Massage World - Feb 2007 by mwcommsltd

MASSAGE WORLD The Massage and Body Therapists Magazine £4.00 February/March 2007 www.massageworld.co.uk

A Sport & Remedial Massage Therapists Guide to Marathon Runners MLD– the vodder method Saving Your Wrists Answer That Phone

3405

WIN A MASSAGE TABLE IN THIS ISSUE!! IAL

calendar I news & views I products I research I student section I directory

R FE F O N IO E 28 T IP G CR E PA S B E SU S

C E P

welcome

MASSAGE WORLD EDITOR

Wendy Kavanagh James Earls

FEATURES WRITERS

Susan Findlay Andrew La Bray Dee Jones Laura Pank Darien Pritchard Charles Wells GRAPHIC DESIGN

Sal Bourne

MEDIA COMMUNICATION

C J Newbury

PUBLISHERS

NK Publishing

ANNUAL SUBSCRIPTIONS

UK / EU: £25 UK Student: £20 Rest of World: £40 ISSN 1474-4171

how to contact us Massage World PO Box 54879 London SW1P 9FW T/F 020 7387 9111 E

massageworld@btconnect.com

www.massageworld.co.uk

DISCLAIMERS The publisher has taken all reasonable measures to ensure the accuracy of the information in Massage World and cannot accept responsibility for errors in or omissions from any information given in this or previous editions or for any consequences arising thereof. The Editor may not always agree with opinions expressed in Massage World but allow publication as a matter of interest, nothing printed should be construed as Policy or an Official Announcement unless stated. No part of this publication may be reproduced in any form or by any means whether electronic, mechanical and/or optical without the express prior written permission of the publisher.

PRINTED BY

Evonprint - Mackley Ind. Estate, Small Dole, West Sussex BN5 9XE T

01273 494 631

info@evonprint.co.uk

www.evonprint.co.uk

editorial by Wendy Kavanagh

n this issue we have an exciting competition for you and the prize is a brand new massage couch. What a great start to the year, a true case of out with the old and in with the new. I love this time of year when the snowdrops and daffodils are peaking out of the ground and spring is truly in the air. It is a great time for review and reflection both in our working and social lives.

In the business tools section, we look at how to capture those new clients by making sure that we actually talk to them in the first place. Susan Findlay helps us along with massage for the marathon runners in training for April and the aromatherapy section deals with mild reactions to various mediums. Along with Spring comes the start of the exhibition and conference season and the time that once again Massage World sorts out its cupboards ready to set up stands around the country in order to meet our readership face to face. You can visit our website to see where the roadshow will be next. See you there...

“As a result of the advert, on the CThA Members Forum, I have one new holistic massage therapist who has joined the team and is very much appreciated by the clients” Donna Woodcock Massage Therapist

To find out how the CThA helped Donna and hundreds of other members last year just when they needed it, call a member of the CThA team on: 0845 202 2941or visit our website at: www.ctha.com

Professional help when you need it

contents Manual Lymphatic Drainage – the vodder method

feature 9

MLD is a fast growing area of massage and one which uses the lightest of touch. Dee Jones explains about the origins of the Vodder method its practice and training.

A Sport & Remedial Guide to Marathon Runners

feature 13

Susan Findlay of the NLSSM discusses a training regime for those aiming to run the London Marathon in April. At whatever stage your clients come to you, it can be a challenge to get them through this event.

Saving Your Wrists

feature 17

Continuing Darien Pritchard’s series on how to reduce poor working habits that take a cumulative toll on the practitioner’s body, this article focuses on practices that will minimise long-term strain on your wrist.

A Case to Consider: allergic reactions

feature 29

Charles Wells investigates a case of moderate allergic reaction after every massage treatment using carrier oils and some essential oils and Arnica that can be a mild irritant despite its healing properties is discussed in depth.

