Calculating Services for a Pre-Paid Event

Calculating Services for a Pre-paid EventThis question recently came in from a long-time chair massage practitioner:

Is there is a calculation for figuring out in advance how many people in a group (office, convention, health fair, etc.) will get a chair massage at a one-time event if it is offered for free? Say the employer or somebody else is paying for the service.

While I know of no formula or rule of thumb for that particular calculation, let’s reframe the question in terms of expectations. Whoever is paying for the massages wants to purchase just enough service so that the people expecting to receive a massage are not disappointed without paying for more massage time than needed.

So, what we are really looking for is both the number of people at the event expecting to get a chair massage and how high or low is their level of expectation. One way to gauge the level of expectation would be by classifying whether the event is open, closed or somewhere in between.

An open event is where there is a virtually unlimited number of people that could possibly get a massage, such as at a convention or street fair where chair massage is used as a traffic builder to get people to stop at a booth. In those situations, the expectation of getting chair massage will be relatively low.

A closed event has a fixed number of potential massage recipients, such as a one-time event in an office that might be used as a reward or incentive for the employees. In that case, the expectation of getting a massage would tend to be high.

Calculating Services GraphIn between open and closed events are other situations, such as health fairs, where people might know that there will be free chair massage, might want one, but understand that there are a limited number of massage slots available, so their disappointment will be tolerable.

Open events
The open event is the easiest one to schedule because it is based on the budget of the customer paying for the services. Once the budget is determined, say $700, that number is divided by your hourly rate, say $70 per hour, which gives you the number of practitioner hours they will be paying for, in this example 10 hours. If the event runs for 5 hours, you would make two practitioners available.

The next question is how long are the massage slots that the customer wants for the event: 5-minute, 10-minute, 15-minute, or longer. Dividing the number of practitioner hours by the length of each massage gives you the approximate number of massage slots. It is approximate because you will probably have to use some of those slots for practitioner breaks, if the length of the event is greater than 2.5 to 3 hours. I personally don’t like to do more than 3 hours of massage without a break.

To finish the calculation for this example, say the customer wants 10-minute massage slots. That would be 6 slots an hour times 10 hours for a total of 60 slots. Subtract two 20-minute breaks (4 slots, one for each practitioner) and you could guarantee the customer that you will deliver 54 massages.

While the event organizer may have advertised the availability of free chair massage in advance of the event and some people may be disappointed if they didn’t get a massage, they generally won’t hold it against the sponsor of the event.

Closed events
In a closed event there is typically a fixed number of people to be massaged. For example,  a company wants to thank each of its 100 employees with a chair massage for meeting a deadline. Here the calculations get a bit more complicated but, as a starting point, it is useful again to understand the calculation described above.

If each employee gets a massage in a 15-minute slot (4 slots per hour), then 25 practitioner hours will be required at a maximum cost of $1750 (if you are charging $70/hour). Since it is unlikely that all 100 employees will be able to get a massage (some will be sick, on vacation or just won’t want a massage), the next step is to make an estimate with the customer for the number of slots to schedule.

After you explain the calculation above, if there is a long lead time to the event, some customers will want to survey their employee’s interest to come up with a number, others will want to just make their best guess.

In any case, the number of practitioner hours you decide upon is what goes into the contract with the customer and that is how the schedule gets set. If the customer opts for a conservative number of slots and you have the flexibility, you could offer to add more slots if the original amount fills up quickly and they end up having a waiting list. That would have to be spelled out in the contract and agreed upon by the practitioners actually doing the massage.

In closed events there is often an implied guarantee that everyone who wants a massage will get a massage, so ensuring that both the customer and the recipients are happy is challenging. Thus, when you are working off a schedule, make sure that you have the extension number of each person scheduled in case you have to call to remind them of their appointment. If, on the day of the event, someone is sick, you can also offer to do double sessions if the event coordinator cannot otherwise fill in the slot.

Semi-closed events
A corporate health fair is a typical semi-closed event where generally a fixed number of people are expected but there is no guarantee of everyone getting a massage.

As in the first two cases, after you explain the basic calculation, you can help the customer to decide how many slots and what slot length they can purchase with their budget constraints.

A final word about scheduling
Customers like to get what they paid for, which means they generally don’t like to see practitioners standing around doing nothing. This can be tricky in situations where there is no pre-scheduling of the massage slots and recipients get taken on a first-come, first-served basis (often involving a clipboard).

In those situations, having some flexibility in the length of the massage is helpful. For example, often things are slow at the beginning of the event. That is a good time to give longer chair massages. As the number of people in line waiting for a massage grows, the practitioners can begin shortening their massages until the minimum slot-time agreed upon is reached. The goal should be to always have someone in every chair getting a massage, even if it is the practitioners working on each other.

Meeting expectations
Understanding the expectations of the customer and the massage recipients is key to repeat business and positive recommendations. Remember, customers come to you because you are the expert. Helping to clarify the decisions they have to make is step one. Now delivering a great massage is up to you.

A special shout out to Tom Darilek and Debra Rilea for their help in framing this question and response.

Posted in Chair Massage, Marketing | 2 Comments

Interview with David Palmer

David WMC VideoAt the 2013 World Massage Conference (WMC) David debuted his first webinar entitled The Future of Professional Touch.

After the presentation and discussion, they premiered a video interview that had been shot in April 2012. You can view it here. In it David describes some of the personal experiences that led him to the path of chair massage..

The WMC is unique in the massage world because it is a “virtual conference” streamed over the Internet and provides an easy way to acquire continuing education credits. You register once for each year (this year was the sixth edition) and have access to any of the live presentations in the June and November sessions.  You can also review the recorded version of each session to watch at your convenience and still get CE credits.

Check it out and register here.

Posted in Chair Massage, Politics, Videos | 1 Comment

Chair Practitioner as Wellness Coach

Massage Magazine May 2013 CoverThis article originally appeared in the May 2013 issue of Massage Magazine. The focus of the issue was on the business of massage and I was asked to respond to the question:

How can I best position myself as a wellness coach offering chair massage services to business?

Here is my response:
In a previous article I discussed why becoming a wellness coach is a good strategy for marketing workplace massage. To position yourself as a credible wellness coach for massage I suggest getting a credential and a good rationale justifying your services. The established wellness industry can give you the first and some revolutionary research the second.

Credentials
Formal training in wellness is often as close as your local academic institution, which may offer degrees or certification in health, wellness and fitness. A quick search will also put you in touch with related academic extension and online courses.

You can also access professional training and specialized credentials through non-profit organizations such as the National Wellness Institute or The Corporate Health and Wellness Association, both of which offer online and in-person training, certification, membership and conferences.

Both the academic and professional credentials are useful paths for getting a broad-based foundation in wellness and developing credibility as a wellness coach. However, you will quickly discover that massage is rarely found in the curricula of the mainstream wellness industry. In part, this is because of our deep-seated cultural phobia regarding touch. Specific prohibitions about touching are still routinely included in many corporate sexual harassment policies.

This absence of attention to massage by the wellness industry is also indicative of an absence of good data justifying the benefits of massage in the workplace.

It wasn’t until 2012 that the first (and as of this writing, only) textbook surveying the field of massage research was published (Massage Therapy: Integrating Research and Practice. Edited by Dryden and Moyer). With chapters on cancer, fibromyalgia, scars, sexual trauma, anxiety and depression, low back pain, neck and shoulder pain, headaches as well as special populations (pediatrics, pregnancy and labor, athletes, and older adults) it appeared that there was little evidence to construct a proactive rationale for massage in the workplace.

Fortunately corporate attitudes are in rapid transition and positive justifications for massage are appearing.

Corporate attitudes
Thirty years ago only in my wildest dreams could I have imagined a business conference entitled Wisdom 2.0 that would bring together leaders from some of the most successful tech companies (Google, Facebook, LinkedIn, Twitter and Cisco) together with academics, researchers, politicians and spiritual educators (such as Marianne Williamson, Jon Kabot-Zinn, Jack Kornfield) to discuss “how to live with greater wisdom, purpose and meaning.” Yet, that is exactly what happened this past February for four days in San Francisco.

Check out videos of some of these presentations. Listen carefully and you will hear the business jargon of future and it will contain words like presence, engagement, compassion and mindfulness and concepts such as conscious capitalism, the innovative mindset, places and spaces of intimacy and reclaiming our selves.

Another easy way to learn about the changing values in business is by tapping into the seemingly bottomless library of presentations offered up by TEDTalks (www.ted.com). One word you will hear over and over again in all of these discussions is connection. Companies want their employees to feel connected to themselves, to each other, to customers, to their work, to their communities, to their environment and even to the greater good of all humankind.

Of course, touch is the physical manifestation of connection and chair massage is a very safe container for a whole lot of touch. So, in the massage version of a wellness coach we are actually connection experts.

Revolutionary research
Why is massage so good at creating a sense of internal and external connectedness? In a word—oxytocin. In the past ten years, this hormone/neurotransmitter has risen from obscurity to take a leading role in the wellness narrative. Here is the short, somewhat oversimplified rags-to-riches story starting with some basic physiology.

The autonomic nervous system has two complementary branches: the sympathetic nervous system (SNS), which generally activates our fight or flight response, and the parasympathetic nervous system (PSNS) which generally promotes rest and recovery and makes us feel calm and connected.

We live in a sea of stress caused primarily by over-stimulation of the SNS. Too much noise, too many smells, too many people, too much work, too much email, too many perceived dangers. The fight or flight response, once the occasional visitor when a tiger crossed our path, has become a constant companion. This chronic stress response has been dissected in thousands of research papers and the conclusion is simple, we are overwhelmed physically, mentally and emotionally.

What has been studied far less, until now, is the PSNS that stills the waters and brings a sense of peace and calm, comfort and compassion, healing and health to our lives. Evidence is mounting that the primary chemical that triggers this parasympathetic response is oxytocin. Originally thought to be released only during childbirth and breastfeeding, oxytocin is now known to be produced by the pituitary gland of both males and females throughout our lives.

We also now know that the most efficient way to stimulate the release of oxytocin is through caring touch. This means that we have a scientific rationale for why massage makes us feel better that we can explain to companies and customers. For the last 25 years my key message was “Circulation is not optional” now it is “Oxytocin is not optional.”

When oxytocin kicks in employees feel better about themselves and each other, productivity and creativity increase because energy is no longer drained away by a hyperactive SNS, and the multiple health problems brought on by a chronic stress response are reduced, resulting in lower absenteeism and health care costs.

Conclusion
To become a serious wellness coach to business carrying the banner of massage, get a credential and become an oxytocin expert by checking out the pioneering work of Kersten Unvas Moberg (The Oxytocin Factor), Paul Zak (The Moral Molecule) and Dr. Gabor Maté (drgabormate.com). The latter two have some engaging videos on YouTube.

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Four Ways to Market Workplace Chair Massage

Outfitted with education, experience and selling points (see related article: 21st Century Workplace Seated Massage) for chair massage, how do you locate some likely business prospects?

1. Finding receptive companies can be as simple as reading the business section of the daily newspaper, or its online equivalent. Local business articles provide a wealth of information about new companies, growing companies and the changing circumstances of established companies. Make a list and call the CEO or human resources department of these companies to find out if they already have or are considering a program to support workplace wellness.

2. You can narrow your marketing even further by identifying companies who already have an interest in workplace wellness. Theresa Crisci of Total-balance Life Choice shows up every time her chamber of commerce invites local companies to describe their wellness initiatives at a health care council meeting. Invariably, four out of five of the companies will never even mention stress reduction as part of their wellness strategy, but are eager to hear her talk about it when she approaches them at the end of each meeting.

