Episode 313

Sep 11, 2020

Allissa discusses 3 factors to help practitioners consider scope in offering self-care and referrals.

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  • Should I Worry About Scope When I Suggest Self-Care?

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Michael Reynolds Hey, everyone. And welcome to the Massage Business Blueprint podcast, where we help you attract more clients, make more money, and improve your quality of life. I'm Michael Reynolds.

Allissa Haines I'm Allissa Haines.

MR We're your hosts. Thanks for joining us today. We are glad you are with us. Allissa, what are you reading this week? What's going on? What's on your mind?

AH I am reading Massage & Bodywork magazine, the September and October 2020 edition. People, it is so good. It is so good. There's so much --

MR It's always very good.

AH It's always really good. And I don't know if it's just because I have made more time to sit down with the paper issue this month, but -- oh, and there's at least one podcast episode for ABMP that goes along with one of the articles in the magazine, which I found really, really enlightening and helpful. And it was great. So I -- there's just a -- everybody can read ABMP's Massage & Bodywork magazine online. And I will put the link in the show notes. It's kind of like a digital magazine. It's not always the best format, but you can enlarge the screen and read it, and it's wonderful.

And the first article that I want to mention that is just so good is Ruth Werner's "COVID-19-Related Complications, Implications for Massage Therapy." And it's robust, and it is so helpful in -- it's helpful in helping me create an intake that assures I am going to be able to safely treat my clients who have had COVID-19 and know they have had it or people who may have been asymptomatic and never tested and didn't know they had it but still have some issues related to it that we don't know about. It's really helped me -- all of Ruth Werner's work through this whole time has really helped me feel better that I can adapt my work to be safe -- or safer, and it's been really helpful to me. So there's that.

There's also a great article by Cal Cates and Kerry Jordan about "Is the Client Really Always Right?" (sic). And that's the one that had an accompanying podcast episode that you should totally listen to. I have two shout outs that kind of came up as I was preparing this information and getting the links. And one is I don't know if you've noticed -- if you get the magazine or you've read it online -- it is just strikingly beautiful. They create an aesthetically beautiful publication. The design is interesting and modern and innovative, and it flows. An entire issue just flows beautifully. So shout out to Amy Klein and Amy Rowe, the art director and graphic designer and that whole design team. I've worked with them a little bit in some of the stuff I've written. And they send us these proofs to approve, and every time we get a proof for a column, or in the times we've written feature articles, I just -- I get the PDF, and it just takes my breath away how beautifully designed this magazine is. It is a delight to look at as well as read.

And then a shout out to Yomassage, our friends at Yomassage, because they've got a digital pop-up ad in the digital edition, and I just love looking Yomassage's pictures and their videos. And I love looking at them because they use normal-people size and shaped bodies. It's not all thin, lanky yoga ladies. It's varying sized and shaped bodies that are just beautifully lit and beautifully dressed and make me feel really good -- and I will take the Yomassage training at some point -- but I just love seeing normal and average-shaped bodies. Not everybody's body shape is normal, but average and typical and the -- I like looking at the ad and being like, that's how my body's shaped. Yay. So anyhow, shout out to those people. And that was a long "what I've read." But there it is. I'm done.

What are you reading, Michael?

MR Nice. I am reading -- actually, I'm listening to a podcast called The Daily quite a bit recently. I think I mentioned it one or two episodes ago. So a recent episode I listened to, which was called "Bringing the Theater Back to Life," really kind of just reminded me of what's going on out there. And I say "out there" because I'm pretty insulated with my virtual businesses and being able to kind of continue and work sort of as normal during the pandemic. But it's a reminder there are so many industries that are just devastated by the pandemic, obviously massage therapy being one of them, another being the theater. So this was called "Bringing the Theater Back to Life," and it was kind of a walkthrough of, first of all, how the theater industry has just been destroyed. No one's working. Everyone's out of work. The theater's completely shut down, which is tragic.

