I was contacted by an associate editor of MASSAGE Magazine yesterday as an "expert" in the area of cryotherapy and thermotherapy.  This is my response to her.  Hope you enjoy and so you can call them out if they don't acknowledge me!  LOL
                
                First let me thank you for considering my input on this subject.  I have studied the uses of hot and cold therapy and feel that it is therapy that works, as it has over the ages when people did not have anything else to use.  I feel that the best ways of using both cryotherapy and thermotherapy are still some of those original ways also – Ice and heat in their natural forms.  That does not however keep me from using some Tiger Balm or Polar Lotion on occasion.
 
                So, let me answer your questions and give a little background on why to use these things.  The main reason for using any hydrotherapy method is to take the body momentarily away from homeostasis to let the body respond by stimulating the system to heal itself.  And obviously cryotherapy will take the body further away from homeostasis than thermotherapy when we look at the base body temperature of 98.6F.  Both applications have a physiological and circulatory effect on the body by causing vasoconstriction/vasodilation thereby causing either a decrease or increase in both circulation and metabolism.  But that is the science of hydrotherapy.
 
                The benefits of cryotherapy and thermotherapy are therefore based on this science.  And the benefits of each will depend on the duration of the treatment – short or long application.  An ice pack left on for 10 minutes will be totally different from an ice bath used by athletes.  Likewise a hot pack applied on a sore muscle for 10 minutes will have a different effect than an hour long hot stone massage.
 
                The benefits of cryotherapy include:

• An analgesic – pain relief can be a counter-irritant to the stimulation of sensory nerves in the affected area.
• An anesthetic – used to numb an area
• A stimulant – used in a short application, cold can stimulate the body by taking it away from homeostasis
• Burn management – especially useful in the case of sunburns/minor burns to minimize blistering
• Tonic – causes muscle to contract to increase muscle tone
                  I use cold stones for facial massage for migraine or headache relief.  I also use cold stones for muscle overuse especially using a marble neck pillow for clients who work at computers.  Additionally, I use cold after treatment of trigger points.
                  Reasons to use cryotherapy include: sprains or strains, inflammation, pain relief, swelling, headaches, muscle spasms, and any stage of injury.
   
                  The benefits of thermotherapy include:
• An analgesic – as mentioned above both cold and hot can be a counter-irritant
• Diaphoretic – heat can cause sweating which is excellent for opening and cleansing pores which is why heat/steam is used in many facial applications
• Sedative – moderate heat will induce relaxation of muscle
• A stimulant – just like cold when heat is used in a short application it can be to stimulate the body. Short applications of both hot or cold can be perceived by the body as a threat and therefore the body reacts to this stimulation physiologically
                  I use heat to help warm up tissue prior to working tense or sore muscles.  I do this using the heating pad on the table or having heated stones available.  I also do full body hot stone massage as a relaxation technique; however, I advise the client that the effects of this treatment will last longer than the hour they spend on the table due to the body’s physiologic response to the treatment.  The body will take longer to come back to its normal homeostasis after a longer treatment of either hot or cold.
                  Reasons to use thermotherapy include: muscle stiffness or guarding, joint pain and stiffness, stress relief, relaxation, pre-stretching or pre-massage.
   
                  My experience has been that clients see a bigger response when I use hot/cold in their massage sessions.   And if you are asking what is the most helpful in regards to how to use hot and cold I would have to say my stones have been the most helpful in using cryotherapy and thermotherapy in my practice.  But that doesn’t mean I don’t have a “tin” of Tiger Balm or a container of Biotone’s Polar Lotion by my table.  Additionally, I will use specific essential oils mixed with my lotion to create heating or cooling to a muscle area.
   
                 
  

And in stating my title I also submit this to all massage therapist in the state of PA to send to their respective State Legislators if you so desire.