3. Piggybacking on firms that specialize in providing corporate wellness programs or Employee Assistance Programs (EAP) can save you a lot of legwork. Even if they don’t offer seated massage as part of their package of services, you can often get your foot in the door of local companies by offering to be part of the increasingly popular “lunch-and-learn programs where you can talk up the benefits of stress-reduction services.

4. The most targeted and cost-free marketing is word-of-mouth referrals. Yuki Takaishi, owner of Touch Wellness in San Francisco, California, found that former chair massage clients who had moved on to other companies would often encourage their new employers to incorporate chair massage services into the workplace. Friends, neighbors and religious or social club contacts can also help you advocate for wellness in their workplaces.

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21st Century Workplace Seated Massage

This article originally appeared in MASSAGE Magazine‘s October 2012 issue.

From the first days of professional seated massage in the mid 1980s, massage in the workplace has been a significant market segment. When my business was providing chair, or seated, massage at companies such as Apple Computer, the service was clearly positioned as a workstyle benefit that set progressive 20th century businesses apart from their stodgy, suit-and-tie counterparts.

While that motivation still exists and evolved, another trend has emerged, driven by a shift in the health care industry that, if seized upon, has the potential to completely reshape the face of massage and the workplace.

The tradition

For the past three decades, chair massage has ebbed and flowed with the growth and recession cycles of the economy. The high-tech and bio-tech sectors, in particular, typically lead the upswing and provide fertile ground for workplace massage. These companies are often created, managed and staffed by a younger generation more interested in quality of life issues. Benefits such as free meals, childcare, concierge services and massage therapy are often part of benefits packages.

Theresa Crisci, who has been doing workplace chair massage for nearly 20 years in Connecticut, identified a big shift in corporate attitudes over the past two decades “For the most part, we no longer have to worry about sexual harassment issues being a barrier for chair massage in the workplace.” Crisci believes that chair massage actually holds a certain cachet for the current generation of young people in the workforce and the companies who employ them.

Another two decade practitioner, Tom Darilek, owner of Seize the Day Energizing Chair Massage, in Austin, Texas, believes employers consider regular massage to be simply another tool for attracting and retaining top tech talent. Darilek also notes that in the past, while companies occasionally would give lip service to chair massage as a wellness tool, they basically treated it as a fad that would fade as soon as the economy began to tighten.

Now, there are significant signs that the wellness fad may finally be here to stay—and there is every reason to believe that chair massage therapists may benefit.

The revolution

The future of workplace massage is tied to the economics of health care policy. At long last, corporate, governmental and academic policy makers have come to the conclusion that a health care system whose primary focus is sickness care is doomed to bankruptcy. They have concluded the ultimate foundation of an economically viable health care system has to be prevention and wellness.

This radical paradigm shift is stamped indelibly into the Affordable Care Act (ACA) of 2010. While the media and partisan politicians were obsessing about the constitutionality of ObamaCare and its new framework for financing health care, mostly overlooked was the fact that the 954-page ACA legislation specifically “directs the creation of a national prevention and health promotion strategy.”

The law created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), composed of the heads of 17 Federal agencies and chaired by the Surgeon General. This high-level federal action group works closely with a 25-member Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, also mandated in the legislation. Both of these groups are developing plans and recommendations that will impact every strata of society, including workplace wellness.

Happily, massage therapy has a seat at the table of this health care revolution. One of the members of the Advisory Group is the esteemed Janet R. Kahn, Ph.D., a 30-year massage professional and the director of research of the Massage Therapy Research Consortium from 2003 to 2008. Her background in massage and integrative health makes her an ideal advocate for the inclusion of massage as these panels refocus the health care system on prevention and health promotion, two areas in which massage excels.

The National Prevention Council and the Advisory Group have already targeted the workplace as one of the primary arenas for implementing this new strategy. I will make the case that seated massage is ideally suited to lead the way in workplace wellness. Then, armed with a clear idea about how to describe and position the unique strengths of chair massage, I will make a few practical suggestions about finding companies ready to hear the message of chair massage.

This might be a good time to note that, while most of the following rationales could also be applied to table massage, the twin barriers of time and money make chair massage a far better fit for the vast majority of workplaces. Experience has shown that, in general, only the very largest companies include the option of table massage in their menu of wellness services.

The prevention intervention

The medical community has traditionally limited prevention to proven clinical screenings—mammograms, colonoscopies, blood pressure screenings, treadmill tests and the like. In the new health care model, prevention also includes dealing with lifestyle and pre-clinical conditions, a particular strength of chair massage.

Seated massage has always been good at preventing little problems from becoming big problems. The reason someone wakes up with a crick in her neck is never because, as she might claim, she “slept wrong.” Rather, it is because of weeks or months of accumulated psychological or physical stress finally reaching a tipping point that resulted in a muscle spasm. Regular chair massage alleviates the results of these minor stresses and prevents muscles from reaching that involuntary contraction threshold.

Too much mental stress is the primary or secondary cause of many medical conditions as well as an inhibitor to healing virtually all injury and disease processes. Most people will agree that high-quality chair massage is an instant stress reducer. While we don’t yet know all the exact mechanisms involved, there is sufficient scientific evidence to support the claim that massage is effective at reducing anxiety and depression.

Human beings were made to move. When employees are immobilized by their jobs at desks and keyboards, their bodies will eventually break down and rebel. The coin of movement has two sides: active movement where people move themselves, which we call exercise, and passive movement where someone else creates the movement, which we call massage. Regular seated massage moves the tissue, which enhances circulation, which lets the body’s own self-healing mechanisms work most efficiently. Neither movement nor circulation is optional and chair massage provides a heaping serving of both.

Immobilized bodies that don’t move result in what Thomas Hanna, the great somatics pioneer, more elegantly termed sensory-motor amnesia. That is to say, chronically contracted muscles which eventually stop giving feedback to the higher cortex of conscious awareness. When this happens we are no longer able to feel the imbalances we have created and we begin to think that our bad posture is normal.

Seated, or chair, massage restores the mind-body connection and we feel better in two important ways: First, we feel the relief of the multi-tiered rebalancing that comes at the end of a massage; second, our capacity for experiencing sensation inside our bodies increases.  We can now feel more and we can feel better. If we are not getting accurate feedback about the state of our health, we see no reason to change. Massage restores that feedback loop and shows us that we have control over how we feel.

This enhanced self-awareness brings us to the second set of rationales for seated massage in the workplace.

Making wellness work

Advocates of wellness and health promotion know in order for the health care paradigm to shift from treatment to prevention, people must be motivated to make significant lifestyle changes.

We have known for decades that five chronic diseases–heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes–are responsible for more than two-thirds of all deaths in the United States. We also know the progression of all these conditions is heavily influenced by lifestyle. Studies have repeatedly shown we would save billions of health care dollars every year if we ate better, exercised more, reduced chronic stress and didn’t smoke.

So why haven’t we change our lifestyles? Because change requires effort and motivation.

One of the unique aspects of chair massage, unlike any other workplace wellness modality, such as smoking cessation, dietary modification, exercise, Yoga or meditation, is it requires no motivation to change. It works immediately with no effort or intervention required on the part of the recipient. With massage, people also come to realize that they have far more control over how they feel than they ever imagined and thus become more motivated to change.

The frosting on the cake is that chair massage also supports every lifestyle change. No matter where you are on the spectrum of wellness, from couch potato to super athlete, if you want to break a habit, start a new one or support any transition in your life, adding massage will immediately make you feel better and positively reinforce your efforts.

Finally, seated massage is the most egalitarian of all wellness programs. You don’t have to be overweight or a smoker or have high blood pressure or even be stressed out to qualify and benefit from regular massage. The only ultimate contraindication for massage is an individual’s reluctance to be touched.

A major transition

Chair massage in the workplace is at a moment of major transition. In the emerging health care economy the time is right to position yourself as a serious wellness consultant who provides massage services. There has never been a better time to showcase the benefits of massage and create a true health care system, one body at a time.


For further marketing tips, check out Four Ways to Market Workplace Chair Massage.

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On the Side of Angels

There is a successful company in Australia, 3-Minute Angels, that started in 2002 providing 3-minute chair massages in pubs and clubs for free. Customers would pay whatever they thought the service was worth. Today the business has grown into a more conventional chair massage provider with hundreds of practitioners offering 5- to 15-minute massages at events and in the workplace.

A similar company in Europe, Ibiza Angels, has trained 200+ massage practitioners to perform 7-minute massages in exclusive night clubs and at high-end entertainment and sporting events.

What both of these companies of “angels” have in common is that most of their practitioners never went to massage school. Indeed, the initial massage training for both businesses is accomplished in about one day.

I can almost hear the outraged grinding of teeth in American massage schools, associations and businesses where the current standard in most localities requires that practitioners go through a minimum of 500 hours of table massage training before they can make a living doing chair massage.

“One day of training? These practitioners are a danger to the general public. In pubs and clubs? This will only lower the status of massage professionals and undercut the ability of massage “therapists” to make a living.”

We have seen the enemy and he is us. – Walt Kelly

I recently returned from two weeks working in Paris and London where, once again, I was struck with how out-of-sync North America chair massage training is with much of the rest of world.

In both England and France, people routinely take one day courses in chair massage and begin to work professionally. In fact, for the vast majority of countries in the world short courses in chair massage (under 100 hours) is the rule, not the exception. Some of the training is done by businesses training potential workers, such as Ibiza Angels. Other courses are offered by private trainers or schools. Consequently, chair massage is thriving.

Why is North America so different? I would argue that the problem stems primarily from the decision to define all “massage” as “massage therapy.” I have discussed the background of that decision extensively in other articles, but essentially, when you opt to define a profession such as massage as primarily a health care service, you automatically raise the training bar to a high level. After all, virtually all health care professions require a college degree plus some form of post-graduate training.

As I watched both Presidential contenders extol the wonders of a free market economy during the debate last night, it occurred to me that our industry could benefit substantially from that approach.

It’s not that chair massage was over-regulated in North America, its more that chair massage simply got swept up by the regulations that were already in place for table massage. There is currently no separate regulation for chair massage and there needs to be.

The idea that you must learn 500-hours of table massage before you can learn chair massage is patently absurd. The reverse makes far more sense. All practitioners should be required to learn chair massage before they learn table massage. It is chair massage that is entry-level for both practitioners and customers, not massage therapy. Learning chair massage first would be a lot less expensive way for students to determine whether they should invest thousands of dollars learning table massage.

In countries where there is little or no regulation of massage, most massage is inexpensive chair or foot massage. That is what the public wants and that is what they can afford. The reason that less than 5% of the U.S. population get regular massage is to a great extent because the regulation of chair massage is conflated with the regulation of table massage. Chair massage needs to be regulated separately to meet the pent up market demand for convenient and affordable professional touch. Better yet, let’s just exempt chair massage from all regulation. Here’s how.

To extract chair massage from table massage, you have to define it. Here is my definition:

Chair massage is non-remedial massage done on seated, fully clothed customers, performed on the upper body above the waist or on the lower legs (from the knees down), in an open, public space.

Note that this definition also includes foot massage as long as the customer is seated and it eliminates the problem of prostitution because it does not allow massage behind closed doors in private rooms. Note also that this excludes massage therapy/treatment from the chair. Only  massage with a wellness, prevention, or relaxation intention is allowed.

If this exemption was amended to every current massage law in the United States and Canada, our industry would explode with new businesses providing services to millions of new customers who would get in the habit of including a massage in their health lifestyle. A good portion of these new customers would then graduate to table massage and massage therapy ensuring our professional growth for decades to come.

Change is not easy

I understand that what I am proposing is not easy, but I do believe it is the only sensible course if we want to make massage truly accessible to everyone. The only reason we have massage regulation is to distinguish therapeutic massage from adult entertainment massage. But a clear and simple definition of chair massage eliminates that concern. Nobody mistakes chair massage for prostitution.