Answer That Phone

feature 40

regulars

A telephone call is often the first point of contact between the therapist and the client, so it is vital that your business practice encourages new customers to book with you rather than move on to the next telephone number on their list.

editorial

industry news and views

muscle of the month

product reviews

the journey of hands

research

faqs

resource directory

course listings

46 February/March 2007 M|W

news&viewsnews&views In the Hot Seat! Japan's Matsushita Electric Industrial Co. Ltd. is recalling thousands of massage chairs in order to carry out safety tests after fires destroyed two of their ‘Real Pro’ chairs in December and January. The Panasonic branded goods caught fire after power cords inside the chairs’ motors emitted sparks. The two incidences occurred in demonstration models after repeated use by customers and would only happen in rare cases say the manufacturer. Luckily, no one was injured. Bring back traditional methods!

Message e g a s s a ouse M sh raised White H ear Mr Bu ssia last y erkel

M Ru Summit in seated Mrs At the G8 ed up to a lk lders. a u w o h e s h when ed her s g a w s s ro a b e m y e but then briefly her arms, ader) and p le u n w a re rm th e (G ed she seated ther shock impromptu is h T . Looking ra e one o g r let he ief becam e h h -C n e in h re w d n smiled S Comma rnet! from the U on the inte s lip c massage o e id a press v r la aders held st popu o le m o e tw th e f o , th ck rubs". ite House at the Wh ed "No ba c s n lk u o ta n r n e a ft A ling. r Bush lient hand e where M aining in c tr conferenc e m o s e needed Perhaps h

Ada Barak’s spa in Israel has introduced a unique experience for their clients. For around £35, your aching muscles can be massaged and soothed by six lively snakes. But don’t worry, Ada uses nonvenomous California and Florida king snakes, corn snakes and milk snakes and believes that physical contact with them can be very soothing. One customer said "I’m actually afraid of snakes but the therapeutic effects are really good."

This year, Massage World are exhibiting at the new look Total Cam Show in Brighton on 11th and 12th March. The need for a devoted show for the CAM practitioner is reinforced by the increasing attention being paid to complementary and alternative therapies.

network, exchange ideas and help drive the CAM industry to an even healthier future. Have a day, come and visit us and partake of the wonderful sea air at the same time.

www.totalcamshow.com

Sitting alongside the Natural Trade Shows this Show will again bring together CAM professionals, suppliers, associations and universities to learn,

UK Market Leaders in Portable Therapy Equipment Tables, Chairs, Stools & Accessories – Table prices start from £170

Click online or FREEPHONE: 0800 083 5530 for more information or to locate a dealer www.therapyessentials.co.uk 6

M|W February/March 2007

news&viewsnews&views Take the High Road The latest school to adopt Injury Prevention Massage – techniques to protect therapists against RSI – into its syllabus is The Mary Reid Salon and International School of Beauty in Edinburgh. School Principal Joan Stewart said "all of my trainers really loved it, when we saw it being demonstrated at the Scottish Beauty Show in the summer; we just knew we had to have it!" "It’s made a great addition to the courses that we have on offer, and makes us quite unique in Scotland."

Points mean... Qualified Body Workers and massage therapists – Do you want to want to earn 20 CPD points – boost your treatments and create loyal clients.? Update your skills with the LaStone® Science Geo Thermotherapy – the application of heated and chilled stones, bringing a greater, more immediate state of relaxation and feeling of well being. You will learn how temperature dramatically enhances results of a full body massage –creating time and space for healing through the power of earth elements… the stones. An ideal addition to your massage and bodywork repertoire. Visit: www.lastonetherapy.co.uk for more information.

"it’s a great way to expand your syllabus, introduce additional CPD courses and generate extra revenue whilst helping the therapist community!" Are you a school or college who are interested in bringing IPM to your syllabus? Contact Injury Prevention Massage on 0870 0663583 or via their website: www.injuryprevention.org.uk For more information about The Mary Reid Salon and International School of Beauty in Edinburgh, call 0131 558 9994 or visit: www.beautyschool.co.uk

ops!

In the last issue of Massage World we published a wonderful piece entitled ‘A Weekend – head and shoulders’ above the rest and omitted to mention the author Diane Harris. Apologies to Diane and our thanks again for such an interesting article.