First thing that you need to do is read this article from a leader in our industry as it was posted in the publication Massage Today - http://www.massagetoday.com/mpacms/mt/article.php?id=15275

I believe that this article has great importance to massage therapists throughout the country where it talks about the "organizations" that are trying to "rule" massage therapy.  And the state of PA is a prime example.  I just spoke to a massage therapist trying to get a license in the state of NY who stated that he needed a certain number of hours of Eastern therapies to get his license there.  Hmmmmmm, are these not the same therapies that the state of PA is trying to exclude from re-licensure?

Back a few months ago I drafted this letter -

An open letter to the Pennsylvania Massage Therapy Board
It is our belief that you are limiting the practice of massage and the profession of Massage Therapy in the state of Pennsylvania.

SO we are going to discriminate against Asian Modalities.  Why?  You are making it a restrictive environment to be a licensed, accredited Massage Therapist in the state of Pennsylvania

Will this stop Asian Massage establishments in the state of PA?  Asian Modalities have a place in the practice of massage regardless of the Boards non-belief in the meridian system… a system which is based on ancient Chinese Medical practice.  Will you also regulate Acupuncturists  and Traditional Chinese Medicine practitioners out of the state? 

You are creating a “black market” for Asian modalities in this state.

Limiting the public’s access to legitimate Asian Modalities adversely affects the public you are trying to protect.  It negates all massage therapists training by limiting the study of Eastern traditions and modalities just because it doesn’t fit into your Western model.  Chinese/Asian Massage “parlors” will not go away because of your regulating it out of the practice of Massage Therapy.  Many of the same modalities that you are trying to negate within the practice of massage are already being accepted into our hospitals and medical wellness centers all through our country.  Instead of trying to regulate Asian Modalities out of Massage why not make it illegal for landlords to rent to someone with signage that says Oriental/Chinese Massage without the associated License Number?

We are legislating a climate where people are becoming unlicensed rather than stay or become licensed.  What you are trying to do is taking a giant step back for massage therapy in Pennsylvania.  By creating laws we are leaving out the human element of massage.  We are letting those who seem to know (or remember) nothing about the application of massage or for that matter any healing therapy to govern us.  Where are the massage therapists on the board?  Will you not stand up for the rest of us?  Have you forgotten your training?  Are we to be bullied by the Western/Allopathic medical industry to be part of mainstream Healthcare?  Do we want out licensed numbers to continue to dwindle as we whittle away at what we are and are not allowed to do as massage therapists.
 
LMTs as a group need to come together in numbers to effectively communicate what we want to be able to do in our jobs and create a stronger massage community in PA.  The AMTA, AMBP and others need to come together to represent us and not acquiesce to the Board.  We need to change definitions within the rules to make a difference to the community.

How is the public being protected by beating us up and not allowing us to practice the healing art of massage as we were taught and certified by our respective educational facilities?  Legislation is currently regulating us out of business because of all the costs and stipulations put on how we can make a living.  And all CEs must be hands on?  That is not part of the original licensure document!
 
And a note to CE Providers – If you think you are already certified in PA for CE because you have submitted your classes in the past and are therefore “grandfathered” in, think again.  You will have to resubmit and be approved all over again.

This was my original rant.  And for the most part I still stand by it.  I think we all need to take a look at Ralph Stephens article and do our own research into what is really happening within our industry.  We need to go through the proper channels - our legistlators - and see what we can do.  Those of us who are currently licensed need to stay within the rules and regulations of the state we are licensed in and continue to move forward to make massage available to all people.  I will continue to teach those classes that I have always taught, in the manner in which I have always taught them, to the best of my knowledge and ability.  I also will take those classes that I feel will be of the greatest advantage to my clients regardless of the tradition from which it came.  (Also, why are some excluded while others are not?)

Please join together and fight for the public as much as yourselves.  All modalities should be available to our clients.

This post may not be my most eloquent but at least my feelings are now out there and it is up to you to make it known across the state and then to the proper places at the state level.

Read the article I included!  It is very important to us all!
 

The question of what is Medical Massage has become the million dollar question in massage circles.  And the question I just received is this "Is there a difference between medical massage and clinical massage?"  For the first part of my answer I will defer to James Waslaski, a leader in the massage field, and a quote from his article in Massage Today from June 2004!