The only other rationale for regulating massage—that it is potentially dangerous—has never been demonstrated. To the contrary, the insurance companies who track these risks would never offer $4 million annual professional liability policies for less than $100 wholesale if there was a significant potential of harm to the customer.

Personally, I am not a fan of one-day training courses in chair massage. However, if a business can provide a chair massage service that people will buy, then why not let them? Just don’t let them call it massage therapy.

Unshackle chair massage and let it grow as it has in the rest of the world. The marketplace wants safe, convenient and affordable massage. Let’s finally let them have it.

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How Culture Mediates Massage

Whenever customers sit in my massage chair, I know that their subjective experience of my touch will be the result of at least four factors:

  1. Their genetic profile (Are they male/female? Do they have biological disorders such as autism).
  2. Their personal touch history (Have they had massage before? Have they experienced healthy touch or abusive touch in the past? Have they experienced touch at all?).
  3. The attitudes and experiences with touch they had in the family (Were they breastfed, or not? Was their family highly affectionate, or not?).
  4. The customs and attitudes toward touch that are emphasized by the culture in which they are immersed.

This fourth element is the subject of this article. As the world continues to shrink and multi-cultural societies becomes the norm rather than the exception, understanding the cultural environment in which a customer was raised is crucial to healthy professional touch relationships. In this article I will give two examples of how culture affects how we touch.

Defining pain

I began my massage career in 1980 working at Kabuki Hot Spring, a spa in San Francisco’s Japantown. I was the only Caucasian male working in a sea of mostly Asian, mostly female faces. While I had been trained in traditional Japanese massage at a school that was run by the owners of the Hot Spring, a majority of the other practitioners had been trained in Japan. It was at Kabuki that I began to understand why Japanese massage had gotten a reputation in the United States as “beat-me-up” massage.

While the Kabuki had private rooms, most of the customers availed themselves of the public baths and the communal massage room, which had 14 massage tables lined up in an open space. Doing massage alongside Japanese practitioners introduced me to what I have since come to understand is a differentiation in how cultures define pain.

I would regularly notice a poor customer at another table squirming uncomfortably under the strong thumbs of a Japanese colleague. If the customer tried to get the practitioner to ease up they were likely to get a slap on the back and be commanded to, “Relax! Relax!”

In the immortal line from Cool Hand Luke, “What we got here is a failure to communicate.”

In Japan, China and many other Asian cultures, if you are feeling a strong sensation while getting a massage, you are happy because you believe the massage is working. In the West, we often interpret the same strong sensation as pain and we think it is a bad massage.

The Japanese practitioners I was working alongside were clearly mystified that anyone would want a lighter massage. From their point of view the problem was not that the massage was too strong, but that the customer was resisting the benefits. To the American customers, the massage simply hurt.

This mistake is still being perpetuated by the flood of Chinese immigrants providing chair massage in malls throughout the U.S. Nobody has taught them that they need to regularly ask their customers for feedback about the pressure and there is often a serious language barrier making it difficult to do so.

For my part, every time I have someone in my massage chair born in the Far East I keep that cultural difference in mind. More often then not they like pressure on the strong side of the spectrum. In all cases, of course, I ask for feedback.

The French form of connection

I use a martial arts approach to teach massage through “Katas,” highly choreographed sequences of select acupressure points and Japanese massage techniques.

Over the years hundreds of people have used my DVDs and other curriculum material as the basis for training thousands of chair massage practitioners around the world. Last year, for example, I discovered that my basic chair massage Kata was famous in France and literally thousands of practitioners were using some variation. They even have a name for it: the Amma Kata.

When I saw a video of one chair massage trainer demonstrating his work, I was amazed. He had been trained by a person who had been trained by a person who had been trained by me. Despite this fourth generational relationship, I was impressed that my original Kata was plainly visible.

What caught my eye, however, was not what was similar, but what was different. The trainer had added two full minutes of slow, deep, luxurious scalp massage at almost the end of the 15-minute sequence.

Recently I had an opportunity to meet with this trainer, Xavier Court, in Paris and spend a week working on the Kata with him and the other trainers working with him. When I experienced his head massage in a chair, I loved it. He had given thousands of chair massages to French people in the workplace and at events and was convinced that the additional work on the scalp was essential to a satisfying experience for his customers.

I explained to him that, in the United States, we had almost exactly the opposite experience. If there is one part of the massage that people most often ask us to leave out, it is the scalp. Here it seems that customers want us to get to the parts of the body that they perceive “need” the work—most often the neck, shoulders and back. If we spent two minutes “just” doing the scalp, people would feel like they were not getting their money’s worth.

In France, on the other hand, there is a cultural recognition that deep relaxation is a goal in and of itself. This is the land dedicated to the 35-hour workweek, five weeks of annual vacation and dinners that don’t start until 9 p.m. Unlike its neighbors to the north (Germany, Netherlands, England, Scandinavia), France is an essentially Mediterranean country with all of the sensuousness and slow pace that implies. It was truly an eye-opening experience that reminded me of an analysis by Virginia Postrel about what is missing from American attitudes toward massage.

What do you see?

These examples highlight the need for cultural sensitivity when doing massage. There are many more differences in cultural perceptions of massage most obviously ones that stem from cultural attitudes and norms about touch and sexuality. Please share your cross-cultural insights in the comments section below.

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Positioning for a Chair Massage Without a Massage Chair

I love to introduce people to massage. I have massaged people in restaurants, on airplanes, at dinner parties and even outdoors in parks. When I go to visit my family on the East Coast, I consider it my pleasure to gift them with massage.

If I want to do a thorough job of it, I like to give a complete upper body massage. But what if I don’t have my massage chair handy? This 3-minute video demonstrates how to position massage recipients over a table top so that they are comfortable and you are able to access all parts with ease.

Of course, the other option for my family was to finally buy a massage chair that stays on the East Coast permanently.

Posted in Chair Massage, Videos | Tagged , , | 4 Comments

Viewing Massage Through a Holonic Lens

One of the critical topics in the massage community is how to define and label what we do. How we define massage influences how we market our services, how we regulate them and how we educate new people coming into our profession.

Like the classic tale of the blind men trying to describe an elephant, how we define massage, to a great extent, depends on where we are standing. Massage is a very big elephant with many facets. So, when we talk about massage, at the least, we need to talk about where we are standing so we can also frame the limits of each perspective and how it relates to every other perspective.

Since 1998, I have been a student of integral theory, which presumes that every perspective is true but partial. The integral approach thus allows for an infinite number of perspectives while, at the same time, providing a framework that allows us to carefully examine and map, in this case, all dimensions of massage.

This article is the first in a series that will analyze massage from a wide range of perspectives using the integral framework. Each analysis will define a lens through which to consider the rich tapestry of massage. The first lens I will use is called the holonic perspective.

The holonic lens defines that every aspect of existence is at once both a whole and a part—a “holon.” Writer/philosopher Arthur Koestler coined the term holon in 1967 and called the hierarchical ordering of any sequence of whole/parts a holarchy.

For example, a human holon is composed of many organ parts. Each organ holon is composed of cells; each cell is composed of molecules; molecules are composed of atoms; atoms of particles and so on. This article is a holarchy starting with letters that make words that make sentences that make paragraphs that make the article.

Each fundamental holon can stand on its own but, when combined with other holons, more complex, more significant holons emerge. That is to say, a holon is not merely the sum of its parts. Each holon transcends and includes the previous structures. While a cell is composed of molecules, it also transcends cells to form a higher functioning, more complex structure.

This concept is imbedded in the origins of the Holistic Health movement that emerged in the 1970s. That movement was a reaction to the reductionism dominant in the specialization of mainstream medicine for most of the 20th century that treated only parts of people, not the whole person. Indeed, one of the reasons I was drawn to massage and bodywork forty years ago was the fact that its resurgence was driven by people committed to a holistic understanding of the body/mind.

There are many holarchies we can study in massage. I will give two examples in this article, one that looks at the physical, objective exterior of massage and one that considers an interior, subjective perspective. In future articles other holonic analyses will emerge.

A Massage Exterior

A complete professional massage holon is composed of a series of sequences or protocols applied to various parts of the body. Which sequences are selected (location) and how much time we spend on each part and in what order (choreography) has a lot to do with how we define any particular massage.

For example, foot reflexology, chair massage, Indian head massage, sports massage, remedial massage, and full-body Swedish or acupressure massage each select their locations and arrange their choreography very differently.

Each holonic sequence in a massage is a composition of various techniques that can be categorized into dozens of variations on compression, friction, stroking, holding, kneading, lifting, movement and mobilization, percussion, and vibration. These techniques and sequences, combined with a clearly defined intention and/or theoretical framework and/or worldview is what defines a particular massage modality.

Finally, every technique holon is composed of touch. Professional massage is a physical connection to and through the skin of the recipient. Most of the time this is done by the hands of the practitioner but can also include the intermediary of massage tools manipulated by the practitioner.

So, to summarize this analysis of massage we could say that fundamental to all massage is touch. But the particular kind of touch in a massage is not casual, accidental or spontaneous. Rather it is the trained touch of definable techniques. These techniques, in turn, compose the sequences that, informed by specific intentions, create what we call a massage.

A Massage Interior

One subjective (interior) analysis of another holarchy inherent to massage might point to the fact that every massage is fundamentally a relationship holon.

While there are many kinds of relationships (e.g. mathematical, organizational, mechanical), in massage the relationship is interpersonal, i.e. between two people.

Within the universe of all possible interpersonal relationships, massage is not a parental relationship or a friendship, but I would suggest it falls in the category of service relationships.

The kind of service that we provide, as noted in the first section, is fundamentally touch which, by definition, means that this service is one that requires physical intimacy.

So, we could summarize this point of view by saying that massage is subjectively experienced as an intimate, interpersonal, service relationship.

Practical Value

These two holarchies point to the internal and external constructions of a massage. Understanding that fundamentally massage is objectively about touch and subjectively about intimacy is critical to the health and growth of our profession. While these should be our primary areas of expertise, by and large, both of these aspects have been increasingly relegated to the shadows of our profession.

With the transformation of “massage” into “massage therapy” we have left behind the philosophical roots of the holistic health tradition.

Consequently an ever-increasing number of students are allowed to graduate from massage programs without knowing how to give and receive touch nor deal with the intimacy inherent in a touch relationship.

The latest striking example of touch-denying in our profession comes from the two surveys currently circulating in the industry—the FSMTB Job Task Analysis Survey and the companion Entry Level Analysis Project. Both are part of the attempt to define entry-level skills for our profession. Between the two, the word “touch” appears exactly one time. Of course the term “intimacy” does not appear at all.

Our refusal as a profession to embrace touch and the intimacy it represents by sterilizing it under the guise of massage therapy is clearly leading us down an unnecessarily self-limiting path. [See the related article Moving from Acceptability to Accessibility.] Our virtual culture is increasingly debilitated by the lack of authentic human validation and connection. We hold an answer literally in the palm of our hands. Let’s give people what they crave.

Posted in Bodywork, Business, Education, Politics, Touch | Tagged , , , | 2 Comments

The Canyon Ranch Think Tank

Have you every wondered why the National Certification Board of Therapeutic Massage and Bodywork (NCBTMB) has such an awkward name? What’s with that business of “Therapeutic Massage and Bodywork?” Couldn’t they have stopped after the word “Massage?”

You can credit a fascinating but mostly forgotten piece of massage history, The Canyon Ranch Think Tank, for making certain that “Bodywork” was included in the name.

Canyon Ranch, located in Tucson, AZ, was one of the first of a new generation of high end spas in the late 1980s  looking to transform the image of “fat farms” into “wellness centers.” Founded by Mel and Enid Zuckerman in 1979, within ten years it was a recognized innovator in the spa industry and was spreading its message of wellness and integrative health through its non-profit arm, the Canyon Ranch Foundation.