COMPETITION Win a brand new massage table Massage Warehouse are giving readers the opportunity to own one of their fabulous Porta-lite Delta tables as reviewed on page 26. This table weighs only 11kg and is a generous 30" (75cm) wide with easily adjustable height. So if you are just starting out, or it is time to upgrade your well used couch why not have a go. All you have to do is answer this simple question:

Q: How many hands can you see on the home page of the Massage Warehouse website www.massagewarehouse.co.uk ? A: 10

B: 20

C: 5

Simply email your answer to:

competitions@massagewarehouse.co.uk Don’t miss this great opportunity, get your entry in now. Good Luck.

February/March 2007 M|W

Introducing

to the UK & Ireland

High quality range of Professional Massage Therapy Products A leading brand in the USA for the past 35 years

Creams

Lotions

• Balancing Cream

• Ayurveda Massage Lotion

• Calming Cream

• Basics Unscented Massage Lotion

• Muscle Comfort Cream

• Unscented Jojoba Massage Lotion

• Versa Crème Original

• Herbal Lavender Massage Lotion

• Versa Crème Unscented

• Desert Blossom Massage Lotion

Oils

Pain Relief

• Basics Unscented Massage Oil

• Herbal Heat Gel

• Basics Grapeseed Massage Oil

• Herbal Ice Gel

• Basics Rice Bran Massage Oil

• Narayan Oil

• Basics Sweet Almond Massage Oil

• Narayan Balm

• European Lavender Massage Oil

• Narayan Gel

• Nut Free Lite Massage Oil • Therapeutic Blend Massage Oil • Therapeutic Lite Blend Massage Oil • Sports Massage Lite Massage Oil • Muscle Comfort Massage Oil • Cedar Sage Massage Oil • Eucalyptus Spruce Massage Oil • Rest and Relax Massage Oil • Sandalwood Massage Oil • Vanilla Massage Oil

PRACTIT IONER & STUDE NT DISCOUN T

FREE DELIVERY to the UK & Ireland on all ONLINE orders over £100 / €120 (ex VAT) Order online at www.vivomed.com Contact us at +44(0)28 4461 7666 or email Andrea@Vivomed.com

Manual Lymphatic Drainage - Vodder Method by Dee Jones anual Lymph Drainage (MLD) is a fast growing area of massage – and one which uses the lightest of touch. It takes time to master this light touch and so the training is in three parts, each module usually separated by a month or more in order for the student to practise. Courses are only open to those who have already qualified and practised in another bodywork field.

Beware of imitations however. There are many people and schools who profess to teach the Vodder method of MLD without having gone through the rigorous training a properly qualified Vodder teacher has gone through. (It takes two years of teacher training for each of the first two modules and three to four additional years to qualify to teach the third module.) If you are contemplating adding this valuable skill to your repertoire ask who the tutor has trained with and ask to see their teachers certificate.

MLD is an advanced massage technique which moves the skin over the underlying tissues using repetitive and circular movements. Dr. Emil and Estrid Vodder discovered and then developed the technique in the 1920’s and 1930’s, going on to train others in the late 1940’s. They then worked with, and set up schools with, the Wittlingers in Austria (The Vodder Schule), CasleySmith in Australia and Asdonk and Foeldi in Germany. These groups in their turn have trained therapists and teachers since the 1950’s. The Lymphatic system was described around 1654 as "A system which purifies the body and regulates irritation, swelling and oedema." (Thomas Bartholin) By specifically stimulating the minute musculature of the lymph vessel walls an MLD Therapist uses the lymph system itself to cleanse the body, reduce any swelling and strengthen the immune system.

February/March 2007 M|W

massagereport mld - the vodder method Described as "One of the best kept secrets on the health and beauty scene." (Jane Alexander, Daily Mail Saturday) , MLD’s intensely relaxing effect masks the strength of the treatment itself. I have been quoted time and again for saying that an MLD facial is like a facelift without surgery and so it is. As the stimulated lymph vessels go to work clearing the loose connective tissue of accumulated excess cells and debris, the skin not only looks clearer and cleaner – it actually is clearer and cleaner, right down to the sub-cutaneous levels. BEFORE MANUAL LYMPHATIC DRAINAGE