"The best short definition I gathered from medical massage therapists is: "Medical massage is performed with the intent of improving conditions or pathologies that have been diagnosed by a physician; a wide variety of modalities or procedures are utilized to focus the treatment based on the diagnosed condition." I was determined to prove that advanced disciplines, such as neuromuscular therapy, CranioSacral Therapy (CST), myofascial release, lymphatic drainage, massage for cancer patients, orthopedic massage, etc., fall under medical massage disciplines, and certification in many of these disciplines usually requires a minimum of 100 hours of training."    http://www.massagetoday.com/archives/2004/06/03.html

Waslaski teaches an Orthopedic Massage class and has a book from Elsevier called Clinical Massage Therapy: A Structural Approach to Pain Management.  I do not have this particular book but any other book from Elsevier is in the form of a textbook.  Elsevier is a company that I dealt with when I was the Massage Therapy Chairperson at a private school in Florida.  More about books in a bit.

So now that I have muddied the waters, let me address the Clinical Massage Therapist part of the question.  I found the following quote:

While a massage therapist can work with clients who have tension, stress and pain, "more serious issues are often treated by a clinical massage therapist. This practitioner uses techniques specifically designed to help injuries heal, improve range of motion, and increase muscle function. Also known as medical massage, therapists who perform this work generally do so by prescription from a doctor."        http://work.chron.com/clinical-massage-therapist-16412.html  Please note that this person is NOT a massage therapist, but that does not make her remarks any less true.

About 10 years ago, I was lucky to attend a seminar at the Florida Chiropractic Convention in Orlando.  This convention has in the past, and I would assume still does, hosted a Massage Therapist track as part of their training classes.  At this particular convention I attended a CE Class about Medical Massage by Sandy Fritz.  For those who do not know, Sandy is the main author of two textbooks by Elsevier/Mosby:  Fundamental of and Science of Therapeutic Massage.  In her lecture she feels the ALL massage is basically medical or clinical.  Her reasoning for this is that all massage has some sort of "medical" benefit to the client regardless of why they are on the table. 

But of course the massage industry as any other profession likes "labels".  It makes for great marketing and sales for massage schools and  continuing education providers.  Don't get me wrong, I do believe there is such a thing as Medical Massage but contrary to some advertisments it is not a required "certification" to do that type of massage.  (Disclaimer - My opinion and I do have a Medical Massage Certificate!)

The standard definition for Medical Massage is that it is an outcome-based, results-oriented specific treatment to a targeted area or problem.  The treatment is by diagnosis and prescription of a physician and may follow their specific instructions after a thorough assessment or evaluation of the problem.  It is also generally billable to insurance.  Be aware that not all states allow billing to insurance companies by massage therapists, licensed or not.  For more information about Insurance Billing for Massage Therapists please look up Vivian Madison Mahoney at www.massageinsurancebilling.com.  I was fortunate enough to take her class and received great documentation on the insurance billing process.  She does have an insurance billing seminar on DVD and if you take a class with Premier Continuing Education you can receive free CE hours from her.  (Shameless Plug)  www.premiercontinuingeducation.com

My personal opinion is that networking with a physician or chiropractor would be the best way to get into this type of massage.  Advertisment and marketing to a specific client base would be another way.  But first you need to have the training to do this type of work.  Clinical-based massage is much more specific and requires the therapist to have more specific training and understanding of the mechanics of the human body.  Back to that Anatomy and Physiology that you learned in school. 

My recommendation and that of James Waslaski in his article mentioned above is to have training in as many advanced disciplines as possible.  Recommendations include (but are not limited to):  Myofascial Release, Neuro-muscular Therapy (NMT), Trigger Point Therapy, Cranio-sacral Therapy and Sports Massage/Stretching.  Additionally more specialized Hydrotherapy applications, including Hot/Cold Stone and other more structurally-based modalities such as certain types of Lomi Lomi and Structural Integration techniques.  You also need to know how to explain why/what you are doing to your clients.