It was this foundation that brought together a group of 13 independent bodywork leaders for four days in September of 1989 “to explore issues critical to the emerging bodywork professions. They were to examine some of the unifying characteristics of touch professionals, and the objective of this particular meeting was to study and contribute to the evolution of the core terminology.”

What this came to mean for the participants was a search for “THE WORD,” an umbrella term under which all skilled touch professions could unify. After hours of intense discussion, the word settled on was, you guessed it, “Bodywork.”

Interestingly, at that time, there were only three serious contenders: “bodywork,” “massage,” and “touch therapy.” Significant in its absence was the term “massage therapy” which, arguably, could be said to have actually won the terminology battle, at least within the mainstream massage community.

Indeed, probably the only specific impact the Think Tank actually had was making certain that the NCBTMB, whose development was spearheaded by a number of Canyon Ranch participants, included the term “bodywork” in its name. I have always used “bodywork” as my meta-term for all touch modalities and still thinks it makes the most sense.

If you are interested in reading the full report, including the formal definition of “bodywork,” you can download a PDF here.

If you would like to read more about why “massage therapy” dominates the terminology in our industry today, check out this related article.

Posted in Bodywork, Education, Politics | Tagged , , , | 1 Comment

Haptics: The Science of Touch

Last week I saw a commercial for the new Cadillac XTS that featured an innovative touch technology called the Safety Alert Seat. The system sends vibrating pulses to drivers through the seat cushion if they drift out of their lane without a turn signal activated or if there is threat from the front or rear, such as when backing blind out of a parking space.

“It’s akin to someone tapping on your shoulder in a crowd to get your attention,” said, General Motors Active Safety Technical Fellow Raymond Kiefer. “Using the tactile sense to communicate crash threat direction provides an effective and intuitive way to cut through the clutter of visual and auditory sensory information that drivers routinely experience.”

Cool!

Chart comparing Massage to Haptic research

Number of annual peer-reviewed research papers.
Source: EBSCOhost

This technology had been developed in a field of touch research that I have been following for the past 15 years called “haptics,” derived from the Greek word meaning “pertaining to the sense of touch.” Thus, if you are studying touch, you are studying haptics.

Since the only thing that all 100+ modalities of massage and bodywork have in common is that they are all based on touch, it would seem only natural that the massage industry would have a close association with the folks doing haptic research. Unfortunately, that is not the case. Even the recently published groundbreaking textbook on massage therapy research (Massage Therapy: Integrating Research and Practice) makes no mention of haptic research.

As noted in the accompanying chart, annual research in massage has actually leveled off in the past five years while annual haptic research surpassed massage research ten years ago and continues to grow steadily each year.

Who is doing haptics research?

There are scores of companies developing products based on haptics research. Many do their own research and others partner with academic institutions such as:

Disney Research is an example of a major corporation investing in touch research: Surround Haptics – Immersive Tactile Experiences

Why are they doing haptic research?

Most research in haptics has focused on extending the human ability to reach, explore, grasp, manipulate and get feedback from the world around us. Applications can be found in robotics, prosthetics, remote medicine and surgery, hazardous environments, manufacturing, communications and education.

Closer to home, the phone vibrating in your pocket and the joystick on your gaming console are both a result of haptics research.

In the future, haptics will become an essential aspect of virtual human interaction in such arenas as business meetings and classrooms. Sound waves are being studied for their ability to mimic touch making virtual handshakes within the realm of possibility.

How is this important to massage?

Since massage and haptics have never interfaced with one another, at first glance, they may not appear to have much in common. But that is definitely not the case. Here are some reasons why we should be working together.

Defining touch

One of the outcomes of haptics research has been to define the discreet constituents of touch mechanics (movement, friction control, vibration, contact force, pressure, duration) and to develop models for discriminating texture, softness, ridgidity, temperature, moisture, shape, proprioception/orientation and weight/heft.

All of these components are critical to massage and thus essential to informed massage education, practice, evolution and research.

Standardizing touch

A serious flaw in virtually all massage research to date is the lack of standardized protocols. “Subjects received ten-minutes of massage to the lower back,” is not a particularly useful sentence in a massage research paper because it is difficult, if not impossible, to duplicate.

We need to define a common vocabulary of touch far beyond effluerage, petrissage and tapotement. Iris Burman and Sandy Friedland made an attempt in their book TouchAbilities: Essential Connections, but far more refinement is required.

One of the reasons that I feel fortunate that my massage modality is Japanese acupressure is because there is a built in precision to the acupressure points, the channels they lie upon and the techniques that are used to stimulate them. I am a big fan of quality control in massage, so I also teach chair massage as one would a martial art, that is through “Katas,” highly choreographed sequences of techniques, point locations and body mechanics. The kata model is one of the few in massage that allows for high standardization of protocols.

Touch tools

As haptics has defined the parameters and functions of touch, out of necessity the field has also had to develop tools that apply and measure each aspect of touch. These tools can obviously be used by massage researchers to apply standardized touch, measure touch or used as controls in touch research.

The biology of touch

Haptics is as interested in the anatomy and neurophysiology of touch as is massage and they have the money to pay for functional MRIs. We need to be monitoring their work, sharing information and cross-fertilizing our fields.

The psychology of touch

Research into how haptic aspects affect the psychology of gaming (the thrill of driving on that racetrack), computer shopping (where you can feel the texture of the skirt you are viewing on your monitor), and mutual virtual touching continues to expand. Investigating the psychology of touch is in its infancy and the massage industry needs to be accessing research and resources wherever we can.

Massage is poor; commerce is rich

The massage industry has suffered from an inferiority complex (fighting a negative public perception) and consequent lack of imagination for decades. Because of our fear of embracing touch (see related article), we have allowed commercial interests outside of the profession to charge ahead with a touch research agenda that is almost totally off the radar of the massage industry.

The massage industry should be in the middle of all touch research, not standing on the sidelines. It is time to take off the blinders and begin dialoging and collaborating with the commercial and academic interests who are spending millions of dollars researching touch.

Let’s get in the driver’s seat, folks!

Posted in Science, Touch | Tagged , , , | 3 Comments

Introducing Touch

Whenever I am in an unfamiliar room, full of people I don’t know, my shy parts come out. I feel isolated, vulnerable and fearful and immediately begin looking for the nearest exit.

However, I also know that the best thing to do is to force myself to go up to someone in the room and introduce myself. Once I have made a connection with another person, my shy parts start to relax and my more social parts start to take charge.

For many people about to get the first massage of their life from a stranger, often in a strange environment, the situation is many times more scarier. These are the people we often encounter when doing chair massage.

That’s why it is crucial that the massage practitioner takes the initiative to quickly make new customers feel welcome. I walk toward the customer with my hand extended, greet the customer by name and introduce myself while shaking their hand. Then I lead them to my massage chair.

The handshake is important because it is the first step in our physical touch relationship and, for most people, a handshake represents safe touch. Stepping forward first is a way to let them know that you resonate with their vulnerability and are willing to step into their space, before they step into yours.

There is generally a lot of verbal interaction that goes on in the first 60 seconds of that relationship. Most importantly I want to know about the customer’s previous experience with professional touch. “Have you ever had a massage before?”, “Have you ever had a chair massage?”, “Have you ever had an acupressure massage?” are all questions that will give valuable information as to their comfort level with touch.

Secondarily, with new customers I want to always ask for and receive permission to touch specific parts of their bodies. “I am going to work on your shoulders, arms, upper back, lower back, neck and scalp.”

As I mention each body part I touch the same area on myself. I find that helps slow me down and not make the introduction sound so much like a rote recitation while, at the same time, giving customers two sensory pathways through which to absorb what I am telling them. Remember, these folks are often nervous and overwhelmed. My job is to help them gain a sense of control. I do this by clearly outlining the structure and content of our relationship.

After I have described where I am going to be touching, I ask them if there is anyplace in their upper body where I need to be cautious, where they have aches, pains, strains, cuts bruises, rashes, injuries, surgeries or the like.

This is their cue to inform me of any musculoskeletal issues that I need to know about, but also the point at which they can ask me not to touch certain areas of their body, if they choose. The most common area that people mention not wanting touched is their hair or scalp.

After I have asked for and received permission to touch specific parts of their body, next I need to know how to touch those parts. Since I do traditional Japanese massage on a sequence of acupressure points, for me that mostly means making certain that my touch pressure be appropriate.

I always verbally give customers permission to give me feedback about my pressure. “If at any time during the massage anything feels uncomfortable, you will let me know, all right?” After getting their assent, I also tell them, “You are going to be in charge of the amount of pressure that I use. When I start working on the acupressure points, I am going to ask you for feedback about the pressure.”

This is an important piece. It is not enough to give people explicit permission to give you feedback; you must also make them practice giving you feedback so they will know you are serious about having them control their experience.

When I start working on the first line of acupressure points, I ask something like, “How’s the pressure? Would you like more, less or should I keep it about the same?” It is important to frame it as a question so that your customers are forced to commit to a response and take responsibility for their bodies.

Many people are so out of touch with their bodies that they have no frame of reference from which to respond. Or, since they perceive you as the “expert,” customers sometimes believe that you have some magic ability to know what the perfect pressure will be for their body.

Thus, I may add any of the following explanations to the mix for further clarification:

“The pressure doesn’t have to hurt to be effective.”

“We are looking for enough pressure so that your body want to go, “Ahhh…” but not so much pressure that it wants to go, “Ow!!”

“Any amount of pressure will activate circulation in the area.”

“It is not a no pain, no gain situation.”

“This massage is not supposed to hurt. It is supposed to make you feel better, not worse.”

And, as my friend Ken Bridgman notes: “Unlike Bill Clinton, I can’t feel your pain, so you are going to have to tell me if it hurts.”

Here are a couple of other notes about solidifying the touch relationship during a massage.

  • For new customers, depending on the length of the chair massage, I will ask for feedback about pressure 2 to 5 times during a massage.
  • Anytime I get feedback from a customer I always thank the person for letting me know.
  • If I get the pressure wrong on one side of the body, I always ask for feedback when I get to the same section on the other side of the body.

If you have any other suggestions about how to make people comfortable receiving touch from a stranger during a chair massage, leave a comment below.

Posted in Chair Massage | Tagged , , | 3 Comments

Animate Your Support

A good way to add value to your services is by passing along useful information to your customers. YouTube is a great source of short, well-produced videos that are free for the linking.

My colleague, Russ Borner, sent along one such link that I have put up on the part of the TouchPro website that sells our local on-site services for the workplace. It is a two-minute animation that hits all of the major points about the important ergonomic considerations while sitting at a computer keyboard. I particularly like the fact that it uses no words, has just the right amount of humor. Check it out below.

Every website is enhanced by a Resources page with links to videos and articles that your customers will find valuable. Leave links to your favorites in the comments section below.

Posted in Business | Tagged | 2 Comments

Micro-Movements

Since I work primarily at home, I spend at least an hour a day in the kitchen. Most of the time I am fixing a meal, but sometimes I am just warming up water or leftovers in the microwave.

The minute or two while I am waiting for the timer to ding is a great time for a fitness moment. Even my relatively tiny kitchen contains all of the essentials tools for a brief workout: a counter and a doorway.

Check out this three-minute video for suggestions about turning your microwave moments into a micro-movement program.

This video that is part of my Fitness Lifestyle approach that I encourage my customers to adopt. Feel free to link the video on the customer resources section of your website.

Posted in Fitness, Videos | Tagged , , , | 1 Comment

The Travolta Clause

When John Doe #1 recently filed suit over John Travolta’s wandering hands in the massage room my immediate reaction was, “Well, there goes the first shoe.”

