When we graduate from massage college, we are eager to help and provide the best possible care to our clients. When I graduated from massage college, I felt the same way but I also felt like I wanted to be the best. The best massage practitioner in my work place, amongst my peers, and be recognized as a strong force in the health care space in my city.
And I wanted that now.
You see, I work in a multimodality clinic amongst many different practitioners, from physiotherapists and medical doctors, to strength trainers, dieticians, psychologists and occupational therapists. I pretty much work in a one stop shop amongst practitioners who are in fields that are much more respected than massage, so naturally I felt the need to live up to that and impress my work colleagues.
As I started my practice at this work place, my imposter syndrome shined bright. I went into every work day and every client feeling like I am only a small piece to the puzzle, make little change, only providing passive treatment, and that every other practitioner I worked with had a more lasting and a long term presence in their health than I did. Additionally, as I talked more to my physiotherapist colleagues who shared clients with me, I started to learn that their perspectives on musculoskeletal conditions were very different than what I was taught and that cracked my brain right open.
One day, one of my physiotherapist colleagues pulled me a side and expressed that one of the clients we shared is very sensitive to the language we use and we shouldn't imply to him that his "bones are misaligned" because he spirals and looks to medical procedures to correct them. Then, he told me those claims are just not true and are outdated. He wasn't wrong, this client was very sensitive to this language but it made me reflect on the knowledge and the perspectives I learned in college.
In college, there was a heavy emphasis placed on assessing for skeletal asymmetries and relying on palpation for assessment. This was the only thing that I felt that I knew how to do and gave me a reason for a client’s pain and discomfort. When this physiotherapist told me this, it crushed me.
Is everything I learned a lie?
Is there any validity to my knowledge or skills?
This is what really had me spiral and make me feel that massage wasn't enough. And I was doubting myself for a good part of the last 2ish years.
I reflected further on this and was even able to pull further evidence of massage not being enough from college. I remember being told by my teachers that massage without manipulation won't make a lasting difference but we weren't going to be taught manipulation so I was just going to have to settle with the fact that massage isn't enough.
The more I thought about it, the more I began doubting myself, my skills, and my effect on clients.
And then this program popped up: a 4-year, part time program to learn how to do joint manipulations. I was pumped. I believed that this was going to be the thing that was going to get me to be the practitioner I always wanted to be. I believed this program would sharpen my knowledge, provide me with efficient techniques to save my hands, and give me the skills that set myself apart from other practitioners.
I signed up right away. I was nervous to go back to school but excited to take on this new journey if it meant I'd be the best when I finished.
But, that bubble burst and it took me about 6 months to realize this program wasn’t right for me.
And here is why.
I realized that through my reflections and interactions with clients and colleagues at my work place, I had developed strong values in person centered and empowerment based care. I realized that I don’t need to manipulate someone's joints in order to make a lasting effect. I also began to feel that the idea of only applying joint manipulations was something I didn’t see myself liking long term.
When I would attempt to practice some of these skills, I kept running into a huge contraindication, and that was my lack of confidence in the skill and explaining the science behind manipulations. Without this, I wasn't able to instill trust from the people I thought would be good candidates for this type of technique and I also wasn't confident that I was taught how to even make that judgement appropriately. I recognized that manipulations take years to master yet I was taught how to apply manipulative techniques in 2 days and was expected to practice on my clients right away. Chiropractors need 8 years before they finish the schooling for manipulations and unfortunately you still hear horror stories of manipulations gone wrong by chiropractors. I knew this wasn't something I could take lightly. I felt that I wasn't provided with enough knowledge or current research to trust the skills being taught.
When people would ask me how school was going, clients or friends a like, I was honest. I felt disappointed in the knowledge that was provided to me and disappointed that I wasn't able to safely and confidently explain and apply these techniques. I talked to physiotherapists I knew who had extra schooling to provide manipulations and they educated me on the assessment skills that I was missing based on the current research in the field.