Recommendations for books include (but are definitely not limited to):  Anatomy Trains by Tom Myers, Kinesiology by Joseph E. Muscolino, A Massage Therapist's Guide to Pathology by Ruth Werner (who by the way will be teaching some classes at Sage Continuing Education in Lancaster, PA this fall! - www.sagecontinuinged.com), any of the textbooks by Sandy Fritz, Trail Guide to the Body by Andrew Biel, Basic Clinical Massage Therapy: Integrating Anatomy and Treatment by Clay and Pounds (an LWW textbook), and Fascial Release for Structural Balance by James Earls & Thomas Myers.  I am currently taking the online course by Niel Asher on Trigger Points that I highly recommend (NAT) and any of the books by Clair Davies on Trigger Points.

I hope this addresses the question posed by my Facebook reader this morning.  Obviously the best place to start is in the beginning and being a licensed massage therapist is that first step!  Having the desire to "make a difference in the pain and posture of the body" is the next step.  I hope this points you in the right direction.  Please feel free to comment here.

References used:  www.medicalmassage.com, www.massagetoday.com, www.mmpa.us

When I first started teaching pathology to massage therapists about 12 years ago I had to do my research on Fibromyalgia before I could talk about it.  I really didn't know that much about it but I knew that people were being diagnosed with it.  And then I found out that possibly some people were being misdiagnosed with it.  Let me tell you what I found out back then.

Fibromyalgia Syndrome (FMS) a chronic pain syndrome involving sleep disorders and a predictable pattern of tender points in muscle and other soft tissue.  It is diagnosed after all other diseases are ruled out and when 11 active tender points are found disributed among all quadrants of the body.  Nine pairs of tender points in total have been identified on the body. 

Fibromyalgia often overlaps with Chronic Fatigue Syndrome and during my initial research there was the possible association with Epstein-Barr virus as this is associated with mononucleosis, a disease noted for it characteristic symptom of tiredness.   FMS also may include Irritable Bowl Syndrome (IBS), hypothyroidism, TMJ problems and myofascial pain syndrome.  The pain is "invisible" with no outward signs.

At that time I also found that FMS sufferers may have the following:

• Type A personalities
• Be stressed over the limit
• May have been dominared or in a position of high stress or hig responsibility - real or perceived.

I also found some things that at that time FMS was NOT:

• Not an autoimmune mistake
• Not a virus, bacterial or fungal infection
• Not a result of direct injury

What is was however was a combination of related sleep disorders, endocrine and neuro-transmitter imbalances and the emotional state of the patient.

In my original notes I have the following:  May eventually be reclassed as a CNS disorder because of the presence of increased levels of 2 neurotransmitters in CSF of patients which may initiate nerve activity and lead to the pain.

I have always taught that massage is indicated but do not overtreat as clients are sensitive to pain.  I also have always noted that clients may have been misdiagnosed in the past.  I have experienced clients that would tell me that they have been diagnosed with FMS but want deep tissue work.  I say (not to the client) that is NOT fibromyalgia.

Fast forward to the Winter 2015 issue of Massage Therapy Journal from AMTA.  (Hey, I'm getting things out of boxes and so I found it!)  The Right Touch - "With recent research suggesting fibromyalgia may be a central nervous system disorder, can massage therapy still help?  The answer is - Yes."  I feel vindicated in my research from years ago!

Have you ever googled or binged (I don't think I'm making up those verbs) the benefits of massage?

I'm sure there are thousands of pages out there about the benefits of massage and why you should have one.  They are mostly the stuff of myth and legend! 

I know that many of the people that know me are shaking their heads right now and many will not agree with what I am about to expound on, however what I am about to tell you is true.  Even if when you were in my classes I told you some of these things.  Believe me, I'm sorry.  These were things that I was taught in massage school also and therefore was passing on to you as fact.  It is time to change our beliefs about what massage is (and isn't)!

