Clients come to us in all kinds of states, and that can lead to not just potentially awkward situations, but sincere opportunities for you, as a massage therapist, to earn deeper trust from your clients by showing professional empathy and concern while maintaining a responsive, high level of care.  Impatience on the part of the client is one such chance. You know what I mean: while you’re asking them questions about whether there are any areas of their body where they are experiencing pain or discomfort and would like some extra focus, they are literally tapping their fingers on their knee, sighing aloud, and saying with their body language, “Skip all this talk. Let’s just get on the massage table.”

So, what do you do?  We massage therapists are wired to please.  So, many of us will sense the frustration and cut the intake short to go ahead and meet the client’s unspoken wish by getting them right onto the table.  A more effective approach would be to continue to hold to your intention to provide the best session by continuing with a thorough intake, while also taking a moment to directly address the client’s impatience.  Try asking something like, “I see you tapping your fingers. Are you concerned about us getting enough time on the table?” You can then reassure them, “Please don’t worry. We’re still going to get the full 60 (or 90) minutes.”  Stand firm in your intention and show them how it serves them by adding, “It is important for me to ask you a few more questions because it helps me give you the massage that best meets your needs.”

While the natural temptation may be to just succumb to the client’s impatient energy and rush them right onto the table, when you politely and professionally share your intention to understand their goals better, it will earn you their trust. They will come to respect your practice as a place where their needs matter and are attended to, which increases the likelihood that they will seek your services again.

Massage is for more than just the muscles. The skin, the fascia, and the lymphatic system are all affected, as well. Even the “boney landmarks” of the body—the knees, elbows, and the little knobs around the ankles benefit from, and can contribute to, a satisfying and relaxing massage experience. During a recent massage session, the therapist was working along the muscles of my lower leg. As he moved skillfully upwards, he jumped right over my knee and proceeded to glide along my quads.

“Whoa! Whoa, whoa, whoa. Hold on, Buddy,” I said. “What about my knees? You just skipped right over them.” I then gave him a little reminder about the basics of muscle anatomy. Where the ends of the muscles attach to the bones with the tendons, there are these little points called Golgi tendon organs. Stimulating these Golgi tendon organs actually triggers the relaxation response in the muscles.

When you take the time to trace with your fingers around someone’s knee, elbow, or the malleolus of their ankle, it can actually be one of the most delicious, relaxing components of any massage. If you are just starting as a massage therapist, or if you’ve been practicing for years, and you find that you have developed a tendency to skip these parts and work mainly in the belly of the muscles, think again. Give those boney landmarks just as much attention, and your clients will be delighted.

Have you ever had a client who walks into the massage room with you and won’t even look up? They’re like a dark, stormy cloud. You can tell that something’s going on, but you don’t know what it is. Maybe they’re upset. Maybe they’re mad. Maybe they’re mad at someone else. Maybe they’re mad at you.

So, what do you do?  It can be tempting to try to ignore that dark cloud, go right through the intake questions, and get the client onto the table as quickly as possible. Really, though, that’s not best thing to do. The massage experience is much more than just the techniques we use. It’s also about demonstrating that your practice is a place where their needs are seen and met. One of the reasons that people come in for massage is that they might be going through some stressfully unpleasant situations in their life. The best practice is to openly and caringly connect with and acknowledge what you are seeing in front of you by asking the client something like:

“How are you doing today?”

“What’s been going on with you?”

Those “how” or “what” kinds of questions can get a client to open up. If they don’t seem receptive to that, try a simpler yes-or-no question:

“Are you having a tough day?”

“Is everything ok?”

Even if you don’t get a big low-down, just the fact that you asked shows the client that you are an attentive, considerate person who notices and responds to their emotional state. That leads to a much more positive and connected session where you’ll be able to get better results for them, because now they can trust that you are not only a skilled massage therapist, but also a genuinely caring human being to whom their needs matter.

Body modesty is always an issue, given that our clients quite literally bare all when they are in our care.  This can lead to a question for some therapists around the matter of whether a typical massage session should include work on the glutes (a.k.a. the muscles of your hiney).’

This group, which includes Gluteus Maximus, Gluteus Medius, and Gluteus Minimus, are actually some of the hardest-working muscles in the body. They connect all the work that the legs do, and they also connect to the lower back muscles. For those of us who are sitting a lot, or even people who are athletic and run, the whole hip area can often use a good working over, and the glutes certainly benefit tremendously from massage.

Unfortunately, with the proliferation of franchised chains and spas, therapists are often instructed to skip working directly on the glutes, so as to avoid even the possibility of an awkward situation, especially if there is a gender issue involved, such as a male therapist working on a female client, or vice versa.  When such a major muscle group like the glutes is not even a consideration, it often means that the client won’t get the full therapeutic benefit of the session.

