April 4, 2019

Rubdown

Viewed in one light, I said, massage is a business, selling a personal service, as a hairdresser does. When I think of it in this light, I always think of John Wayne calling peremptorily for his rubdown:




That's a long time ago, and a lot of water under the cultural bridge, but it still illustrates a lot the massage that actually happens in the world. We like to talk about massage as medical treatment or as cosmic connection, but much of it is just "where's my rubdown?"

There's a directness and lack of pretension to it. I have a few clients who think of it this way, and I like working with them. I relax them, soften things up, work out the kinks a bit, and I'm on my way. I have a client who just had his 95th birthday, who listens to Glen Miller during the session -- the music of his youth, as I might listen to Crosby Stills & Nash -- and at the end he'll say, "that felt good!" and we're done. In chatty mood, we might discuss single-payer insurance (I'm fur it, he's agin it) or rent control (we both take a dim view of it.) I'm not expected to fix anything or deliver any insight.

I have younger clients who treat it the same way. One professional woman who works at her laptop the whole time I'm setting up, hops on to the table for her 90 minute massage, hops back off, and is back at work again before I'm all packed up. We exchange a few pleasant words about her last business trip, maybe, but my job is to deliver the rubdown. It's an uncomplicated, straightforward service relationship. If massage was my first career, rather than my third, it might rankle a bit -- being the help -- but I'm long past all that. I don't mind being a servant, as long as I'm treated well. It's comfortable. Soothing.

The text for my ethics class in massage school, made much of the the care massage therapists must take with the power imbalance of the therapeutic relationship: we were the experts, the authorities, and our timid clients would believe anything we said and follow any instructions we gave. Well, yeah, sometimes. Sometimes not.

March 30, 2019

Handwritten Massage

Tracy Walton, one of the most thoughtful people who writes about massage, considered a passage she wrote twenty years ago, and pondered whether she could still endorse it:


Handwritten Massage

She decided she could, that she did. But in mulling it over, and thinking about what massage as a business and a medical intervention has become, she wonders: is this what we wanted? Is this really what we were trying to create?

Reading Tracy's post made me wonder something more immediate and more personal: how well have I kept my own practice aligned with what I am trying to do in the world? How hard have I even tried? And have I ever really thought it out? The anxiety of "can I actually make this work?" and the day to day business of getting a practice off the ground have carried me along -- in my case, for twelve years. The work itself is absorbing and joyful. My practice is a personal and practical success. But what am I succeeding at?

I wanted to be my own master, choose my own hours, make my own rules: and my life has been much happier and calmer since I achieved that. I also wanted a life that encouraged -- demanded -- a daily cultivation of compassion. I wanted, in Tracy's words, "to build a bridge that may heal us both." Have I done that? Well, in some ways.

This is where the larger context of massage as business, massage as medical intervention, comes into play. I don't actually get to set my own rules (nobody does.) Whatever I do, I'm working with my clients' expectations, and I'm working within the laws and customs governing massage here in my corner of the world. By local expectation, law, and custom, massage is a business, selling a personal service, as a hairdresser does; and it's a medical intervention, treating musculoskeletal ills, as a chiropractor does. And then (not by law, but by alternative custom) it's sometimes a third thing: a healing ritual, addressing spiritual ills, as a shaman does. In any given day I might have clients who think of a massage primarily as any or all of these. I'm an affable man and I try to deliver what's expected. But what do I think it is? What do I want it to be? I'm going to think about that for a while. I don't have a simple answer.

March 8, 2018

That Email I Always Write

A friend of mine "threw her back out" a week or two ago and emailed me for advice. I realized as I answered her that I seem to write this email a couple times a year, so I thought: "I'll edit this lightly and post it." 

I asked a few questions to see if it was likely to be a serious injury or a degenerative condition: it wasn't. No numbness, no functional impairment beyond the pain. "What she'd done to it" was crouch down to load the dishwasher. So I wrote:


Yeah, this is a pretty typical onset.


First thing to know: this is very common and it is very likely to resolve of itself within a week or two, regardless of what you do. It is more like a headache or a cold than like a degenerative condition. And it's more common at your age [parent-of-toddler age] than it is at mine [sixty]


Second thing to know: disks do not "slip." Spines are not fragile. They are incredibly tough structures that it generally takes enormous forces to injure. In the absence of obvious trauma what you've likely got is a pain problem, not a back problem. Which can be totally as debilitating in the short term, for sure, but it's important to think about these things accurately.