There are currently 5 generic claims about massage that you will find everywhere on the internet and quite possibly in your massage textbooks.  They are as follows:

• Massage increases endorphins
  
• Massage boosts immunity
• Massage decreases cortisol levels
• Massage increases blood circulation
• Massage releases toxins

These claims start in massage school and are perpetuated by our instructors.  I have already admitted to spreading them myself in my classes.  Before I really start to sort of debunk these claims, I need to give you a little background on my information.  I have been reading about these things not being totally true for quite some time now and recently as I have been cleaning and unpacking some things in my office at the new house I came across an article in Massage Today by Tracy Walton.  She is a leader in the massage world when it comes to Oncology Massage and I have attended one of her classes on massage for cancer and the research on it.  When I was in school cancer was a total contraindication for massage.  The myth at that time was that massage spreads cancer cells.  Research tells us that is not true.  Therefore massage for cancer patients  helps them fight pain, nausea, fatigue, anxiety and depression.  Easing pain and improving mood for them is due to growing research support for these options.

In the article and in her e-book "5 Myths and Truths About Massage Therapy", Tracy Walton looks at the 5 generic claims mentioned above and also talks about the difference between the clinical vs. mechanistic outcomes in any type of therapy, treatment or drug program.  Clinical outcomes are those things that create a change in the signs and symptoms of the client or patients problem.  Did massage help or work?  Examples are a change in their stress level, or pain level or with their range of motion.  Mechanistic outcomes create a change in a biological substance.  The examples here are changes in hormone levels, blood sugar, endorphins, cortisol, etc.  These changes must be measured in saliva, blood, urine or tissues. 

As you have probably figured out by now the 5 claims above are more mechanistic outcomes that none of us as therapists are trained to report.  Also, clients are coming to us as massage therapists for clinical outcomes;  they want to reduce stress, decrease pain and soreness or just be relaxed.  The fact that massage may reduce stress  DOES NOT equate to massage lowers cortisol.  To paraphrase Tracy, "massage works, just not the way we were taught".  Clients DO NOT come to us for mechanistic outcomes.

So what is the research and what about those 5 generic claims?  I will summarize Tracy's book.

Massage increases endorphins - studies are inconclusive.  Massage does reduce pain and makes the client feel better and relaxed but is not proven to increase endorphin levels.

Massage boosts immunity - this is hard to prove.  The immune system is very complex and massage could influence immunity over time but mainly massage promotes relaxation and reduces stress.

Massage decreases cortisol (just one of the stress hormones, but the one with the most press) - again, this has not been proven and in fact was disproved in one study!  Decreasing stress and increasing well being is still what we do as massage therapists.

Massage increases blood circulation - the questions here are where, how deep, arterial or venous, for how long and does it matter?  Results in studies are inconclusive as to this issue.  We do know that hyperemia is present locally with certain strokes thus promoting tissue health in that area.  But the lowering of blood pressure or increasing the actual circulation systemically is that proven.

Massage releases toxins - just what are these toxins of which we speak?  I have always hated the word toxins - there are by-products of the metabolic process, but sometimes these are good by-products that go out in the blood stream to affect another part of the body.  Even lactic acid has it's uses.  Lactic acid becomes a fuel when oxygen levels are low in athletes and dissipates in the body with normal breathing.   We could just as easily say that breathing releases toxins in the body.  Either way there is absolutely NO RESEARCH to suggest that this happens more during a massage.  And blood or urine would have to be measured to test this.  (Oh, and water after a massage DOES NOT flush out these "toxins" either!)

Not enough overall studies have been done to prove many of the claims that massage therapists and educators have made over the years.  The thing that I think would also be hard to do with any massage study would be measuring the effects of the massage because every massage measured must be exactly the same.  And we all know how hard that is to do!

So please don't start a rant on me here ( or go ahead - it will increase my blog traffic - LOL) but these are the actual facts based on research or lack thereof.  For more information go to www.tracywalton.com or Google (or Bing) 5 Myths and Truths About Massage Therapy.  It is a pdf download so you can read it at your leisure.  There are some other links within the ebook that you may find quite interesting also.

You read it here!  Massage is good for you regardless of any research.

 I'm beginning to feel like there should be a group for CE Providers where they could come together and share their stories.   The ones and the horror ones!

You know the ones, they go like this:

Wow, you've got a good thing going, how can I do that?