Upon this reflection, I realized how strong my beliefs were surrounding manipulative techniques. I fully believe there is a time and a place for them. I would never apply them on someone who is reluctant or hesitant, could potentially have difficulties with their blood pressure, or anyone with joint stability dysfunctions. Most importantly, I never want to apply a technique on someone if I couldn't confidently explain the physiology of what is happening during said technique. Because I couldn't verify any of those things I knew I couldn't practice this on my clients nor did I want to subject my close friends or family to it.
This reflection also brought to light for me how our words to our clients matter. Telling someone their bones are out of alignment or even telling someone they have muscle knots implies that no matter what they do, regardless of if their activities of daily life (ADL’s) are intentional or not, they don't have control over their own body. Through past experiences, I learned that any time I would tell someone that their pelvis was anteriorly rotated and could be the reason for their pain or even saying something like “there is a knot right there, that's why it hurts when I press it”, their next question to me was always how could they prevent that from happening again. Realistically, pelvic rotations are super common in everyday activity and so is muscle tension so do I say "Oh just stop walking, sleeping, running, twisting, bending forward, sitting, basically just stop moving because then you won't be at risk for this dysfunction anymore". First, that would make anyone feel guilty for simply living their life and secondly, that creates a "God complex" making the practitioner the ONLY thing that could get their pelvis back in alignment or their muscles to relax. This would clog your schedule as a practitioner too, because now, any ache or pain someone has they will associate with misaligned bones or muscle tension and that only you can fix them.
I don't want to be someone who makes anyone fear their ADL's. I want to empower people to live to their potential. So now I am at a point in my practice where I am not assessing for structural asymmetries and I am trying to focus more on the consultation. Asking deep questions about their pain, what stresses they may be under, having them reflect on all that they can still do and giving pats on the back when they do the small things that help the pain be less severe. Reality is, pain is complex, we can't simply associate it with just structural asymmetries. If I verified the person didn't get injured through some sort of external factor, then I like to get them to reflect on their basic needs like sleep, diet, exercise, mental health, shelter, social life. All of those contribute to pain perception. Maybe a person has a stable home and family life, they eat mostly well, and exercise regularly, but they don't have a reliable social circle, they work long hours, and only sleep 4-5hrs/night. I feel like if I can get people to understand that those things matter in the long run and encourage them to make small changes towards meeting their basic needs then they will have better long term outcomes than if I simply told them they have misaligned bones and tight muscles and that's why they have pain.
I feel a lot better about the direction my practice is going now. I feel like I am more confident in the skills I have already, I feel well versed in taking a person-centered approach to massage therapy, and I feel strongly about my values. I am grateful for the opportunity I got to participate in this program because it opened my eyes up to how much I already am doing to build the practice I want to have. I was always looking for more in education and resources but never stopping to reflect on all that I have learned already.
What's to come for me?
I want to study pain and understand the nervous system on a deeper level. Ultimately,
massage has the greatest impact on the nervous system and I feel that massage has a much larger affect on desensitizing the nervous system than we give it credit for.
I want to review my knowledge on orthopedic conditions so that I can sharpen my critical thinking skills, ask the right questions, and provide proper advice and techniques accordingly.
I also want to learn more about the fascial system. I just think its really fascinating how our body is connected.
I'd like to explore cupping a bit more just because its fun and gives me another option in my treatments to save my hands. Acupuncture would be cool to learn too for the same reason.
I'd love to read more books on the mind body connection and refine my consultation skills to ask deeper open ended questions more comfortably.
To wrap this up, I am quite proud of myself right now. For coming to the realization that I am doing a good job, I have a steady clientele, I have strong values, and I am exactly where I am supposed to be for having practiced as a RMT for 3.5 years.
I am also proud of myself that I didn't stick to something just because I felt guilty or ashamed for quitting. I would have done that in my 20's for sure but as a woman who is in her 30's flirty and thriving, we don't have time to ignore our values and not honour our boundaries.
The last thing I will leave you with is this:
No matter where you are in your journey, trust that it is exactly where you are supposed to be. Strive for excellence but don't forget to look back on your path once and a while to see how far you've come and what lead you here today.
Wishing you well,
~Felicia
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