The reason it's important is that when your unconscious brain is deciding whether to throw the panic pain switch, it consults your opinion on how serious this injury is. It does this without you ever being conscious of it. The first thing you know is an explosion of pain. But back there behind the conscious mind, your unconscious mind is flipping through the files on "back pain" and deciding whether to escalate the twinge to the whole pain explosion. If it finds a bunch of old info about fragile backs and slipping disks and degenerative conditions, it's VERY likely to throw that switch.

And as you know excruciatingly well, you do NOT want it to throw that switch.

I used to have this back pain a lot, mostly before I worked at the Foundation. The worst episode, I missed about ten days of work. I had to crawl to the bathroom. I get it, believe me. The pain is totally disabling when it's bad.

So the general rules: stress makes an episode more likely. Lack of sleep makes it more likely. Lack of exercise makes it more likely. (Of course, what this pain does is 1) stress you out, 2) make it hard to sleep, 3) make it impossible to exercise. Catch-22. I hate it.)

You don't want to get the switch thrown again, but you want to move as much as you can without setting it off. Right now you mostly just wait and let it calm down. If you have a tub -- and can get into it in your present state -- a hot bath can work miracles.

And in a day or two you should have a friend come over and do some gentle massage work on it :-) Your big job right now is to convince your back that it's okay, that nothing overwhelming is going to be demanded of it, that it actually still can move and all will be well. Which it will.

Hugs--
Dale

I realize that I could capitalize on back pain by saying I could fix it. But really I don't see massage doing a lot for it, and especially not in the acute phase -- that is, in the first day or two. After that, yes, massage helps the nervous system settle down. Even better is massage before it happens in the first place. Nonspecific back pain, like a lot of stress-related conditions, is a lot easier to prevent than it is to treat.

February 20, 2018

Just Relaxation Massage

I took a three day Shiatsu workshop, a couple weeks ago -- great fun, I learned lots. (And forgive me: no, I still don't believe in energetic meridians. More about that anon, maybe.) I ate lunch with some other participants, the first day, and when asked about my practice, I said, "Oh, I do in-home massage. I've been doing it ten years, now. I love it." And then the demon of self-deprecation got hold of me, as he will, and I added, "Just relaxation massage."

That's the way we massage therapists often talk about it, among ourselves. Just relaxation massage. The lowest common denominator. Swedish; spa massage; fluff n buff. The stuff anyone can do.

But I've resolved to stop talking that way. The thing we call "relaxation" isn't trivial, and it isn't easy to do well. In fact I think it's the most important part of massage, and probably the active ingredient in most of our successful "treatments." It's what I personally get massage for. But it's hard to talk about clearly. It's an experience that does not lend itself to words.

I wrote recently to one of my own massage therapists: Thanks so much! That was a transcendent massage. Changed the quality of the sunlight coming through the leaves.

It didn't fix me. No particular issues were addressed. I'm still the same sorry messed up mortal I was before: working at a desk all day will still make my neck stiff, and dealing with obnoxious people will still annoy me, and I will still want to eat more than I should at the end of a long day.

So what's it for? What's the point?

The point is going to another place, where the quality of the sunlight is different, where everything is clear and luminous and spacious, and nothing needs to be done. We don't stay there. And an hour afterwards maybe it won't make any obvious difference in our lives. But really forgetting that other place is there -- that would be a catastrophe: that would set us up to be dislocated and uprooted in hundred different ways. We need to go back periodically, to be reminded: it's still there.

June 10, 2017

Six Things To Know Before We Start

1. Timing. The time we set is when I arrive, not when the massage starts. It takes me about ten minutes to set up. If it's our first appointment, you'll fill out a one-page intake form and we'll talk about what you're looking for and what I'll do. You can ask me questions and give me instructions. (You can ask me questions or give me instructions any time, of course -- please do! -- but this is time formally set aside for it.) The massage itself typically lasts about 90 minutes. Then it takes me another ten minutes to pack up and get out. This adds up to about two hours, for the first time, maybe fifteen or twenty minutes less, after that. It's a big chunk of time. If you're picturing me showing up at the door at 7:00 and being out the door at 8:00, then we need to plan for that, and you need to be okay with having just 45 minutes on the table.

2. You are not my host. Different relationship. You don't have to keep me entertained. You don't have to offer me coffee. If you feel like chatting, that's great; but you don't have to. I have clients who barely acknowledge me when I come in and set up: they keep working right up until I say "ready!" Then I go wash my hands while they get on the table.