How can you charge so much for CEs?

XYZ Provider only charges half of what you do.

How do you get to be an instructor/CE Provider?

Massage Therapists don't make enough money to pay for these classes every two years AND pay for their licenses.

That's not the way I was taught to do that in school.

Let me show you how I do it.

Or the students who constantly have to tell you a story about their mother, or brother or second cousin or something else that they think has to do with what you are teaching, but really doesn't in the end.

Or the ones who are only there the month before license renewal because they need the credits.

And then there are the ones who would like to pay you for the credits, not attend the class and get the certificate anyhow!

The ones who ask inappropriate questions, the ones who tell you that you don't really know the modality you are teaching because they saw a You Tube video and it wasn't like that, the ones who show up at a class 6 months pregnant and can't participate because the first part of the hand's on section has them laying face down for an hour or the modality itself is a total contraindication to massage, the ones that already know everything but again needed the credits, the ones that need to have their phones on because there just might be an emergency at home, work, whatever!

I've seen a lot of all of this and I'm still a CE Provider because I love to teach.  I love to share my knowledge with others who want to learn from me.  But I am tired of those who think it is easy and an easy way to make big money.  It's not! 

I've spent a lot of hours creating handouts, updating handouts, redesigning handouts and in general making my handouts!  Creating the documentation that you need to get nationally certified to teach my courses is an exercise in itself!  I've been Florida certified, Pennsylvania certified and now Nationally certified and each one wants a specific set of documentation.  And this doesn't include the amount of time spent in the actual class or classes to learn the modality and the time spent practicing and then implementing the modality on clients in order to hone the skills to be able to teach it.  (And by the way, knowing something does NOT mean that you can teach it responsibly!)

My biggest pet peeve right now is that I have a 20 page Ethics document that the National Board will not approve as an online CE, however I just downloaded a 4 page document that would probably take me 20 minutes max to read that apparently has been approved by the Board for 4 hours of CE!  And the online Ethics class that have used for the last 12 years has not changed since I first took it and also is less pages that the document that I submitted.  But I digress!

Teaching Continuing Education to massage therapists has been very rewarding to me but students need to understand that for the most part CE Providers have a lot of time and effort into creating their classes, preparing for their classes and teaching their classes.  We (as CE Providers) need the same respect that hopefully was given to the instructors in your original Massage Therapy Program at whatever school you attended.

Oh, and the money part?  Remember that as instructors the amount of money we are paid depends on the location where the class is being held.  Each venue has its own percentage that they give a CE Provider and some locations pay by the hours on site or by the CE hour.  When you factor in travel and expenses it is not really as much as you think.  So stop wondering why a class may have been cancelled.  An instructor that has to travel and stay overnight at a location for only a few students is losing money!  So when your instructor shows up and there is a very small class count yourself very lucky indeed.

I guess the comment that gets me the most has to do with the price of classes.  I have taken classes that required me to travel and pay more that what most would think is fair, however they were classes that I wanted to experience more than just needed for licensure.  These were classes that have been something that I have added to my massage toolbox.  Modalities that my clients have benefited from not in direct proportion to the monies that I had spent in learning them.  But if they are also classes that I benefited from in being with the instructors.  Classes that I have in turn gotten "stories" from and grown as a therapist.  Every instructor we meet on our journey has a story and gives a little of themselves to each and every class - good, bad or indifferent.  We have instructors we loved and ones not so much.  Hopefully we learned something from each one.  What to do and what not to do.  The cost of the class was the price to learn that lesson.

