November 23, 2011
Here is something we haven’t really covered. Sometimes, even in the course of doing everything right something goes wrong. One of my Thai teachers actually broke someones rib doing Thai early in her career. I have done Thai for nearly 3 years now and am pushing the 1000 session mark. I have had a couple of incidents recently that had me scratching my head. The first is a 60 year old male client. While lying prone I was pressing on his right shoulder. He is a thick guy but I didn’t feel I was pressing particularly hard. He felt a pop under his right pec in the rib area. I assume it was cartilage. He took a few moments for it to ease off and we completed the session. I didn’t know until 2 or 3 weeks later that it caused him enough pain to have to take it easy for a week or so. I will see him again next week but don’t have a clue how that could have been prevented or for sure what happened. Did he tear some scar tissue? Was it in the cartilage? Was it one of those issues where the injury was waiting to happen and I was just the cataylst for the injury? Should I have had him iice which is what we would have done in physical therapy years ago. I have liability insurance for that just in case moment. In the U.S. I would be afraid to not have it. Any advice or comment here?
Saturday I worked on one of my fellow Yogi’s who was having a “low back” problem from sone type of extreme bootcamp she is attending to lose weight. I found the issue in the SI joint and used all the techniques I knew to free it up. The back siezed up on her several times during the session so I backed off and finished with her prone and rocking techniques to get her to relax. She got up and went to the rest room after the session. On her return she was unable to get back to the room. It seized up on her again and she ending up on the floor in childs pose trying to get some relief. I helped her to her car feeling bad. I offered to put ice on it and told her to do so last night and maybe heat later with Ibuprofen. She called this morning and after walking and doing some Iyengar type yoga for a bit finally got some relief. I assume she finally broke the SI lose. 98% of the time the client gets releif of some sort but not this time. I’m sure she still has some inflamation going on. I love the therapeutic work but sometimes s*^t happens! What is your approach in cases like this? Do you stay away from acute injuries, refer them or what? Thanks Mark
Well, this is indeed an interesting subject. I know several people who had bones cracked or broken by a Thai Massage therapist. Actually I am one of those victims. Once someone was working on my abdomen and stuck his knee in there (terrible idea and an inappropriate technique). He ended up cracking one of my ribs. It wasn’t totally broken, but any rib fracture takes 4-6 weeks to heal in general.
The main problem is the direct pressure or linear approach. Of course there are areas on the body where direct pressure is no problem, like the hamstrings or the quads. With “no problem” I don’t mean to say that you cannot cause pain, but there is little danger of causing real damage.
However when you work on a sensitive area like a joint, shoulder let’s say, unless you know this client’s body very well, you don’t know exactly what’s going on in there and what can happen. Therefore in such a scenario I always start out with motion techniques, rocking, circling, wiggling, swinging etc. Those techniques are almost guaranteed to not cause any damage, and they are just a safer bet in many cases.
After doing that for a while I can add stronger techniques, but by then I have scouted out the area and I have a feel for how far I can go, if there is a restriction or a painful spot or a holding pattern.
Thai Massage is not painful in itself, but due to the nature of the techniques it has the potential to be painful and even damaging if applied without real sensitivity. For me the best way to deal with this is to lead with rocking/motion techniques.
The second thing to be aware of is to work slowly. Any techniques which are executed rapidly have the potential to cause problems since there is not enough time to observe a client’s reaction and to back off. This applies especially to strong stretches.
After saying all this, I have to add that there are no sure fire guaranteed outcomes in any healing arts. What’s one of the most dangerous places to be statistically? A hospital.
What is one of the leading causes of death in the US? Hospital related issues like infections, wrong diagnosis, wrong treatments, wrong drugs and side effects. And that’s in a highly professional environment and in spite of best efforts.
So you can never rule out any problems in massage therapy 100 percent, but you can adjust your approach and your techniques in such a way that the probability of causing any damage is extremely unlikely. That’s about as close as you can get.
The other thing is that there are certain conditions for which massage just doesn’t work. I had a client once who had had lupus on her head and she never wanted her head touched. She didn’t like it and it didn’t help her. You can’t drive a square peg through a round hole, and we have to acknowledge that massage is not working for every condition and we have to know or at least try to know when to back off.
Some of these things can be found out in client interviews, some can be found out with the one-to-ten questioning method, some can be felt with sensitive hands (like a client’s body rejecting your touch), and some will come as a surprise to us because we did not see it coming.
Massage therapy is many times safer than other medical treatments and procedures, but it will never have a perfect score either.
Regarding you question if I stay away from acute injuries – that depends on the nature of them. For example my wife had a motorbike accident a while ago and she injured her knee. It was black and blue and swollen and it was obvious to me that rubbing on it would not help, so I stayed away from it. However later when the swelling had subsided and the bruising was gone, then I worked on it to release the trauma in there.