If you are ever concerned about your work on someone’s glutes being misinterpreted as anything inappropriate, rather than avoiding the area, simply converse with the client. Explain that these are very hard-working muscles that would benefit from this work, and ask the client if it would be ok to work on the gluteal area. Sometimes the client will say that they don’t need any work there, and sometimes they’ll greatly appreciate it. Either way, asking is better than just skipping. If you are still uneasy about working in that regions, ways to carefully respect someone’s modesty when working on their glutes could include:

• Starting out working through the sheet or blanket, with just a gentle tracing around the greater trochanter
• Using a shiatsu-style rocking technique through the sheet or blanket
• Still working through a sheet or a blanket and applying pressure or twisting action with your knuckles

When working directly on the skin, taking care to use careful draping, crossing the sheet over their glutes and tucking it securely under their leg and torso.

Most importantly, remember that what the client receives from the massage in the end is your intent. If your intent is purely therapeutic, even if the client is a little shy in the beginning, by the end of the massage, they will know that the only thing that you ever meant to do was to help them feel better.

We all need to be listened to, but sometimes, that need can actually obscure communications. Take care not to be misled when a client gets carried away responding to your intake questions. Massage sessions typically begin with a question from the therapist to the client along the lines of “What would you like to work on today?” or “What brings you in today?” or one of my favorites, “Are there any parts of your body that hurt?”

Sometimes, though, people can get caught up in their stories. Everyone loves an invitation to talk about him or herself, particularly from their massage therapist.  Asking them how they are doing or checking in on any pain or discomfort shows them that their needs matter to you, which is vital to building a strong rapport with your clients that will bring them back again and again. Plus, it’s vital for you to know where to focus your work.

Occasionally, though, you’re going to get an earful of just why that toe or shoulder or knee hurts—in tedious and gruesome detail. From there, you might assume that this person’s primary area of concern is absolutely killing them and think that you’re going to need to spend a good hour of massage just trying to make it feel better. That would be a reasonable assumption, based on the amount of detail that they went into and the time they spent talking about it. It’s tricky, though, because sometimes people simply like to talk about their pain and problems, but they don’t mean to be saying that they only want work there. They might actually be looking for more of a generalized massage, or even a full-body Swedish.

Don’t be fooled by these inadvertent miscommunications. Always ask, “So do you want to do specific treatment work to help your problem area get better, or would you like more of a full-body massage?” Add this question to your intake, and you might be very surprised how often someone was just caught up in the story but actually wants you to do more of a generalized massage session.

Unique and specific techniques, like myofascial release, can greatly enhance the therapeutic benefit of your work on your clients, but when using them, it’s important to consider, and appropriately set, the client’s expectations for the session. Myofascial release is a wonderful way to create space for muscles to relax. Tension in muscles can sometimes be caused by the layer of membrane, called fascia, that surrounds the muscle group, which can be adhesed or dehydrated, preventing the muscles from moving freely.

If you have someone with an old sports injury or who has recently undergone surgery, or just somebody where it feels like their muscles are bound up and barely have any room to move, that’s a good indication that the top layer of the musculoskeletal system may need some stretching to give the muscles room to expand. So, myofascial can be a wonderful way to start a massage to make sure that the rest of the work will have the most beneficial impact.

One time, though, I had a massage therapist who started using myofascial release on me as the very first technique in our massage session and proceeded to do it for close to 30 minutes, which was a full half of the session. I found that very unusual because myofascial usually doesn’t involve any oil or lotion, and most of the time, someone’s applying oil or lotion within the first few minutes of a session.

If someone comes in and their main complaint is stress or a busy life, and they’d really just love to have an hour to relax into a nice Swedish experience, they’re going think it’s weird that for half their massage there isn’t even any oil or lotion being used and you’re just pulling on the top layer of their skin. It’s about the context, and it’s about your intent as well as your client’s goals. It’s important to remember that if you’re going to start off and do a lot of myofascial work, which might be the right thing to do, you need to be sure to tell your client why. Consider the typical experience your client may have had before in massage, and clearly dialogue through it.

We’ve all heard from clients the occasional horror stories of their having been “brutalized” in a session with another massage therapist in which techniques were used that were so deep as to be painful and leave them bruised. Some of us may have even experienced that type of massage ourselves. How does that happen?

While clients do have different levels of sensitivity to pressure and it’s always important to check in with them about it, it’s also essential to consider the speed with which we administer deep techniques. A good rule of thumb is to remember that if you know that you’re going for depth, slow way down and make sure that the tissue lets you in first. Otherwise, you’re going to be tearing through muscle tissue and causing your clients unnecessary pain. That kind of pain can alienate clients, not just from you as a practitioner, but from massage in general. Then their stories to their friends and family can even leave others scared of ever getting massage in the first place.