Sure enough, over the next few weeks other massage practitioners came out of the woodwork testifying to similar experiences and the tabloid press went into overdrive. At last count, the number of  accusers was up to five.

In the massage industry this was old news. I heard from practitioners over a decade ago who had Mr. Travolta as a customer and told essentially the same story. With a little bit of discrete asking around as I traveled the country I found out he had a well-deserved reputation of a celebrity to avoid in the massage room as did a number of other high profile, famous folks. Ho hum.

However, the suit did bring to mind the question about the potential fallout of reporting customers who propose illegal activity to massage practitioners. After all, if someone on the street solicited sexual services in exchange for money to an undercover police officer, that person would be arrested.

So what happens if a practitioner reports illegal sexual advances from a customer to the police? I was particularly curious as to whether our two primary professional liability insurance organizations would support the practitioner. So, I put the question to the American Massage Therapy Association (AMTA) and Associated Massage and Bodywork Professionals (ABMP).

Specifically, I wondered:

  • Do they encourage such reporting?
  • Does their liability policies support such reporting?
  • What if the customer sues the practitioner for defamation?
  • Will they defend a member against such a suit?

So, I asked and got prompt responses from both organizations. First, from Ron Precht, Communications Manager of AMTA:

AMTA has always encouraged massage therapists to protect themselves, if they feel they are in danger or feel a client has put them in an unprofessional position.  That includes reporting incidents to police, when the massage therapist feels threatened.

The personal injury portion of the AMTA insurance policy states that injury arising out of offenses of libel and slander are covered when committed in the conduct of the enrolled member’s professional services. So, yes, the policy is intended to defend insured members when they are named in lawsuits alleging libel or slander arising from their provision of massage therapy services – such as when reporting a client for illegal sexual advances. Of course, the facts and circumstances of each claim are unique, so coverage can only be assured after evaluation of the specifics of a claim or lawsuit.  If it was found that the insured member lied or intentionally disparaged another, coverage would be excluded.

Next, from Les Sweeny, one of the owners of ABMP:

Regarding reporting advances, we are strongly in favor of it; we want our members to act in their own best interests and safety, but to help identify inappropriate behavior. If a customer were to sue a member for slander/defamation, the insurance policy included with membership would cover the cost of defending the member.

So, the upshot is that both the AMTA and ABMP policies contain a “Travolta Clause” protecting their policyholders if they report a misbehaving customer and the customer decides to counter-sue. That is good news. It makes it much easier to be clear with customers who are thinking about crossing the line. And, if you feel threatened in any way, don’t be afraid to call the police.

Let’s just hope that the massage practitioners in the Travolta saga have their policies paid up-to-date.

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MTBOK: Missed Opportunity?

Reading the impressive 58-page paper entitled Massage Therapy Body of Knowledge (MTBOK) was both exhilarating and disappointing. Developed by a coalition of six national massage organizations, Version 1 of this effort was published in 2010 and is a landmark document for massage therapy and a must-read for everyone in the profession.

MTBOK: Missed OpportunityThe purpose of the MTBOK Project is to define the scope of practice for massage professionals and the entry-level knowledge, skills and abilities (KSA) necessary to responsibly perform massage therapy. It is intended to be a living document that is constantly modified and updated as information, understanding and perspectives change.

Unfortunately, the MTBOK effort, while commendable, is fundamentally flawed as, once again, the mainstream massage industry conflates “massage” with “massage therapy.” This is a 30-year old problem that continues to hold back our industry by presuming that all massage is massage therapy. You can read the history of how this came about and why it has been a disaster for the industry in the related articles How Massage Became Therapy and Moving from Acceptability to Accessibility.

In this article I want to use the MTBOK report to help identify the difference between “massage” and “massage therapy” and lay the groundwork for future discussion.

First, let’s start with the report’s definition of “Bodywork” on page 39. It notes, correctly I believe, that bodywork includes all forms of massage therapy. Indeed, bodywork is the umbrella term for all forms of skilled touch some of which are massage, and others of which are clearly not (e.g. Reiki, Therapeutic Touch).

Where the report fails is that it doesn’t make clear that the subset of bodywork that includes massage can be further subdivided, only one category of which is massage therapy. That is to say, while all massage therapy is massage, not all massage is massage therapy [See The Realms of Massage].

What part of massage is not massage therapy? That’s easy—personal care massage.

The MTBOK paper, like the industry as a whole, defines massage therapy (meaning all massage) exclusively as “a healthcare and wellness profession” and goes on to say, “The practice of [massage] involves a client/patient-centered session, intended to support therapeutic goals.” Really? That is not the massage I have been doing for 30 years.

I don’t serve “clients” or “patients,” I serve customers. The personal care service I perform has more in common with cosmetologists (“If you feel good, you look good”), tour guides (“Let me show you your body from the inside out”) and aerobics instructors (“Let’s get fit”) than with physical therapists or athletic trainers. Indeed, the Bureau of Labor Statistics places the largest concentration of massage professionals, by far, in the personal care service industry, not the health care industry.

So, clearly, there is personal care massage and there is health care massage therapy. Is the body of knowledge required for safe, effective practice the same for both occupations?  Obviously not, but inadvertently here is where the MTBOK paper has done us a great service. Since all massage therapy is a subset of all massage then, if they did their work well, within the body of knowledge of massage therapy must be the core knowledge, skills and abilities to perform all massage, including the subset of personal care massage.

It’s all about touch

Let’s start with one of their definitions on page 6: “Massage therapy at its essence is human touch with clear intention, focused attention and the attitudes of compassion and non-judgment.” I would maintain that this is also a perfectly serviceable definition for personal care massage so let’s take the word “therapy” out of the sentence and we can all agree that the primary KSAs of all massage should revolve around touch.

So, what does it take to be a professional touch provider? Clearly far less than is required to become a massage therapist. In fact, separating personal care massage from massage therapy will finally allow massage therapy to have the growth path it so justifiably deserves—that of becoming medical massage, a health care specialty—while allowing basic massage training to focus on the simple but profound benefits of touch.

The MTBOK sections on Boundaries, Ethics and the Therapeutic Relationship along with Body Mechanics, Self Care and Massage Techniques contain a wealth of relevant suggestions about learning to be a good skilled touch provider. The in-depth knowledge outlined in Anatomy, Physiology, Pathology, Kinesiology, Assessment, Treatment Planning, Documentation, Research and Information Literacy however, are far more suited for a massage therapist.

Massage therapy training has always been too much and too little. If you read through the MTBOK recommendations, you can come to no other conclusion than that 500 hours is a woefully inadequate number of hours for training a qualified massage therapist. The 2,100-hour standard in Ontario province or the 3,000-hour standard in British Columbia are much closer to the mark.

However, 500 hours is far more than is necessary for me to train a world-class chair massage practitioner doing personal care massage. I could accomplish it in 300 hours and half of that would be supervised practice.

At this point there is ample evidence that the effort to attract the marketplace to high-priced massage therapy has failed. The only significant growth markets for the industry are the chair massage provided by the current wave of Chinese immigrants in malls and low cost suburban table massage offered by Massage Envy and its clones. Neither of those approaches, by and large, requires the full training and skill set outlined in the MTBOK. Each of those avenues could rightly be called “entry level” for both the practitioners and the consumers. I would suggest there is little point in training thousands of massage therapists for jobs that don’t exist. Better to train personal care service massage practitioners for jobs that do.

Let’s first teach all our massage students to do one thing really well—skilled touch. If they later want to specialize in massage therapy in all of its many, varied and glorious forms, great, but that is advanced training for a clearly limited market.

Posted in Bodywork, Politics, Touch | Tagged , , | Leave a comment

Stand Up and Get Fit

Last week I caught a Fresh Air interview with New York Times columnist, Gretchen Reynolds, author of The First 20 Minutes. One of her science-based claims that caught my attention was the importance of standing regularly to break up periods of sitting. It is the kind of key recommendation that we can offer to all of our office-bound massage customers because it takes so little effort and has such big rewards.

Reynolds recommends standing for two minutes every 20 minutes while desk-bound even if you can’t move around your office. “If you can stand up every 20 minutes — even if you do nothing else — you change how your body responds physiologically.”

The basic problem with sitting for extended periods is that sitting makes it harder to get moving and our bodies are made to move. If you can stand up every 20-minutes the big leg muscles start contracting and releasing enzymes that break up fat in the bloodstream reducing the amount of fat in your heart, liver and brain and decreasing the chance of diabetes, heart disease while improving energy, mood, brain function, memory. If you can walk even a little bit, the benefits multiply.

My rational mind just loves having my personal behavior validated.

Split keyboard

Since I spend a large part of many days sitting in front of a computer, like I am right now, I worry about repetitive strain injury. In fact, during one intense desk-bound work period about a decade ago, I did begin to develop symptoms in my wrists, forearms and elbows. I managed those symptoms by switching to a split keyboard, which allows the wrists to be at a more natural angle to the forearms, and by learning to mouse with my left hand as well as my right.

About two years ago, I added a new routine to my workday. On the desk next to my keyboard is a timer that chimes once every 25 minutes and then again five-minutes later. During that five-minute interval the rule is, I have to be standing and away from my desk.

I used to be one of those people who could focus intensely for hours at a time without taking a break. Many times I didn’t want to take a break fearing that it would break my concentration or make me lose my train of thought. No longer.

While I started taking five-minute stand-up breaks for ergonomic reasons, it turns out to have multiple unintended benefits.

  • The break actually improves the quality of my work. Moving my whole body by standing up activates more parts of my brain. Recent research detailed in Jonah Lehrer’s recent book, Imagine: How Creativity Works, talks about the importance of distraction in the creative process.
  • I get more chores done. It is amazing how many things you can check off the To Do list with a focused five minutes: feed the birds, clean the toilet/sink, do some dishes, vacuum a room, get some rice cooking, load the washing machine, make a quick phone call. Did I mention I work at home?
  • I get more focused exercise. Ten push-ups, pull-ups, squats, etc. along with rehab work for the knees, shoulders, elbows or wherever I happen to have a current issue needing attention.
  • I get to take a breath. Studies have shown that when we get excited or anxious, like working under deadline or on an idea we think has potential (me, most of the time), we unconsciously slow down our breathing or hold our breath. Something to do with not wanting the tigers nearby to eat us. Not good.
  • I get to see what’s up with my neighbors. One of the exercises I do during that five-minute break is look out the window and refocus my eyes for distant vision. Staring at a computer screen all day is a great prescription for eyestrain.

Since I live in San Francisco, I already have customers who work at adjustable-height desks that allow them to work standing or sitting. Your massage customers who are cubical dwellers will find their own ways to fill their stand-up time. Our job is just to let them know that it is important.

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The Great Frame-Up

While dozens of massage chairs have been developed since the first one debuted in 1986, today there are only four basic designs that have survived the intense competition of the marketplace. What distinguishes each design is the unique metal frame to which all of the other cushioned parts that support the face, arms, knees and seat attach.

Patent drawing of the first massage chairDesigning and building a massage chair is far more complicated than creating a massage table. Massage chairs have four surfaces on four different planes that need to fit to the customer’s face, chest, shins and seat, rather than the one surface required for a massage table. Each surface must be adjustable enough to accommodate a wide range of lengths and weights and the chair itself should be adjustable for tall and short practitioners. Add to that the requirement that the chair must fold into a transportable package that is lighter and smaller than the typical massage table and you end up with a major engineering challenge.

In the spirit of acknowledging, for the first time, the unsung innovators of chair massage development, I will categorize each frame by name of its designer in descending order of popularity.

The Beyer Frame

Scott Beyer is the consummate tinkerer. In 1987, he attended a seminar I taught in Dallas where he saw the original massage chair-in-a-box I had developed with Living Earth Crafts. The next year Scott moved to San Francisco and began developing what has become the most popular massage chair design in the world.

