Treatment Guidelines for Massage Therapists #2: Work the Attachments

I’ve told you about my “Consultation & Tryout” sessions. The tryout part is a very short treatment, about 20 minutes, to address a local problem.

20 minutes give me plenty of time to work out the attachments around the affected area. Often nothing else is needed in a session.

Case example:

(of course name and job is changed)

Steven came to me because he couldn’t sit down for a year. In his job as a sales representative for a technology company he had to work on the computer, the phone, and visit prospective clients, so he was driving a lot.

In his office, he had managed to work while standing up, but in meetings standing was awkward, so he sat down a little sideways, with sharp pain around the left sitz bone (ischial tuberosity).

Of course driving was extremely difficult, and since this had been going on for a year, other problems were showing up: low back pain because of the sideways sitting and pain under the heels because he was standing for long hours in the office.

He said that seeing a couple of doctors had been inconclusive, and nobody really knew what to do with him. Ischial bursitis came up as a possible diagnosis.

Because an acquaintance had told him about me, he was interested in my inexpensive “tryout” option. At this point he was willing to try anything, but he surely didn’t want to waste any more money.

So here’s my quick fix, and the point of this lengthy story: If you’re not sure what to do, just work the attachments. In this case, of course, everything that attaches to the sitz bone.

It’s what I did, and he felt better after the tryout, and the drive home was the first time driving without pain in a year. He came back for a “sixpack” of short sessions, and started sitting down at work already after the first two treatments. A long flight he had been scared of was no problem, and he’s feeling like a normal person again.

Including the tryout treatment, fixing his problem had cost him $290, and took about five weeks, seven visits. He already was doing much better during the first week.

Work the Attachments

  • Often a lengthy analysis is not necessary, and it makes sense to try the easiest approach first. If that fails, you can still use a more complicated approach later.
  • No matter where the problem is, just work attachments to the area. Shoulder pain? Go around the whole rotator cuff. Pain in the knee? Work everything around the knee, especially where hamstrings and gastrognemius cross over behind the knee. You get the picture.
  • Don’t do any kind of aggressive friction, and don’t worry about trigger points–just use very slow strokes to get between the different tendons and muscles.
  • You have to work slowly so you don’t cause any harm–to the client it should feel stretchy, not like sharp pain. Check in often.
  • Move the joint in different positions. Not to stretch, you just want a light pull on the attachments. Work from different angles.
  • Your idea is just to loosen up areas where different layers of muscle, tendon and fascia are stuck together. Don’t try to violently pull them apart–just ease your way in, and remember: No sharp pain!

You might have learned a lot of wonderful tests to determine range of motion, muscle activity, and maybe you use a posture chart to analyze which shoulder is lower, which hip higher and all that. You can do that AFTER your first try didn’t show great results. It’s always good to have options.

But I don’t like charging a lot for a thorough intake. Neither do I like to spend more time than necessary. A lot of people wouldn’t be able to afford any of my treatments if I always took a whole hour.

If you’re a massage therapist, how do you work with localized symptoms? Do you offer short sessions? What’s your opinion on “the quick fix”? Please share in the comments!

3 thoughts on “Treatment Guidelines for Massage Therapists #2: Work the Attachments

  1. Pingback: Treatment Guidelines for Massage Therapists #1: Trial and Error « Lu Mueller-Kaul

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