AFTER TREATMENT

As no oils or powders are used it is completely safe even for those with sensitive skin. This non-invasive technique simply uses the muscles and structure of the existing lymphatics to clear accumulated fluid. For anyone who has clients going through a detox or weight loss programme MLD is invaluable for its ability to safely remove excess `debris’ from all over the body and to help tighten the skin. Taken further, it eases the swelling/ inflammation caused by everything from more vigorous treatments, trauma from accidents and on to surgical intervention. As a pre and then post op treatment it is unparalleled in its ability to ease most and usually all - of the tissue swelling associated with trauma and surgery and so speed the healing rate of damaged structures. MLD’s role as one of the cornerstones of CDT (Complex (or Combined) Decongestive Therapy) for lymphoedema and lipoedema comes as no surprise to those who understand the lymph system’s amazing ability to regulate swelling and fluid imbalance. It is a vital part of lymphoedema treatment, opening up alternative avenues for the dispersal of excess fluid and avoiding the areas affected by lymphatic malfunction. MLD also has an effect similar to the tens machine in pain control. In reducing the swelling, promoting healing and reducing

M|W February/March 2007

pain, MLD becomes one the most effective treatments for any trauma, however caused. It is one of the safest massages available to women who are pregnant. MLD uses no oils or powders so absolutely nothing is being introduced to upset the developing foetus. From top to toe there is no need whatsoever for a pregnant woman to suffer swollen anything. MLD has a strong effect on the immune system. By decongesting the `transit stretch’ of loose connective tissue – clearing out any lingering debris – and making the whole transport system more efficient, MLD helps quicken the transport system of our bodies immune response. I have often been told by clients that when the whole family came down with something, they were surprised that they didn’t.

Training route Manual Lymph Drainage, Vodder Method, is a post graduate qualification. In order to start training you must be fully qualified as a nurse, doctor, physiotherapist, osteopath, or as an aromatherapist or massage therapist with at least 2 years experience. For those who want to add a facial to their skills, a Vodder Method Face Course is available. This is a three day course covering the head and neck in detail and starts you on the road towards that light, circular touch so vital to the success of MLD. The main training is split into 3 modules all of which have theoretical and practical sections.

Basic, Therapy I & Therapy II and III Basic: is a five day course which must be completed by all students. MLD is so very different from any other technique that it is vital to take the time to get each movement correct. This is an attendance course only. There is no exam and it does not qualify you to work on the general public.

massagereport mld - the vodder method Therapy I: is a second set of five days which continues the work started in the Basic course and starts to look at the treatment of pathologies. This is an exam course and the successful student can start using MLD on patients and clients who have an intact and viable lymph system. If you are interested in the more medical applications you can then go onto:

Therapy II and III: which are taught together. This is an eleven day residential course held in the autumn each year in Devon. Theory and pathologies which can be treated with MLD are taught by the Medical Director of the Vodder Clinic and School who comes over from Austria. The practical work is taught by one of only six qualified teachers world wide. Once this level is passed then the whole world of MLD is open to you. This course studies the many causes of oedema including lymphoedema and working with patients who have a compromised lymph system. Buyer beware! If someone is offering you a shorter course, check them out first. Are they qualified to teach MLD? Is the training acceptable to MLD UK (MLD’s Governing Body) ? I have had many students who came to MLD Training after spending quite a lot of time and money on courses only to find they weren’t awarded an acceptable qualification for what they wanted to do. The Vodder, Casley-Smith, Foeldi and Asdonk method certificates are acceptable worldwide. It is very difficult to accurately describe the experience of an MLD treatment in a few words. If you are interested in this amazingly subtle massage, the best advice would be to find a qualified practitioner and book yourself in for a treatment. I always keep in mind the comment of one of my clients who told me that "I have lymphatic massage from time to time but you are very different and the effects last at least

Quick Check List MLD is contra-indicated for anyone with untreated malignant disease, Right-side cardiac insufficiency, thrombosis or acute infection. (Students work on each other during the practical sessions.)