The comment that massage therapists don't make enough for XYZ class is a result of the industry overall not paying therapists enough and therapists not being willing to charge enough for their service and knowing their worth.  I know that this is harsh but as a group we sometimes find it hard to charge money for something that we love to do.  As a therapist we need to make the decision that we are worth what we charge (remember the expenses part of the job) and that it takes work outside of the therapy room to have enough clients to make a living.  If you aren't making enough to take the classes required in your state or pay for your license you need to step back and take a look at your practice or the place you are working.  Are you being paid fairly at a job or are your expenses too much for the number of clients you see in a week?  If you need more clients then go out and get them.  Having a business requires more work especially in the beginning to get a client base.  And if you are working for someone maybe it is time to start looking for something better.  BUT, the bottom line as far as having money for classes really comes back to you.  I would like to share a post from a Facebook group that I belong to about just that!  And as one poster said - this applies to massage for you as a therapist also!  If you are going to do the work you have to get the work!  Here it is:

         "Usually it's about 24 CEs every two years. CE classes can range all over the place in price, but you want to be able to take classes you're actually INTERESTED IN, and those won't always be the cheapest, particularly if you're traveling to a magical venue like Bali, or Hawaii. Now I'm not going to suggest that's where you take your CE's, just opening that possibility, because manifestation begins with potentiality. What I will do, is the math. 24 CE over two years give you 2 years or 104 weeks to pay for them. Lets' round that to 100 and you can take 4 weeks off. If you look, plenty of QUALITY CE classes in your local area are priced between $20 and $30 an hour. That means with 100 weeks to pay for them, you need only put aside $4.80- $7.20 each week from tips. Skip one trip to Starbucks each week, tip yourself instead. Get an envelope."

This is an excellent summary of what is needed to be able to "afford" those "costly" CE classes!

The rest of the stories will be for another blog post!  You can see what I teach and the exorbitant prices that I charge on my Current Classes page on this website!

This was the question I posed to my students in the last 3 classes that I taught.

After some thought I got answers of the back and the legs.  My response was that they are both. 

Technically they are transitional between the trunk and the lower extremities.  Anatomically they are generally referred to as part of the trunk.  Functionally, because of their actions, they are part of the lower extermities.

So just what do the gluteal muscles do?  Their main actions are extension of the hip as in standing or walking, especially in climbing or stairs.  They also help to perform lateral rotation of the hip (maximus), abductions and medial rotation of the hip (medius & minimus).   Their major synergists (helpers) are the hamstrings and piriformis along with tensor fascia latae. 

The attachements of these 3 muscles, maximus, medius and minimus are on the illium along the crest and then along the body of the illium moving inferiorly.  The distal attachments are into the IT Band and the greater trochanter of the femur thus the hip movements which each of these muscles.  The gluteals are stretched by their antagonists, theilipsoas, tensor fascia latae, the adductors and themselves in some cases.

So how does this affect your clients?  Think of what they do for a living.  How do they use their bodies?  Or even what do they do occasionally that may affect their muscles?  Of course anyone who walks or stands at all during the day will be using these muscles and/or overusing them.   Conversely if they are not using them they could also be affected. 

Low back pain may be associated with gluteals as well as any of the other muscles that attach to the illium at the iliac crest.  Piriformis syndrome or sciatica may also be related to tight gluteal muscles since they sit superficial to piriformis.  Skiers, runners as well as truck drivers and couch potatoes all may end up in your office with gluteal issues.  Don't ever let them tell you that they don't use their glutes!  Work them!  They can be worked over the sheet without any embarrassment to your client!

I was contacted recently by a current student (not one of mine) with some Lomi Lomi questions so here they are and here are my answers.

Q. How often do you perform Lomi Lomi massage or how often do clients request that service?  What type of clients typically see you for Lomi Lomi massage (specific issues or more spiritual or do they just find it relaxings)?  Is Lomi Lomi massage more stressful on your body than Swedish massage?  Do you typically perform this massage at a client's home or in an office space?  What about Temple Lomi draping?  What kind of draping do you use for Lomi Lomi massage?  And finally what are any common misconceptions about Lomi Lomi massage?

A.  Whew!

In answer to how often I perform Lomi Lomi, I would say every day.  After I learned Lomi Lomi it became a part of every massage that I do.  I may not do an entire Lomi protocol at every session but every client gets some part of Lomi as part of my regular massage now.  It is not necessarily a requested service but I have had clients call me specifically for Lomi when they find out that I do that type of massage.  I would say that the ones that do call me for Lomi are looking for a different type of massage experience outside the standard Swedish relaxation massage experience or even the deep tissue massage experience.  Most people have seen the videos online or have had someone come back for Hawaii and tell them of their experience of having a Lomi massage.  Not everyone however understands that there are as many variations of Lomi as there are of Swedish massage.