There are other acute injuries or conditions which can respond well to massage, like sciatica for example.
November 23, 2011
Thanks for the response. In the first case, I have done around 10 sessions on the guy already and never had an issue. I wasn’t pressing on the back hard so the pop in the chest area was really odd to me. I wasn’t aggressive and he wasn’t elderly. I guess it just goes to show anything can happen anytime so be prepared. As to the sacral issue and the back lock up. I have seen spasms like this but not ones I caused. I just felt bad and have asked myself what I learned form this. Again this was someone I had worked on many times and was a yogi. Since hurt, I guess I should have progressed much slower and backed away completely after the first spasm. Instead I waited for it to subside and then continued on. I went to the rocking at the end and probably should have started there. I guess I am posting and discussing for some answers but also for others who encounter similar issues. Do you ever put ice on your clients or heat?
Sooner or later all of us will run into something unexpected or a strange situation. We can minimize those but not eliminate them completely. For my part I have always put a lot of emphasis on developing my sensitivity, working with energy and getting a lot of client feedback. None of that guarantees anything but it puts the probabilities in my favor. That’s why I keep talking throughout my courses about “feeling softness”, “sinking in slowly”, breathing, working from the hara, using body weight instead of muscle power etc.
It actually pains me to read so many posts on the internet where people say that Thai Massage is a really painful affair, and some people are even proud of that, either on the receiving end or on the giving end.
I feel that it is always better to err on the light side rather than on the heavy side. This is what works for me – still no guarantees. The more sessions you do, the bigger the chance that you will encounter something unexpected, a curve ball.
I have never used ice on a client. However I have used heat many times, mostly with the massage hammer’s infrared heat lamp which I have demonstrated in several videos. One of my regular clients often asks me to “put the heat on”.
I have sometimes encountered situations where what I was doing with the Thai Massage work just didn’t work. In those cases my fallback is to switch to something totally different like using guided imagery, EFT techniques, or energy work.
I have also had cases where I referred a client to someone else who I felt was a better solution for the client for a particular problem, and I have had cases where I felt that the client and myself were not a good match and I discontinued work with them. I have also had cases where I felt that I was not getting anywhere with my work and could not convey a real benefit.
This is different from what you were describing, but for the benefit of everyone reading this exchange I wanted to mention some scenarios where things don’t work despite our best efforts.
Those are times when we have to learn that we can only try out best, but we cannot guarantee any outcomes, and we cannot take it personally or feel guilty when something does not turn out the way we would like.
It is a known fact that the suicide rate among surgeons is much higher than the general population. I can see why.
We don’t deal with such extreme situations in Thai Massage, but the lesson still is that we cannot accept full responsibility for every outcome in massage therapy since there are too many factors which we cannot control, like a client’s state of mind, an unusual change in condition, bio rhythms, abuse of the body and mind by the clients themselves, counterproductive life style habits, traumatic events in a client’s life, an onset of a condition which even the client is not aware of yet, etc.
None of this absolves us from our responsibility to be as well trained as possible, and to try our best, but it does put the limits of our work and any healing work into perspective.
By the way, this is a very useful topic which you started, Mark. I think it is very useful to discuss those times when things don’t work out as expected. And it doesn’t just apply to Thai Massage. It touches on this entire subject of the interplay between therapist and client, healer and healee, doctor and patient, what the responsibilities are and how to deal with expectations – quite a complex subject really.
November 23, 2011
Hi Guys, I have been in situations like this and Shama is correct in his suggestion to go slowly on any body you are just learning about and also to have some self compassion. We arrive in this space for such a short time and do our best to listen and respond with our skill and caring.
Sometimes what we would consider a negative reaction can be what some call a “health crisis” moment. It is when we have tapped the flood gates of someone’s physical or emotional barriers and it is common for the body to react. It is often received well when we can remain present and offer support even when our tendency might be to feel guilty. I will sometimes just examine what I could have done differently and if nothing I turn that light back on to my client to listen and offer support, sometimes if they are attached to blaming I will offer them a free 2nd session and start a deeper conversation about their history and our next session.
On a practical level regarding injury, like Shama says we often do not know the extent of it so take caution. I was advised long ago by one my teachers to not treat a person with low back acute issues in Prone and in stead use side lying which helps to keep the sacrum and l4l5 region open. I will use rocking techniques for the direct area and acupressure to the meridians around the so called hot spot.
hope this helps!
Thanks for your contribution, Liz. I also use mostly rocking techniques when I feel that something might be really wrong. The first rule is to do no harm, and it is almost impossible to do harm with rocking techniques. Then I go from there and see how far I can go. Often the healing doesn’t come from stronger techniques, but from more intuitive and empathetic work, as you have mentioned. I agree that good communication can be an essential element of some sessions, and in some cases it can be the most important element in my experience, because that’s where trust is established and rapport created.
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