And there is one theater in, actually, Western Massachusetts, in your neck of the woods-ish, Allissa, that are attempting to do pandemic-safe theater performances. They're doing a performance of "Godspell" in Western Massachusetts, and apparently, they pulled it off pretty well. They're using adapted distancing on the stage. Obviously, with the audience, they're distancing as well, really kind of adapting the performance to fit safety protocols and, of course, the cleanliness protocols behind the scenes and everything. So anyway, they're pulling this off, and there is -- and they sold out of these shows, of this theater performance, and it's becoming a model for theaters around the country to kind of watch and see how to start reigniting the theater industry.

So it's just -- no real big lessons or anything or business-y stuff to take away. It was just something interesting I listened to to remind me that there's some real tragedy happening in the arts, in wellness, in so many industries that I really am hopeful that these professions and industries come back to the point where they are thriving again, and that we can enjoy the arts again, and we can enjoy being in close contact as wellness practitioners again and can really adapt in a way that makes this safe and healthy for everybody. So they're just interesting podcasts to listen to. And yeah. So that's kind of what I have. That's what I've been listening to.

AH That's cool. Thank you.

MR Yeah.

AH Who's our first sponsor, Michael?

MR Well, great segue because you just mentioned our friends at ABMP.

AH Oh, my gosh! [Laughing]

MR (Indiscernible) How about that? [Laughing]

AH For reals, people, when I was prepping my -- what I've read, I did not realize that ABMP was the sponsor of this particular episode.

MR There you go.

AH But ABMP is a sponsor of this particular episode, and they've told us they're proud to sponsor us on our podcast.

Sponsor message At ABMP, you will find CE courses you love available for purchase or included free with your membership in ABMP. And you can find that at abmp.com/ce. It's called the ABMP Education Center, and it is huge. You can explore hands-on techniques, complete ethics requirements, discover trending courses like "A Detailed Approach to Low Back Pain" from Allison Denney. She is a great, I think, columnist, and I love her features. All ABMP memberships include 200-plus video-based, on-demand CE classes. And if you're not a member, again, you can actually purchase access to a single course or a CE package all at abmp.com/ce. And if you want more from ABMP, you can get more. You can check out the ABMP podcast that I referenced earlier, available at abmp.com/podcast, or wherever you typically listen to a podcast.

MR Yay.

AH Yay. Everybody go visit abmp.com. Woo hoo.

MR All right. I love it when you address listener questions. And I think today is one of those episodes.

AH I love listener questions. And I love this one especially because it comes from a massage therapist -- or a soon-to-be massage therapist; he's at the end of his schooling, I think, in Texas. And he emailed ages back because he was thinking -- he's actually a retired law enforcement and was subject to a lot of trauma in the particular genre that he was in. And he asked about becoming a massage therapist and what the market was like for male therapists, and just really interesting and innovative questions that often come from someone who is approaching massage as a second career or a retirement career or a mid-life change.

Anyhow, he's at the end of his schooling and sent me another question. And it is -- I'm going to kind of -- it was a long question, so I've broken it up a little bit here. And he says, "I have a liability question with regard to recommendations outside of our scope and would like to see how you handle it. Obviously, as our training is drilled into us, we do not diagnose. That being said, where's the line between diagnosing and pointing a client towards a good, legitimate source for an issue that a client appears to be having? Can we point them towards something as innocuous as foam rolling for self-care between massages or a good yoga stretch website? Can we point them to more specific videos from legit sources on stretching and self-care? For example, if we think their pec issue is coming from constant desk work and shoulder rotation, some would say the very fact that we are pointing them in that direction for something specific would cross the line of diagnosing. Training paints a pretty hard line, but is there safe middle ground to connect clients to good information?"

This was such a well-thought-out question. There's a little bit more to it that I'll get to in the second part here. But my short answer is, as always, yeah, it depends. It depends on how your state or your governing jurisdiction, your governing body, defines your scope, or if they do at all. Some states and localities don't have anything to say about massage, in which case you kind of get to determine your scope based on your training, which we'll get to in a moment. But if your state allows you -- if it's written in your scope that massage therapists manipulate soft tissues of the body and stretch muscles, blah, blah, blah -- if it's in there, then yeah. It's fine to say, I think some stretching would help with that pain in your shoulders. Here's a stretch, and you demo it for them. Or here's my favorite video that I think would -- that demonstrates this rhomboid stretch really well, and pass along that resource.

