they could decide whether or not to continue with
[00:52:48] pursuing me working with me as massage service and usually that's the case is that I am telling them
[00:52:53] the reason why I'm doing it and why I can't do it is for your safety and for your health
[00:52:58] and that's what you need to find in a massage therapist certainly all right Jess and where can
[00:53:06] people find you where do you work out of and where can people find you on social media and email and
[00:53:11] whatnot I have two locations where I currently practice I have a practice in Winchester, Massachusetts
[00:53:19] and the second location is Amherst New Hampshire my website is physiotherapyboston.com
[00:53:26] all one word and I have a Facebook page it's Jessica and for real LMT at physio therapy Boston
[00:53:34] and I think my Instagram is still my personal page but you could still look me up there I also have
[00:53:42] as I as Brett mentioned I did teach aerial circus arts for a time including aerial conditioning
[00:53:49] and that you could also find a Facebook and Instagram Cirque body LLC CIRQUE BODY LLC
[00:53:57] awesome thank you so much for coming on today Jess we really appreciate it and hopefully we'll
[00:54:02] be able to have you on again at some point absolutely thanks Brett no problem take care
[00:54:07] you too