The Beyer Frame on the Quicklite Massage ChairThe reason for its popularity is the simplicity of the design, which made it relatively easy to manufacture and eventually, easy to copy. Scott sold his design to a manufacturer in Montana called Golden Ratio which named the chair the QuickLite. Golden Ratio neglected to get any patent protection and by the mid 1990s multiple versions were being made throughout North America, Europe and Australia.

Golden Ratio went out of business about ten years ago, giving imitators even more leeway to copy the design. Today, with the advent of Chinese manufacturing, this design totally owns the sub-$200 massage chair market. Even the major manufacturers of the best massage chairs sell versions of this design as their low end or entry level chair.

The primary selling points of the Beyer frame are its light weight (as little as 14 pounds) and its ease of adjustability, which is to say, it had very little adjustability and thus is very easy. Some manufacturers have tried to add features that would increase the adjustability for the customer and/or practitioner but inevitably they also increased the chair weight. This design also has the shortest assembly and fold up time of any chair, about ten seconds each.

Besides limited adjustability, the Beyer frame has another drawback. Its defining characteristic is a support beam that runs next to the crotch of the customer. While some customers may actually enjoy the extra “massage” it provides, the message it telegraphs to our unconscious parts is less than desirable for professional massage.

There is one safety issue inherent in this frame design. A portion of the seat extends past the back legs of the chair, meaning if customers lower themselves to far back onto the seat, the whole chair will flip up into their face and they will land on the ground.

A low price also sometimes means low manufacturing standards. Welds have been known to break on the cheaper chairs creating serious liability issues for practitioners. My best advice is to buy only from a reputable company with a good warranty.

Unfortunately, Scott did not make a fortune off his creativity, but he deserves a top seat in the Massage Inventors Hall of Fame for his design.

The Riach Frame

The second most popular chair design was created on the back of a paper napkin by Linda Riach and welded into reality by her engineering husband, Jeff. The Riachs are legendary in their own right as the founders, owners and current operators of Oakworks, a 35-year old massage manufacturing company.

The Riach Frame on the Portal ProThe Portal Pro chair that Linda sketched was defined by the unique cable system that linked the front and back leg braces providing an entirely new level of support and independent adjustability for the face, leg, shin and seat pads.

While patent protection on their chair prevented exact duplicates, similar designs abound such as the Avila by EarthLite. Any time you see a chair that folds like an ironing board, you are looking at a relative of the Riach design.

However, every feature has a trade off. The compromise with the cable adjustment system is that moving the cable up or down a notch changes the relative relationship between the seat, chest pad and knee rest, which requires a second and sometimes, third, adjustment.

The Portal Pro weighs only 19 pounds and retails for $449 with a carry case included.

The Lloyd Frame

After Living Earth Crafts stopped production of my original massage chair in the late 1990s, I began scouting for a new manufacturer to work with. At that time, Stronglite owners, John and Laney Lloyd, were developing a second-generation massage chair and invited my participation.

While they were kind enough to give me co-design credit for the resulting chair, the truth is John had already come up with the basic frame design by the time I arrived on the scene. Since this article is defining chairs by their frames, it is the Lloyd name that goes on this design.

The Lloyd Frame on the Ergo ProThe great innovation of the Lloyd frame was the elimination of any cabling holding the legs together. That meant that the seat height/angle and chest pad height/angle could be adjusted independently. In addition, the back legs can be raised or lowered for the height of the seat and comfort of the practitioners without changing any angles or requiring adjustments for the customer.

The first version of the chair was made out of wood but that was retired a few years after the introduction of the current, metal version, called the Ergo Pro. The Ergo Pro weighs 19 pounds, currently retails for $379 and includes a carry case. [Available for a discount at the TouchPro store.]

Occasionally the Lloyd Frame has been copied, but its relative complexity has not made it an easy target for knock-off manufacturers. Also, like Oakworks, Stronglite has developed a robust international distribution network that has a vested interest in keeping a lid on copycats.

The Lloyds sold their company to EarthLite a few years back, which also owns the Living Earth Craft brand.

The Gillotti Frame

Michael Gillotti is a guy who knows how to think outside the box. His late 1990s design for a massage chair is still the most aesthetically pleasing chair on the market today. Michael was the founder and former owner of Pisces Productions, which he ran for over 30 years.

His chair, the Dolphin II, is the only massage chair in this group still manufactured and assembled in the United States, but retailing at $525 (carry case extra), it has effectively priced itself into niche status.

The Gillotti Frame on the Dolphin IIIf the Riach Design was based on an “X,” the Gillotti Design was based on an “O.” The frame is built on three curved, nesting tubes that telescope in and out of each other allowing the chest pad and face cradle attached to one end to move from a totally horizontal to a totally vertical position. On the other end of the frame the seat can perform the same maneuver.

One unique advantage of this design is that, unlike the other three frame designs,  the Gillotti frame allows the customer to step into the chair from the side, making it easy for people who have difficulty raising their legs to sit down, e.g. if the customer has a range of motion limitation or is wearing a tight skirt.

Structurally, the most glaring problem is lateral stability. With one long length of tubing and no struts supporting either end, the lateral flexion is unnerving for both the customer and the practitioner.

Michael also wanted to create a massage chair that could also function as a table. Unfortunately, when adjusted for the prone position all of the weight of the customer goes into the chest or the shins and virtually none into the seat making it uncomfortable for more than a few minutes.

As beautiful as it is, I have never seen a knock-off of the Gillotti design.

The Future

All of the manufacturers keep tweaking the designs of their portable chairs, but it is unlikely that we will see any true innovation in frame design, such as the four described in this article.

Where the real frontier exists is in designing stationary massage chairs. With the explosion of chair massage in retail settings, thanks to the current wave of mainland Chinese immigrant workers, there are now hundreds of fixed location chair massage studios where a stationary chair would be appropriate. When you remove the constrictions of weight and portability a whole new range of possibilities for comfort and functionality emerge.

Just as the original chair unleashed the first wave of the chair massage industry, a stationary massage chair will signal the arrival of the second wave. I am currently looking for a development partner, so if you have any interest…

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The Fainting Phenomenon

This week I got an email from Katy who writes: “I was about 20 minutes into the chair massage when the massage therapist began to work in and around my right shoulder blade.  I began to feel clammy and tried to breathe deeply and out of nowhere, I began to black out.  I sat up and just said “water” and wasn’t really aware of anything around me.  I almost dropped the water he had handed to me.  I sat down on a different chair (with much help) and in about 5 minutes felt much better.  I declined the offer to finish the massage.”

In the mid-1980’s, when chair massage was shifting from an occasional massage tool to being a discrete bodywork specialty, practitioners began to notice a phenomenon almost never encountered in table massage: seated customers experiencing symptoms of fainting or even passing out completely.

While a rare occurrence, episodes happened often enough that those of us practicing and teaching chair massage became concerned about its cause, prevention, and management when it did occur.

Why on a chair?

The medical term for fainting is “syncope” [sing’kuh-pee] and is defined as a sudden, brief loss of consciousness. “Pre-syncope” is the experience of symptoms leading up to a loss of consciousness. All syncope is caused by a loss of adequate blood flowing to the brain.

If a person is upright when this happens, then oxygen no longer reaches the brain in sufficient quantities to maintain consciousness and the individual passes out. The cure for fainting is simple. Get the customer horizontal, preferably with his knees up to allow gravity to restore blood flow to the brain. If the person is only experiencing near syncope, then it may be enough for them, while in a seated position, to drop their head between their knees.

In one sense, fainting is nature’s way of telling us to lie down by falling down. This is the reason table massage practitioners rarely experience customers  fainting. They are already lying down and gravity is working in their favor.

The three most important things to know about syncope are:

  • Most episodes are transient; that is, they happen once and never again.
  • Fainting is rarely life threatening, unless someone hits their head on the way to the floor.
  • Everyone who faints revives spontaneously.

Etiology

There are literally dozens of possible causes of syncope but the ones that concern chair massage practitioners most are:

  1. Low blood volume is most often caused by stimulation of the vasovagal nerve reflex, which expands the blood vessels (vasodilation) causing a rapid drop in blood pressure. That reflex can be triggered by such factors as anxiety, pain and fatigue.  Dehydration also causes a drop in blood volume so recent exercise or overheating need to be considered.
  2. Reduced blood flow because of medical conditions that narrow the blood vessels (smoking, high blood pressure, high cholesterol, diabetes) or mechanical restriction of blood flow to the brain. This last point has been highlighted by some practitioners who believe that the positioning of the customer’s head in the face cradle is key. Some lower edges of a face cradle may press in to the carotid artery and trigger a syncope reaction.
  3. Low blood sugar can also cause a sudden drop in blood pressure often times in combination with another risk factor. That means empty stomachs can actually be a hazard in this regard.
  4. Certain medications such as diuretics, beta blockers, calcium blockers, and other CNS depressants that might slow the heart rate, cause fainting symptoms to more likely to occur.
  5. Other conditions where syncope and pre-syncope have been seen include migraines, epileptic seizures, hyperventilation (extremely nervous customers), alcohol intoxication, and cardiac arrhythmia.

Given these known causes, a practitioner should be especially alert to nervousness, hot days, recent exertion and careful positioning of the neck in the face cradle of the massage chair.

Screening and monitoring

While the actual incidence is low, the single greatest determining factor for syncope is whether you screen before and monitor your customers during a massage. Thorough screening and monitoring can eliminate 100% of the episodes of customers passing out. With proper management, the occasional customer who does feel symptoms of fainting will not lose consciousness.

Before you seat customers in your massage chair, they should be screened just as you would for your table massage, preferably with a written card to save time. If the customer has any current or chronic medical conditions or is taking medications, pay particular attention to the ones discussed above in Etiology.

In addition, we recommend screening for the following:

Consumption of food or liquids (other than water) within the past five hours. Not having eaten may signal a hypoglycemic state. If convenient, suggest the customer get a glass of juice or a muffin before the massage.

A history of fainting. Carefully question a customer to determine if the recurrent syncope is related to a low blood pressure or other medical condition. What does their primary health care professional attribute these episodes to?

Just having an empty stomach, a history of fainting or a medical condition does not mean that a customer can’t receive the seated massage. But it does mean that, if you decide to give the massage, you will need to be extra alert.

If there are any yellow flags raised during screening, then it is a good idea to ask the customer to report any dizziness or queasiness during the massage.

Finally, as with all screening protocols, the ultimate rule is “when in doubt, don’t.” If you have any question in your mind about whether to work on a particular customer, then you should not proceed. Tell the customer that you are not certain whether the massage is appropriate for their condition and that they, or you, should check with their primary care provider. Never practice beyond the level of your training and experience.

During the massage

Since syncope can occur for so many reasons, during the massage you will also pay particular attention to syncope precursors in the customer’s body. The most common sign is a customer fidgeting in the chair or lifting the head slightly out of the face cradle as though to yawn or take a breath. These are involuntary reactions to not enough oxygen getting to the brain.

Less frequently you might feel the customer’s skin become hot and sweaty or cold and clammy. If you become aware of any of these symptoms, immediately stop the massage and ask the customer if he or she is feeling okay. If not, then you need to quickly either get him or her turned around in the massage chair or into another chair with the head dropped between the knees, or lying on the floor with the knees pulled up.

After an episode has occurred

Customers who have near syncope experiences will recover within a few minutes. Explain that they have had a temporary drop in blood pressure and reassure them that they will be fine as soon as normal circulation resumes. After the episode has subsided, you might spend a few minutes exploring the causes of the episode. If there were red flags raised during the screening, you probably already know the reason associated with the episode. If the initial screening brought nothing obvious to the surface, ask the customer if this has ever happened to them before and then go over the screening questions again. Perhaps you will discover they are diabetic or have low blood pressure and it didn’t come out in the initial screening.