If your state says stretching is out of your scope or your jurisdiction or anything like that -- they say that no, we -- in Massachusetts, it used to be that we couldn't do specific stretching, and nobody was really sure what that was. We were like, does that mean I can't do "passive range of motion" kind of stretching in my treatments? Does it mean that I just can't tell people to stretch or direct them? We didn't -- it was very confusing, but it got fixed.

But if your state or your jurisdiction, your governing body, says, you are not allowed to stretch, then I think that recommendation would be something more like, I think you could benefit from some stretching and some range of motion, especially in the shoulders. That's out of my scope to recommend, but here's a yoga teacher or a yoga class or a physical therapist or a trainer that I would suggest. So you can say, I think you would benefit from this, but I cannot give you the direction on that. Here's the team of people I trust. Pick one.

Now, I think to say -- if someone comes to you with shoulder pain, when you say, I think your shoulder pain might be helped by this, you're not diagnosing. You're responding to the complaint that they have presented you with. If they didn't come in for shoulder pain, but you think, to your hands, it feels tight, or when you did some gentle motion, it seemed really restrictive like they should have more range of motion -- if they didn't come to you with that complaint, I wouldn't say, hey, I think your shoulder's tight and restricted. This is how I can massage it, and this is the team of people I think could help you stretching, because then I think you -- I don’t think you're diagnosing, but I think you're verging into that territory if you're addressing something that they haven't complained about just because you think in your head there might be an issue. It's different if you're working on the shoulder and the client goes, oh, that hurts. Okay. Now we have a complaint. But be mindful of seeking out issues and wanting to treat issues that they have not presented you with. I think that could verge out of scope.

Okay. So again, determining your scope, there's a couple of different factors here. I touched on one, which is read the legislation that governs you. And there might not be any. If there was ever a legislative effort from your state chapter of AMTA -- AMTA was and still is, in many places, initiating legislation and regulation around massage in states that don't have permitting and licensure and stuff like that. So if there is or ever was a legislative effort from AMTA, check in with the leadership of your chapter, of your state's chapter because they might be able to point you towards some either official or proposed documents that would indicate scope and if that is relevant to you in your area.

I would also say in determining scope, especially in regards to recommending stretches and self-care, how close is that self-care technique or that thing to the work that you already do? Are you suggesting that the client do something that is similar to the way you treat them? So like foam rolling, what does it do? And I'm not asking physiologically what does it do because we don't really know. But we know that mechanically it squishes muscles around, right? If you are sitting on a foam roller and using it on your hamstrings, the foam roller is creating -- is a force, is a thing that's creating pressure from the hamstrings up to the bone in your leg -- what is that -- the femur. And it is -- so it's mechanically squishing the muscle between the foam roller and the bone. Well, that's what massage does. We mechanically squish the muscle between our hands and the skeletal system underneath it or whatever. These are very broad terms. Clearly, I haven't been in AMP (phonetic) in a while.

But yes, that foam roller is doing the same thing that your massage does -- not exactly the same, but you get where I'm going here. It squishes the muscle. So I would feel comfortable recommending -- if I was into that, and I had any training in foam rolling -- and we'll get to that in a second. That is a technique that does essentially what your hands-on work does. I would feel comfortable suggesting that if there was a situation in which I felt it was appropriate and would be beneficial to my client. I recommend people roll a tennis ball under their foot if they've got some plantar fasciitis issues or just some pain. I don't know if it's plantar fasciitis. I don't diagnose, but if they've got some pain in the sole of their foot -- so that tennis ball is doing to that tissue on the foot the same thing I do when I'm massaging it, which I am absolutely qualified and within my scope to do. So there's that criteria. Is the thing you're recommending doing the same thing you do in your treatment? If you are allowed to stretch in your state, if you're allowed to do passive and active range of motion in stretching, then yes -- suggesting a stretch for someone to do at home is similar to what you would be doing with them in your office -- I think it's okay.