The house doesn't need to be tidy. There can be dishes in the sink. Your four-year-old can wander in and out of the room, looking for his airplane.

I have one regular client just says "good night" and goes to bed, when I'm done: I lock up and drop their key back in through the mail slot. I've had a couple clients who have their own massage tables, so they can stay on the table when I leave. Some people like a hug and a chat and when I show up and when I go; some people prefer me to just appear and vanish. I'm happiest when people are doing what they're comfortable with. I'll follow your lead: I like the variety.

3. Undressing and getting on the table. When I'm all set up, I leave the room and wash my hands while you get undressed, get on the table, and get under the sheets and blanket. Some people like to already be in a robe when I get there. Doesn't matter to me, just as it doesn't matter how much you undress.

4. Music. I don't bring music, so if you want music, you'll need to set it up. The stuff people like to play runs from Enya to Tchaikovsky. The Beach Boys, 1940s swing, technopop, Navajo flute -- I like everything. But be aware that the tempo of the music will influence the tempo of your massage! The William Tell Overture gets you different bodywork than Arvo Pärt.

5. Your pets and I will get along fine. Dogs generally like massage to be going on. They seem to understand it right away: oh, this is chill time! They often curl up under the table, or nearby, and fall asleep. Cats are inquisitive, and need to check out my massage duffle, and sometimes get a little impatient that all this petting is going on and none of it involves them. Occasionally bold ones may jump up on the table, and I'll gently set them back down on the floor. I only recall one that insisted on jumping back up and staying there: I just worked around him.


6. Tweakability. The main value-added with in-home massage, besides that you get to stay home? -- it's that it's infinitely tweakable. You decide how long. You decide on the music, if you want any, and how loud it will be. You decide on the the lighting. You decide on the warmth of the room. (I bring a table-warmer, sort of like an electric blanket under the sheets: but you decide whether I turn on high, or at all.) I bring a stack of pillows for some people: some people like more than just a bolster under their knees. Make yourself comfortable, and ask for what you want! That's the whole idea. Some people have special oils they want me to use. I'm delighted to take the time and effort to make it comfortable: if I didn't like that sort of thing, I'd be working in an office.

June 4, 2017

Recalibration

"One of the things I love about massage," said a client yesterday, as I was packing up "is what it does to my vision. I feel like I can see so much more clearly."

I have the same experience: I step out of a massage room and the world seems much brighter, sharper, clearer. I would love to know if this is an objective, measurable effect. I suspect that it is. One day I worked my sister-in-law's neck and shoulders, because she had a headache, and after a few minutes, lifting her head and looking at the opposite wall, she said, "wow, I can read the print on that poster now. I couldn't, when you started."

Some of this effect -- if objectively real -- may not be very mysterious. The eyes are focused by tiny muscles that attach to the eyeball, and they're likely to be involved, willy-nilly, in the "hold still and make no sudden moves!" general orders that the brains sends down in response to pain or fear. With pain relief and a sense of security, the general orders should be rescinded, and the muscles should recover their nimbleness and do a better job. That's perfectly understandable.

The mysterious part is that my vision doesn't just seem as good as normal. It seems better than normal, better than it's been for weeks. And that sense that my whole body just works better -- in some difficult-to-describe way -- is the main reason I get massage. It's partly the relaxation, of course -- lying down in a comfortable place for an hour accounts for some of it. But the effect seems larger than that, and it lasts for several days.

There are explanations for this effect that, while widely believed, don't hold water. The effect of massage on stress hormones (cortisol and so forth) appears to be so minimal that it's not really worth mentioning. The supposed flushing of toxins has been thoroughly debunked. The energetic explanation seems to be circular, if not nonsensical ("I feel better because my energy has been rectified, and I know my energy has been rectified because I feel better.") True or false, it doesn't take us very far.

So here's my guess, for what it's worth. We live in conditions of high stress, minimal movement, and (in some ways) extraordinary physical comfort. Soft beds, silky fabrics, and well-padded seats are normal, for us. Our nervous systems are not designed to deal with this little input, and a couple bad things happen because of it. One is that we get phantom pain. Just as our brains produce tinnitus -- in the absence of sound perception in a certain range, it gets alarmed and makes up noise in that range,  apparently considering that any signal is better than none -- we get those weird, variable, hard-to-place pains that massage therapists often end up fruitlessly chasing. The pain is real enough, just as the ringing in the ears is real enough, but you're wasting your time looking for the bells.