In any case, let them know that most fainting spells are benign, but they should mention it to their primary care provider at the earliest opportunity. There are, in fact, some serious cardiac and neurological conditions that might underlie syncope and pre-syncope and this episode should become part of the customer’s medical history.

Summary

While the incidence of syncope or pre-syncope in a customer receiving a chair massage is slight, an ounce of prevention is worth a pound of cure. Proper screening and awareness of symptoms during a massage will prevent virtually all syncope episodes. Knowledgeable management of syncope and near-syncope occurrences will prevent undue distress on the part of the customer and the practitioner. Being competent and knowing your limits will buy you the cheapest and most effective liability policy you can own.

If you have your own fainting experience, I would love to hear your stories.

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An Outsider Analyzes Massage

David Palmer

The shy David Palmer

I was a mama’s boy. The youngest of four males born to my parents within five years, I was the baby of the family and spoiled rotten. There are a number of family stories dramatizing that fact, my favorite of which is how I bravely got on the school bus for my first day in kindergarten only to run screaming down the aisle for my mother the moment the doors closed. I did get chauffeured to school that day but still the teacher had to peel me off my mother’s leg while firmly assuring Mom that I would be all right.

And, eventually, I was. The next day, and every subsequent day, I couldn’t wait to get on the bus. However, I remained a sometimes painfully shy kid until I graduated from high school and was living on my own making my own way in the world. I managed my shy nature with loving support and (mostly) outgrew it with self-sufficiency and self-awareness.

Today shy kids are diagnosed with “social anxiety disorder” and given Paxil or other medication. Our contemporary culture has a well-documented tendency to turn every cursory personal quirk into a disease that needs treatment. While I am certain that there are a few shy folk, overweight people, fidgety kids and existentially troubled adults who could benefit from a prescription, I harbor the sneaking suspicion that: a) these are symptoms of a cultural disorder, not a personal one, and b) that it only benefits the pharmaceutical companies to encourage us to believe that the reverse is true.

Virginia PostrelI was thinking of this tendency to pathologize life as I was re-reading an article by Virginia Postrel analyzing the massage industry. Ms. Postrel is a journalist who focuses on the intersection of culture and commerce. She has been a reporter for Inc. and The Wall Street Journal as well as a columnist for The New York Times and The Atlantic Monthly. She has also authored two books, The Future and Its Enemies and The Substance of Style about how cultural trends become commercial enterprises.

One of her columns from The Atlantic Monthly contained an insightful outsider’s critique of the massage industry tracing its history from the strip club to the strip mall. Below is a lengthy excerpt from the original piece published in The Atlantic.

As a business, massage has two basic problems. The first is that prostitution is generally illegal. A brothel can’t openly advertise its services: no “Madame Julia’s House of Great Sex.” Instead, Madame Julia pretends she runs a “massage parlor,” which creates confusion, and sometimes legal obstacles, for people who want to buy and sell back rubs.

The second problem is that most potential customers consider massage a luxury—an optional indulgence, if not a slightly shameful extravagance. So they’re acutely sensitive to price. A massage business can’t pass high labor costs along to consumers without suffering a rapid drop in sales.

One way to attack these problems is to declare massage a medical service. Hence in 1983 the American Massage & Therapy Association dropped its ampersand to create a new profession: “massage therapy.” Customers and legal authorities can be pretty sure—though not 100 percent certain—that a massage therapist isn’t selling sex. A therapist not only will keep the client discreetly draped with a sheet but also will take a reassuringly clinical approach to kneading naked flesh. A masseuse, on the other hand, may well be a hooker in a skimpy disguise.

Calling massage a “therapy” also suggests that it’s good for you, which means you don’t have to feel guilty about spending money on it. You might even be able to pass the bill on to your insurance company (only rarely, so far). Massage therapists understandably want their clients to think of massage as a necessity. “At one point in my career I had to defend massage against the ‘prostitution attitude,’” says Brenda L. Griffith, a massage therapist in Richmond, Virginia, who has been practicing since 1988. “Now I have to defend massage against the ‘pampering attitude.’” Many of her clients do, in fact, have chronic ailments for which massage offers some relief.

But relentlessly touting the healing power of touch makes too many massage therapists sound like quacks. The medical strategy also treats clients as patients, eliminating potential customers who feel healthy. It attracts clients by turning everyday life into a disease. Who, after all, doesn’t suffer from stress? Like graphic and industrial designers who refuse to talk about aesthetics, massage therapists seem embarrassed to say they make people feel good.

As something of a massage addict, I don’t buy the medical line, and I don’t think it’s necessary. Assuming it’s not too vigorous, a massage not only feels good but also helps me think. It’s relaxing, but not so relaxing that I fall asleep. Like a nice glass of wine with dinner or an all-white Heavenly Bed in a hotel room, a massage break adds a little pleasure to everyday life. Even if the massage does nothing for my health, I consider the money well spent.

Humans are sensory beings. Massage doesn’t need to justify pleasing our muscles and skin any more than music has to justify pleasing our ears. Chefs don’t have to call themselves “nutritional therapists.” Hairstylists don’t have to pretend that gray hair is a disease. Enjoyment is a perfectly fine reason to get a massage.

I love that last line. Why is it that people feel they are not allowed to get a massage unless something is wrong? In our quest to distance ourselves from a shady past have we turned massage into purely a medical treatment? Have we trained the public to see massage as being required only when we have something amiss in our soul, psyche or somatic self?

When I ran a retail chair massage studio, I noticed that virtually all new customers felt obligated to justify their visit with a medical complaint such as a crick in their neck, a headache or a sore back or shoulders. At the end of their visit, either their problem is resolved, or not, so regardless of the outcome, there is little motivation for them to return unless we take the time to reeducate them away from the point of view that there has to be something wrong before they can get a massage.

Interestingly, at the time the article was published in 2006 it provoked a harsh reaction from the American Massage Therapy Association.  The president at the time, Mary Beth Braun, wrote a letter of complaint to the magazine accusing Postrel both of connecting massage to prostitution and implying that massage is only to make people feel good.

Setting aside the fact that both charges are a gross misreading of the article, what exactly is the problem with “feeling good” being the foundation of massage? Wouldn’t it be a major contribution to society if the primary focus of massage was to make people feel good? It just might even be a non-pharmaceutical solution to “social anxiety disorder.” [And, for more on why a strong mother-son bond is crucial, check out this great article.]

Do you think “feeling good” is a legitimate goal for massage? Have we overemphasized the need to define massage as “therapy?” Your comments below are welcome.

 

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The Realms of Massage

The first professional massage I ever received was around 1970 in an old Russian Banya on the near-North Side of Chicago called the Luxor Baths. The clientele was a mix of the old Jewish expats who had moved to the suburbs (Nelson Algren used to hang out here) and the new Hispanic locals. Luxor was an artifact from an earlier time complete with swimming pool, wet and dry saunas, a steam room and metal tables where friends would beat and brush each other with soapy oak leaf brooms.

Luxor also had a massage room and, with some encouragement from my friends, I finally gave massage a try. It was a memorable experience and I have been hooked ever since.

Notably, I didn’t get my first massage because something was wrong with me. I got a massage because it made me feel great and that is the experience I have been seeking to share with the world ever since.

Traditionally, within most cultures, professional massage has operated in two very discreet economic realms: the personal care services industry and the health care industry.

  • As a personal care service, massage is found in saunas, spas, hair salons, in the foot massage services provided in the streets of near- and far-Eastern Asian countries as well as neighborhood bathhouses and as various forms of seated massage now throughout the world. This is the kind of massage I received at the Luxor Baths.
  • In the health care industry, massage evolved through a variety of healing modalities, such as osteopathy and chiropractic, orthopedic practice, nursing and physical therapy (called physiotherapy in many countries).

These two domains were easily distinguished from one another both by terminology (customers vs. patients) and by intention (relaxation vs. treatment) and there was generally little confusion or overlap.

That clarity started to dissolve in the 1970s as a new economic arena began to emerge. It was called “health promotion” or “wellness” and was a reaction to the dominant health care paradigm, which in fact did not focus on health care, but rather sickness care.

The counterculture that emerged from the sixties first manifested this new approach by embracing such practices as natural childbirth, organic and vegetarian diets, supplements and herbs, and varieties of personal growth dubbed the “human potential movement.” Books such as Our Bodies Ourselves began to advocate rejection of the cult of experts in favor of personal responsibility and control. The goal became prevention, not treatment, and creating a balance that integrated the mind, body and spirit into a unified whole.

Inevitably, business began to capitalize on this cultural trend and the fitness industry was born. Health clubs replaced gyms, Nike shoes replaced sneakers, wellness centers replaced spas and self-help programs replaced the confessional. Also about this time, corporate wellness programs started to get a foothold as companies began to suspect that the only way to reduce their ever-rising health care costs was by encouraging employees to maintain good health through proper exercise, diet, and emotional balance.

Massage slipped easily into this new and exciting economic domain. The Esalen Institute in California championed new approaches to massage that focused on mind/body integration as well as a new category called “bodywork” that included innovative modalities developed by Ida Rolf, Milton Trager  and Moshe Feldenkrais.

The advent of this new wellness arena, however, has muddied the once clear distinction between personal care services and health care services as both try to carve for themselves a slice of the wellness pie.

And where has that left the massage industry? Also very muddied. According to the massage schools, associations and regulators, massage is no longer a personal care service, it is a health care service. I can no longer get a massage like I did 40 years ago at the Luxor Baths. Now I have to get massage therapy. But I don’t want a health care massage. I don’t even want a wellness massage. I just want to lie down and bliss out in the hands of someone who makes me feel good. I don’t care if the practitioner has 50 or 500 hours of training. If I like the massage, I will go back. If I don’t, I won’t.

We need to bring back and validate the personal care massage realm. That is where the most growth is happening (chair massage and franchise table massage), that is where the jobs are, and that is where I want to get my massage.

Do you believe massage should reclaim its identity as a personal care service? Does defining massage exclusively as “therapy” confuse the public and needlessly restrict our growth?

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Chair Massage: A foundation for fitness

While I am a big believer in making every moment a fitness moment (see Creating a Fitness Lifestyle), the reality is many people don’t have even the most basic motivation to move to a healthier lifestyle. That’s where chair massage fits in because it not only requires minimal motivation, it actually provides motivation and support for getting off and staying off of the couch.

The reason why I consider chair massage foundational fitness is because, of all the activities that fall into the fitness/wellness category, chair massage is the one that requires the least time and effort, while offering the greatest value. The only motivation required for chair massage is to sit down and do nothing. The chair massage specialist does the rest.

This is one of the most unique and important features of chair massage. All other wellness modalities require high degrees of motivation, practice, support or cost, for example, dieting, exercise, smoking cessation, Yoga, meditation, table massage and Tai Chi.

The foundation of fitness is movement. It is movement that creates circulation in the body/mind and, as I am fond of saying, circulation is not optional. Without good circulation your body and your mind literally wither away and eventually die. Much of what we define as the “aging process” is simply a result of inhibited circulation/movement.

Exercise, which requires a high degree of motivation, is active movement, where you move yourself. Massage is passive movement, where someone else creates the movement/circulation within you and requires minimal motivation.

In addition, over time, as people experience regular massage, they reopen the communication links between their brains and their bodies. That is to say, massage heightens awareness of our internal sensations about what makes us feel good. As a result, recipients tend to become more motivated to lose weight, stop smoking, eat better and even develop a regular exercise program.

As lifestyle changes go, regular chair massage is a great place to start. It triggers the pleasure centers while enhancing circulation. On an ongoing basis it supports all other fitness/wellness activities and lifestyle changes. Each massage rebalances the body/mind by smoothing out the rough edges created by exercise, dieting or withdrawal from smoking and other addictive substances.