What about things like a TENS unit? Those are available on Amazon now. A TENS unit, it's got these little patches, and it sends an electrical stimulation through the muscles. Massage doesn't do that. I am specifically prohibited from using any kind of device like that in my massage practice. So even though it's an over-the-counter thing, even though anybody can get one on Amazon or at CVS now, I would not suggest it to a client because it is wildly out of my scope. Just like you can get Vitamin C at your pharmacy counter, but I can't recommend anybody ingest anything. That is wildly out of my scope, so I would never do that. I would say -- if I felt someone would benefit from electrical stim, I would say, are you seeing a chiropractor or physical therapist? They may be able to suggest more therapies that could be helpful along with massage. I wouldn't even say, maybe you need a TENS unit. You can get it on Amazon, because I'm not allowed to do that in my massage room. So there's that.

Secondarily, scope is also determined by your training. So in my state, it could be completely allowed to do intraoral massage for a TMJ or migraine stuff or whatever, any kind of dysfunction. I'm allowed to do intraoral massage. However, I'm not trained in intraoral massage. There was nothing in my schooling. I have not taken any CE. I haven't even taken any online CE that would instruct me as to the do's and don'ts how I can help and not harm somebody by sticking my fingers in their mouth. So for me, I feel that intraoral massage is out of my scope because I don't have advanced training in it. My state says I can do it, but ethically, I'm a little on the fence about it. Maybe I would take some online classes or a live class, and then I would feel comfortable doing it. That's kind of a decision you have to make on your own.

It's the same for, again, stretching. If you didn't learn any stretching or range of motion in your schooling, I would really take a class on it. Or do one of those at-home, personal trainer classes, at least, to cover your butt. Same thing for abdominal massage for womb health. There's Maya Abdominal Massage. I am trained in basic abdominal massage in my general massage training, but I've never taken any CE on it. So if a woman said, hey, I've heard that massage can be really good for fertility or endometriosis. Can you do that? I'd say, I can do basic abdominal massage, but I do not have the deep training specifically for those issues. I don't know enough, but let me find you someone who does. That is more of a personal and ethical decision. My state, who regulates me, says I can totally massage people's bellies, but there's a line there.

And I just -- I got on a tangent there, so I just want to double-check my notes. Oh, so -- and I kind of touched on this. I responded to our listener, and he came back and said, you know, my state doesn't say stretching, but in the statutory definition of massage, it says Swedish gymnastics, which is hilarious to me because I remember this from my schooling, which is a system of light calisthenics and stretching. So he feels like his scope involves stretching. Awesome. That problem is solved. But he also says, I know that our instructors in massage school said it's a good idea to have some type of certificate for any technique we use outside of basic massage. And that speaks to that component of, yes, it might be in your scope, but you should probably get some CE on it to cover your butt. And that might be taking a Maya Abdominal Massage class. That might be taking an intraoral class. That might be taking a very specific stretching class or a personal trainer certification. It can't hurt, and it will probably help.

And those are my feelings about scope. You need to look at the legislation that governs you, if there is any, consider how close the care you're recommending is to the actual physical massage you do in your massage room, and also consider, are you trained in it? That's it. I'm done.

MR Well put. Thank you for that. [Laughing]

AH Thanks. I try. I prepared.

MR And thanks to our listener for sending that question in as well. I love those.

AH Thank you, Bruce (phonetic) You're the best.

MR Good stuff.

AH Good luck finishing school. All right. What's next, Michael?

MR All right. Let's show some love to our sponsor, Jojoba!

AH Yay.

Sponsor message This episode is sponsored by The Original Jojoba Company. I think massage therapists should use the highest quality products because we're soaking it in for however long we massage every week and so do our clients. So I have been using jojoba for years. It is the only company in the world that carries 100% pure, first-pressed quality jojoba. I am delighted to be partnering with them. I have found -- because my state is requiring right now that we wear gloves to massage, which is ridiculous but there it is; it's the rule -- I am preferring jojoba to lotions or creams right now because it just works better with the friction and the gliding between my glove and skin, so I am loving it even more than I normally do. I also love it because it's nonallergenic, so I can use it on any client and every client without worrying about an allergic reaction or sensitive skin or a nut allergy. You, my friends, can get 20% off the price of the product when you use our link massagebusinessblueprint.com/jojoba. And it's been a while since I've spelled that out, so J-O-J-O-B-A.

MR Wow, 20%.

AH 20%!

MR That's crazy!