I must say that I do not do Temple-style Lomi which is a more modern take on Lomi and not necessarily what would have actually been practiced by the Kahunas and Kapunas of old.  The Lomi practitioner of the Islands would have been skilled in more than just the manual manipulation of tissue but also would have been knowledgable of herbs and the skillful manipulation of joints and other areas of healing.  My tradition of Lomi comes from Aunty Margaret lineage as my original instructor studied directly with her on the Big Island - Hawaii.  The Lomi protocol that I do is not more stressful on my body than Swedish massage or any of the other modalities that I know.  In fact, I would say that it is probably less stressful based on the movements and body mechanics I have learned to use with the Lomi that I have learned over the years.

I do work out of an office or my own home and rarely do out-calls any more.  And my method of draping is pretty much the same as any standard Swedish massage.  I modestly drape and always use a bottom sheet for my Lomi massage.  As I said before I do not practice Temple Lomi.   I have had students come to my classes expecting Temple Lomi but have not gone away disappointed with what they have learned.

I think that the most common misconception about Lomi Lomi massage is that it is ALL Temple Lomi since that is what they see most on the Internet and You Tube.  I have had my class cancelled at a spa because that is what they thought it was going to be and would not even give me a chance to do a practical demonstration!  There are many books available to you and many versions of Lomi, if you are interested then take some classes.  In fact I would love to come to Michigan and show you my version of Lomi!

Please come back to my website as I am currently in the process of creating some videos of my Aunty Margaret style Pololei Lomi and would love for you to see them.  I love Lomi Lomi and the results that I get with clients - both relaxation wise and structurally.  I hope that you give it a try in a variety of its different styles.

And thanks for the question!

Everyone should have a list of their favorite quotes.  Those sayings that lift you up when you are down, push you on when you are slowing down or just make you laugh. 

Well here are some of my favorites - I hope that some of them either are or become yours.

Life isn't about finding yourself, it's about creating yourself.  George Bernard Shaw

Go confidently in the direction of your dreams! Live the life you've imagined. As you simplify your life, the laws of the universe will be simpler.     Henry David Thoreau

Don't look back, you're not going that way.               Unknown

If you think you can, you can, if you think you can't, you're right.           Henry Ford

Not all who wander are lost.     J.R.R. Tolkein

All that you are is a result of what you have thought.             Buddha

Most of the shadows of this life are caused by our standing in our own sunshine.   Ralph Waldo Emerson

You can, you should and if you're brace enough to start, you will.       Stephen King

When you change the way you look at things, the things you look at change.            Wayne Dyer

Life doens't happen to you, it happens for you.      Jim Carrey

Don't cry because it's over, smile because it happened.             Dr. Seuss

Be yourself; everyone else is already taken.    Oscar Wilde

A mind needs books like a sword needs a whetsone, if it is to keep its edge.       Tyrion Lannister

No one can make you feel inferior without your consent.      Eleanor Roosevelt

Insanity is doing the same thing over and over again and expecting the same results.     Unknown

Frankly my dear, I don't give a damn!      Rhett Butler in Gone With The Wind

Hope spings eternal.     Alexander Pope

There's no place like home.      Dorothy in The Wizard of Oz

More is not better, it's just more.             ME!

Not being a follower does not make you a leader.           ME!

Tomorrow is another day.            Scarlett O'Hara in Gone With The Wind

Don't take life too seriously, you won't get out alive.      Elbert Hubbard

And no wishing for more wishes.              Genie in Alladin

And I'm sure there are more that I use on an almost daily basis, but those are the only ones I could think of right now.  Those little blurbs that you see every day, the ones on fortune cookies, the ones from movies, the ones that just stick in your head from whatever source, they are the ones that have meaning to you for whatever reason.  Whatever they are you keep them and use them all the time.  Just remember to get rid of the negative ones and stick with the positive ones!