Best of all, you don’t have to be overweight or a smoker or in shape or out of shape to benefit from a chair massage. It is the most egalitarian of all wellness modalities and provides a solid foundation for fitness. Given its low cost, chair massage clearly provides the greatest value.

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Change-ability: Mastering the Inevitable

Note: This is the fourth and last of a series of articles called “C”-ing Your Way to Success about  the value of Conviction, Clarity, Consistency and Change-ability in business.

The first three “C”s discussed in this series (Conviction, Clarity, Consistency) are paths, not destinations. While the successful development and execution of a business plan may use these guideposts, it is a mistake to think that the ultimate goal is 100% conviction, clarity or consistency in your operation. That is because other than death, change is the only certainty. In fact, the one often defines the other. When something ceases growing or responding, it is considered dead.

Our job then, is to become experts at understanding the nature of change, the patterns of growth.

While the quality of consistency gives your business stability, nurturing “change-ability” gives your business flexibility. Both are essential. One of the best books you can study on the subject of change is not a business book at all. It is a philosophical treatise disguised as a book of divination. The I Ching, or Book of Changes, is one of the classics of Chinese literature and is at least three thousand years old. The I Ching catalogs sixty-four aspects of change, in the same number of chapters, which are essentially meditations on the patterns of growth in the universe.

Mastering change-ability is important in two ways. It makes you increasingly skillful at predicting what will happen next in your business, and it makes you flexible in your ability to respond to change.

Predictability

When you study the nature of change you become expert at seeing the larger patterns in which your business operates. The most common example of these patterns are business cycles. This is the normal ebb and flow of the activity in your business. These patterns repeat daily, weekly, monthly, yearly, or over even longer periods of time. The more skillful you are at recognizing these patterns the more accurately you will be able to create reliable forecasts in your business plan.

Let’s look at some examples of business cycles.

  • The street fairs you work at tend to be slow in the morning, busy through the afternoon, with a late rush of customers, mostly people who worked in the other booths at the fair. Knowing that you will be about the last one to pack up and leave, you make certain that there is adequate staff and energy, for this final wave of business.
  • You notice that when you provide chair massage in the workplace certain types of clients prefer to have a massage at the beginning of the week, others in the middle, and still others at the end of the week. Because you also have a table massage business on Mondays and Tuesdays, you can more easily target your marketing to the mid and late week groups.
  • Your business increases the first and third week of every month because that is when you client base tends to get paid and can afford a massage. Consequently you plan your marketing and administrative chores for the second and fourth weeks of the month.
  • You anticipate that you will always sell more gift certificates around holidays and special occasions and you know you have to begin your promotion plans at least two months in advance.
  • Perhaps your business focus is on relaxation massage and you anticipate that most of your customers, after a year or so of allowing touch into their lives, will seek out other types of bodywork. To plan for that transition you establish mutual referral relationships with remedial therapists, Rolfers, Feldenkrais practitioners, sports massage bodyworkers, and the like.

The greater your ability to understand the processes of change, the more refined and accurate your business forecasts will be. As you become increasingly expert at recognizing the patterns inherent in your business you will develop an intuitive sense of what steps are needed at any given moment to keep your business healthy. Intuition, despite what some people claim, does not come from the cosmos. It is most often the result of awareness–paying attention to the smallest shifts in the world around us–and experience, lots of experience, over many years. The more we consciously accumulate business experience, the better we become at asking the right questions when faced with a business decision, and the more likely we are to arrive at the right answer.

Flexibility

Change-ability also means the ability to respond to the constantly changing business climate. When external and internal conditions alter, do we resist modifying our plans and actions, or do we smoothly adapt to the new circumstances? Developing flexibility in business is essential to long-term survival. There is no hiding from rapid change in our world. Being conscious of change makes it more predictable and being prepared for change makes it more manageable. Flexibility is the key to preparedness.

Practicing flexibility starts with exercising a flexible mind. Hopefully, the older we get, the more we appreciate the importance of accepting that what we believe is not always the way things are. Prejudice has no role in a flexible mind. When you start saying things like, “I can’t stand Republicans/Democrats/Jews/Mormons,” be careful. Not only are you limiting your options, but the world has a funny way of creating circumstances that may turn exactly those people into your next market.

A flexible mind also sees opportunities where other people see only problems. When circumstances in the business climate change it is always an opportunity for you to learn something new about your market, your service, the nature of business, or yourself. Don’t resist change, embrace it. Without change the world would be a very dull place. With change our businesses remain fresh, vibrant, and exciting places to spend our time.

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Hygiene Protocol for Chair Massage

Click on the picture to view the video demonstration

While there are probably more infectious agents on the doorknob customers touch as they enter your massage space than are on your massage chair, the public nature of chair massage makes a solid hygiene protocol essential. It is a matter both of perception and professionalism.

I have seen potential customers stand in front of a line of massage chairs at an event carefully scrutinizing the hygiene habits of the various practitioners to find the one that best lives up to their standards. As the media continues to spotlight drug-resistant infections and virulent pathogens spreading around the globe, the general public is becoming increasingly germ-phobic.

Since we are trying to reduce stress, rather than increase it, we need to set customer’s minds at ease by being proactive about hygiene. There should never be a concern about customers spreading bugs to one another, or to me, or from me to them.

In terms of liability, having a simple, consistent hygiene protocol makes it easier to explain clearly to customers, health department personnel and lawyers the impossibility of someone, for example, having acquired herpes from sitting in your chair.

Wipe down. Cover up.

The two-step protocol TouchPro recommends starts with a canister of hospital-grade sanitary wipes. We use two sheets, one in each hand, to sanitize the chair at the start of the day as well as between each customer.

At the beginning of the shift, every vinyl surface is wiped, along with the adjustment hardware and any other metal or plastic parts around the face cradle. Between each customer the minimum rule is to wipe down the face cradle, arm rest and any other part of the chair that might have had skin to vinyl contact, typically the leg rests if the previous customer was in a skirt or shorts. The final step is to put the two sanitizer sheets together and wipe your own hands thoroughly.

Here’s a note about the wipe down process. The basic rule is, the juicier the better. The effectiveness of the sanitizers at killing the bugs is directly related to how long the moisture stays on the vinyl or your hands. That’s why we recommend wiping down the chair immediately after a massage, so you don’t have to keep the customer waiting before a massage for the alcohol to evaporate.

After the wipe down, the face cradle should be covered up to prevent the customer’s face from touching vinyl. The preference of the practitioner determines whether paper towels, cut-out or form-fitted disposable covers, or washable cloth covers are used.

Back in 1986, we started with paper towels but quickly moved to the round, disposable nurses caps with a breathing hole or slit cut into the center. When the form-fitted disposable face cradle covers came on the market around 2005, we switched to those and never looked back.

Addition hygiene issues

Obviously, everything you learned in massage school about keeping your fingernails, hands, breath and “pits” clean applies to chair massage, but there are a couple of other issues that should also be considered in your hygiene protocol.

In 2009, during the H1N1 avian flu pandemic scare, the media was in a frenzy over the potential deadly effects of the virus. To allay any fears of our customers, I wanted to advertise that all of the chair massage practitioners in our studio had been vaccinated to prevent them from contracting and/or spreading the virus. Unfortunately, because it was a new strain, the vaccine was rationed to the very young, old, immune-suppressed and front-line healthcare workers. Because of the shortage we were never able make that guarantee but every year since, I get myself vaccinated as early as possible. Annual flu vaccination as part of a chair massage hygiene policy just makes sense.

And, finally, what about those doorknobs? In a chair massage studio, I do disinfect them at the beginning of every day, unless they are brass. Brass doorknobs disinfect themselves in about eight hours, while stainless steel and aluminum knobs never do. It’s called the “oligodynamic effect.”

In summary, have a hygiene policy, write it down, and make sure everyone in your business follows it.

Check out the companion video.

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How Sticky is Massage?

Stickability ImageIn the world wide web, “stickiness” refers to how long you can keep a user on your website or how often you can get them to return. It is a measure of user engagement and loyalty.

So how loyal and engaged, that is to say, how sticky are massage customers? Judging by the frequency with which Americans get regular massage, the sad answer would have to be that massage is not very “sticky” at all. [Note: If you want to bypass the calculations and jump to the bottom line numbers, scroll down to the last three paragraphs.]

There are only two professional consumer surveys done for the massage profession. The one commissioned by the American Massage Therapy Association (AMTA) is annual and the other, sponsored by the Associated Bodywork and Massage Professionals (ABMP), is biennial.

While neither of them explicitly states how often American adults get massaged, with a bit of combining and extrapolation of the two surveys, we can arrive at a reasonable approximation.

The most recent ABMP survey reports that, of the number of people who actually got a massage in 2010, their frequency of utilization was as follows:

  • 22% had 1 massage
  • 22% had 2 massages
  • 28% had 3-5 massages
  • 6% had 6-10 massages
  • 17% had 11-20 massages
  • 3% got 21 or more massages

The previous ABMP survey, for 2008, reported these percentages:

  • 32% had 1 massage
  • 21% had 2 massages
  • 35% had 3-5 massages
  • 5% had 6-10 massages
  • 5% had 11-20 massages
  • 2% got 21 or more massages

Now, since both the AMTA and ABMP surveys report the total number of adults getting a massage in a twelve month period, we can use the percentages above to get a range of how many total U.S. adults appear in each frequency category. In the AMTA survey, the total number of adults getting massaged ranges from a high of 24% in 2007 (pre-recession) to their current figure of 18% (between July 2010 and July 2011, unchanged from the prior 12 months). The ABMP figures are strikingly lower. In their latest survey only 16% of US adults got a massage in 2010, up from 14% in 2008.

To chart it out I multiplied the ABMB frequency of utilization percentages by the percentages of people in the U.S. reporting they received a massage in the two time periods surveyed by each organization. Here are the results of each survey by category.

Frequency of Massages Per Year AMTA ABMP
2007/08 – 24% 2010/11 – 18% 2008 – 14% 2010 -16%
1
Massage
7.7% 5.8% 4.5% 3.5%
2
Massages
5.0% 3.8% 2.9% 3.5%
3-5
Massages
8.4% 6.3% 1.0% 4.5%
6-10
Massages
1.2% 0.9% 0.7% 1.0%
11-20
Massages
1.2% 0.9% 0.7% 2.7%
21+
Massages
0.5% 0.4% 0.2% 0.5%

Hang in there. We are almost to the finish line. While I wish that the ABMP survey had broken out the specific number of people who got 3, 4 or 5 massages in a year, using the data we have, we can sort the frequency into three sub-categories:

  • Infrequent users – 1 or 2 massages per year
  • Occasional users – 3-5 massages per year
  • Regular users – 6 or more massages per year (less than the average number of haircuts per year)

With these definitions and using the best case ABMP figures, we can see that, at the most, only 4.2% of the adult population in the U.S. are regular users of massage. The best case data from the AMTA puts the percentage at 2.9%. Ouch! No wonder the associations do not make it easy to get this number and prefer us to focus on the 16 to 24% who got at least one massage in a year. In another article I make the case that this lack of loyalty and engagement, of “stickiness,” is primarily a result of the high price of massage and discuss what we can do to make massage more affordable and accessible.

One final note: We need to have better data and better analysis of the data we currently have. We can’t make good decisions about our future unless we have good data. The calculations above should have been readily accessible to anyone. The glaring discrepancies in the results between the two surveys should be explainable. The ABMP should be congratulated for the relatively comprehensive and transparent way in which it presents its data compared to the AMTA. However, I would urge both organizations to make all of their raw data from every study they commission available to anyone for analysis. The truth is out there, we are just having a hard time finding it.

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