AH It's wonderful.

MR All right.

AH Michael, I don't have a quick tip today. Do you?

MR I do indeed. Actually, I'm going to cheat a little bit on my quick tip today. I'm going to be a little bit sales-y, so be warned. But it's going to be kind of a hybrid. It's going to be a little bit of a quick tip on getting your website redesigned, but really, it's going to be a sales pitch for our website service. So stay with me here.

A lot of massage therapists in our community are slowly ramping up, kind of reopening, getting back to work with protocols, etcetera. And we've had a number of people that are asking about getting their website redone or redesigned or just kind of taking the time to get their website where they want it to be. So it occurred to me that we don't do a great job of promoting this service that we have, so I'm going to go ahead and promote it a little bit today. We do websites. At Massage Business Blueprint, we have a website package. I personally do it; I'm the one that puts it together and does it for you.

And we put it together because we know that this constantly comes up over and over. In our Community, people are always asking, hey, who'd you work with for your website? How'd you get your website designed, blah, blah. How do I get it done? And plenty of people are comfortable doing a DIY approach through Wix or Weebly or Squarespace, and that's a great option. But many people don't have the desire, time, skill, comfort level to do that, and they want to hire someone to do it. And so we just constantly saw this long list of people that said, eh, I worked with someone. It took forever. They never finished it. They charged too much. They never got back to me. I didn't get what I want -- just long list of complaints when working with somebody about a website. So we thought, hey, let's provide this. Let's do this for people. And so we beta-tested earlier this year, and I think we've had five website launches so far, all very successfully. Turned out great. Kind of got the program down running smoothly. And so it's official; we are doing this for massage therapists who would like to get a reasonably priced website that is done fast, that looks great, and that is easy to manage.

And so it's on our website. So if you go to massagebusinessblueprint.com and go to the Recourses section, it's linked there. You can also get there by going to just massagebusinessblueprint.com/website. And the price is $1,500, one-time setup fee for the website and $35 a month for the hosting, the licensing of the software to manage it for support through Allissa and I, so it's more hands-on, personal support. So it's a little higher than you'd pay through a DIY provider, but we answer questions that are more personal, like, hey, how do I get more traffic to my website? And we give you lightweight tips and consulting on how to actually use it more effectively. So it's much more hands on, much more personal.

We're not trying to be sales-y and push anyone into doing it, but we know that it's hard to find options for websites for massage therapists that are priced appropriately, that are done well, and that really give you what you need. And so it's a really fast process. So it's a three-meeting process: kick-off meeting, site review -- final site review -- and then launch. We don't mess around. We get this launched fast. You're not going to be waiting six months for a website. You're going to be probably three to four weeks at most before getting it launched, maybe even sooner. It's up to you. We can go faster. And we've had a number of our members that really love their new website. So I wanted to share that with our members -- or our listeners, rather, to let people know about it.

Anything to add?

AH Just that my website was built on the same platform that we use for this service, and I really like it. It took minimal training for me to learn how to log in and make basic changes. And whenever I need anything changed, I -- with this change to my new business, my new office location, I needed something changed in the footer, my actual address and stuff. And it wasn't something I could change myself. I didn't have access to that, or I didn't know how to have access to that. And all I had to do -- and you get this kind of service too -- was to email Michael and be like, hey, these are three updates I need on my website that I haven't been able to make myself. And very quickly, he got back to me and said, yup, I'm on this. You'll hear from me in a few days. And then it was done. And it was so -- and I talk to Michael a lot, but I didn't get that service just because it's me. And the fact that it was just so easy for me to go in and make all the changes, I like it. I've worked with all the DIYs. I've worked with WordPress. And I find this platform very easy to use. If you can use a Word document, you can handle this.

MR Cool. Thanks.

AH That's my endorsement.

MR All right. So yeah, check that out if you're interested, massagebusinessblueprint.com/website, or find it through the Resources section. And I'm done.

AH I'm done too. Thanks to our sponsors. Thanks to you for listening. Everybody have a productive and lucrative week.

MR Awesome. Thanks, everyone, for joining us. As always, you can find us online, massagebusinessblueprint.com. Have a great day. We'll see you next time.

AH Bye.

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