The other thing that happens -- and this is what I'm driving at now -- is that sensory perception and motor responses may get blurred and muddy. There may not be enough day to day feedback to maintain clear and distinct brain maps of the body. There's a famous experiment in which a brain researcher taped two fingers of a monkey together for several weeks. By the end of that time, the two separate brain maps for the two fingers -- brain maps are actual physical regions of the brain used for analyzing sensation and directing movement -- had merged. The two fingers always did the same thing and felt the same way, so the brain, being thrifty, discarded the extra map. At that point, the monkey could no longer move the fingers separately, even when they were untaped: it would have to remake the separate maps before it would be able to feel and move the fingers separately again.

I speculate that something like that is going on in our excessively padded, sedentary lives. The range of movement and sensation and motor-feedback that most of us experience is extremely limited, especially compared to our ancestors on the savannah. This level of comfort was not in our design specs. It may not be accidental that the sort of massage we favor seems to have arisen in Turkey a couple of centuries ago. The comfort of the Turkish upper class then was routinely commented upon (disapprovingly) by European travelers: their soft sofas and cushions, their pillows and carpets, struck Europeans as dreadfully decadent. Now we all live like Turkish pashas: a bare wooden chair or bench has become a rarity, and sinking into an easy chair or a couch to watch TV strikes us as ordinary relaxation, not as self-indulgence.

It might do us good to be less comfortable, some of the time. It would certainly do us good to move more (but we all already knew that). In the meantime, we can jump start ourselves with massage: remind ourselves how good it feels to be able to bring the senses to a sharp focus, and for the body to be well-tuned and responsive. There's a more vivid life available.

January 1, 2014

A Body in the Parking Lot

I pulled into the parking lot at the cafe, and there was a body, lying on the wet pavement, in one of the parking spaces.

As I got out, she stirred, and tried to sit up; failed, and lay back down.

I hurried over and asked her if she was all right. Breathing, bleeding, shock, said my Dad's voice, in my head. She mumbled something. I crouched down beside her and took her hand, doing a quick look-over for injuries, for scene-of-accident signs. Nothing. She returned the pressure of my hand normally: not a clutch, but a trusting squeeze.

I couldn't get intelligible speech out of her, though, and she couldn't tell me her name. I asked if she wanted to try to stand up, and she gave it a brief try, but failed. There was alcohol on her breath, but she wasn't reeking. Some more people came by, and I asked them to call 911. While we waited -- a long time, it seemed to me -- she began having gentle spasms, and muttering in distress, murmuring about something about her babies, weeping a little. All the time she held my hand. "You'll be all right, hon," I said.

Other people came along: a young Portlandia couple with open faces. The young woman put her down jacket over her, to warm her. Why hadn't I thought of that? I'm useless, useless in emergencies. Someone came out of the bar to look for her; he knew her name, but not much else. Police showed up, asked some questions, established that an ambulance was a good idea. The spasms faded. The woman, secretively, brought my hand to her mouth and kissed it.

Finally the ambulance, the paramedics: people I have great trust in. I stood up to ease my knees, after all that crouching, and the sweet young woman who'd given her jacket took over the hand holding. The paramedics, brisk and clear, got her name from her, and more information than I'd managed to get in twenty minutes. They brought the rolling stretcher over. "They're going to make you feel better," said the young woman. A moment later I saw the woman surreptitiously kiss her hand, too.

Meanwhile, blood pressure, blood sugar, questions of the guy who had been at the bar. Too little food and too much drink, that was clear. The seizures were something the guy vaguely thought maybe she had before, maybe she took medicine for.

The rolled her away to the ambulance. Everyone dispersed. I went into the bathroom at the cafe, and washed my hands well. I felt a little ashamed of myself for doing so, but I also wished I'd warned the nice young woman to do the same: Hep C is no laughing matter, and the cops and paramedics had of course gloved up at once. I went out, sat down, and got my breakfast.

That's it, that's all the story I know. I did the only thing I really know how to do, which is to convey tenderness and caring with my hands. She'd responded to my touch, as clients sometimes do, like a dry plant to water, and I could not shake the conviction, though I knew it was groundless -- really just what I was predisposed to think -- that the alcohol and not eating enough were her responses to touch starvation.

We don't take care of each other. Half of what's wrong with us human beings, I sometimes think, could be headed off if we just still hunkered down together picking lice, imaginary or real, out of each other's hair, of an evening, the way all the other primates do: just touching each other kindly, huddling close, and tending to each other. Instead we've made a world of artificial light, and images thrown on the walls, that we stagger through alone.