If you know you’re strong, really take the time to check yourself and see if your speed is correct for the level of pressure you are using. If you think that you might be going too fast, slow down and keep checking in with your client. To keep in touch with the client’s experience as you work your way in, you can ask:

“How’s the pressure for you as I work here?”

“Is it ok if I go a little deeper now?”

“How’s that?”

Remembering that it’s not just about the pressure, but also the speed can help you better calibrate your deep work on your clients to ensure that they enjoy an effective session with you that leaves them feeling great.

I’ve noticed a ‘narrowing syndrome’ that sometimes develops among experienced massage therapists. When you first go to massage school, you learn all sorts of techniques which are new and exciting, and you try them all on your clients. Then, as you practice and become increasingly more confident, you find that a certain set of techniques emerge as your favorites. You develop a level of comfort and expertise with them, and you use them increasingly often. What can happen over time, though, is that by favoring those few techniques, many of the others that you learned go unpracticed and, eventually, get forgotten. This narrowing of your repertoire can lead to clients experiencing massage from you that consists entirely of only one or two techniques.

For example, I have experienced massage from seasoned therapists that consisted of nothing but slow friction strokes. While those may be effective, that singular focus risks a massage that can feel repetitive and not entirely effective. What’s more, it’s important to remember that different techniques  produce different effects, each suited to the various needs presented by clients. So, while using a lot of deep friction can be fine, it could be even more beneficial if you were to occasionally throw in some invigorating petrissage, or soothing effleurage.

The antidote to this ‘narrowing syndrome’ is to continue to keep your skills fresh by ensuring that you not only take continuing education, but build up a network of different therapists that you can occasionally get massage from, as well as give massage to, so that you are able to get honest feedback from other professionals in the industry and continue to be exposed to different techniques.  This way you will keep your toolkit of techniques broad enough to provide your clients with varied, effective, and pleasant massage.

Let’s say you have a big, beefy athlete of a client on the table, with lots of delicious areas to work on. You dive in. You get the belly of the muscles. You get into the soleus, work their erectors. You proceed to work on their arms and get into the deltoids. Everything’s great, but you have to ask yourself: are you massaging the whole muscle?

I find that, a lot of times, therapists will focus on the belly of the muscle, spending lots and lots of time getting in there: fluffing, buffing, twisting, turning, compressions, and such, but not tracing the muscle all the way to its origins or insertions. It is important to recognize that a muscle has its own intelligence, and when you touch any part of it, the rest of it wants to be touched, as well. If you’re going to use a technique, be sure you use it to work the full length of the muscle, to its tendon and its attachment point. The muscle doesn’t end in the middle. It ends where it ends, and it starts where it starts. Go from end to end, and your clients will love you even more-so.

In today’s digital age, with so many of our clients (and ourselves!) spending so much time hunched around our smartphones, curled up with our tablets, and bent over our laptops, a new syndrome, which I call “computeritis,” seems endemic. It may be common for massage therapists once they hear of a client’s heavy use of such devices to jump to conclusions as to the culprit of the client’s pain. It’s important that ‘Computeritis” not be our first or only assumption when a client presents with neck or shoulder pain and tension. It’s vital that we get a fuller picture of our client’s lifestyle, without which we could very well be assuming and jumping to incorrect conclusions and to an incorrect treatment approach.

I’ve been working in a massage clinic for 12 years now. One time, I saw a therapist go in to do an intake with a client and come out only a minute later to give the client a chance to disrobe and get on the massage table.  Shocked to see that the therapist was back out so quickly, I quietly observed,

“that was a quick intake.”

“Oh yes,” said the therapist. “The client seemed eager to get on the table. So I did a few questions, but kept it short.”

“Great,” I said. “What’s the problem with the client?”

“Well, they do a lot of computer work, so they have a lot of tension in their neck and shoulders.”

“I see. And does the client have any hobbies?”

“I don’t know,” said the therapist. Oops!

Years ago, I had a client with a lot of shoulder pain. He worked with software, so it would have been easy for me to assume that, like everyone else, he was also suffering from computeritis and treat him accordingly. But I asked the patient when he felt his pain and tension the most, and he answered, “when I’m on the field.” Wow, that bit of new information provided the missing piece of the puzzle and completely changed my understanding of his condition. It turned out that he was a pitcher on a baseball team and his pain was due to his pitching technique. I learned from that experience never to assume that someone’s job sums up their lifestyle and to always get a little more information, even if it means taking an extra minute or two during intake.