For further information contact: Mary Hudson, MLD Training 01590 676 988 or visit the website www.mldtraining.com For a list of qualified teachers and/or practitioners go to www.mlduk.org.uk Dee Jones has been at the forefront of Manual Lymph Drainage, Vodder Method since 1991. She is a founding member of MLD UK, the Governing Body for MLD in the UK. She has lectured and taught at hospitals and on courses all over the UK and Europe. In addition to teaching she is the Clinical Director for an in-patient lymphoedema clinic and also sees clients privately, for the NHS and for heath insurance companies. Dee has had several articles written about MLD and herself in Harpers & Queen, The Mail on Saturday, Top Sante and many others. She is also mentioned in Jane Alexander’s book "Supertherapies’

February/March 2007 M|W

A Sport & Remedial

Massage Therapists Guide to Marathon Runners by Susan Findlay ith the season changing, the days getting longer, more people are running and many will be training for the London Marathon in April. Some will have sensibly started the required training regime during the dark winter months, building up their stamina gradually and systematically. Others will have waited until the weather was more enticing thus leaving themselves a little less time for the body to adjust to the demands being made. Finally there will be those who start training just a few weeks before and realise they might have left it a bit too late. At whatever stage your clients come to you, it can be a challenge to get them through this event.

Janet’s Story Janet is coming up to her 50th birthday, although slim and long legged in stature, biomechanically she has limitations which originate from her feet. She is someone I would not actively encourage to run long distances simply because she lacks the support and absorption needed when making contact with the ground. But it is important that I consider her ultimate desire to run a marathon in her 50th year and rise to the challenge. It may not be the ideal situation, but this is what makes this profession interesting.

She has what is often referred to as flat feet. Although the arches are not completely collapsed, there is very little ability for the feet to absorb the impact generated from running due to almost non-existent or low arches. If the feet are not doing the job they were intended to do, which is to absorb the impact from the ground, the force is generated through the joints of the skeletal system rather than the muscles. As you can guess, it leads to joint injuries and pain. Janet originally came to me with symptoms of knee and lower back pain. This is typical of her condition. February/March 2007 M|W

sportsmassage massage therapists guide to marathon runners

If you do get someone who comes in displaying signs and symptoms of knee, hip and lower back pain, you might need to consider what is happening at the base, as it influences everything above. At this time I chose to do a full postural assessment and gait analysis. The assessment showed strong evidence her feet were a problem and needed support.

Recommendations were 1. A pair of running shoes with extra cushioning for absorption. Highly recommended are specialist running shops, as they have the knowledge and observation skills to fit people appropriately for the sport. 2. Professionally fitted orthotics (inserts for the shoes), specifically made for her. 3. Alternate the road running with the treadmill and include other disciplines to help build up her cardiovasular fitness. 4. Her training also needed to include non impact choices such as using the cross trainer, bike or swimming, to increase her endurance and stamina. 5. Janet needed to build up muscle strength and engage the underused muscles, such as gastrocnemius, soleus, and quads.

The week before the marathon is when runners should be tapering down, having a week of active rest, so as to build up an abundance of energy in the muscles. 14

M|W February/March 2007

6. Stretching the tight and overused muscles such as the hip rotators. Muscle Energy Techniques and Soft Tissue Release, and Activated Isolated Stretching are examples of effective stretching techniques used. It took her longer to build up to the level of fitness needed to do the distance on the road, and this had to be accounted for in the time scale of her training. She did the Marathon in less than 4 hours, which is excellent going for anyone never mind having to work through numerous challenges. Unfortunately she now has it in her mind that she wants to and can do more marathons.

The Wild Card Many new clients are unaware of the benefits of regular massage when training. The Wild Card is someone who has either not had massage or regular massage, but decides it would be a good thing to have the week before the event. They usually bring a list of "mild nigglies", which have been plaguing them for months, but they do not think they are that important and "run through them". From a remedial point of view, dealing with the "nigglies" could be a disaster, so it is inadvisable to give anything other than a general flush, leaving any remedial work for after the marathon. The week before the marathon is when runners should be tapering down, having a week of active rest, so as to build up an abundance of energy in the muscles. If remedial work is commenced at this time, not only will the body go into healing mode, but in essence, the massage will rob the athlete of their energy reserves. It can be a challenge to find the balance between achieving a good flush, and taking it so far that the body is having to repair and recover. Keep in mind that it is much better to do less than to go too deep and do too much. Here is a great opportunity to educate your client about the benefits of regular Sport & Remedial Massage in conjunction with training, hopefully without making them feel like they won’t make it to the end this marathon.

The First Timer The primary focus of most Sport & Remedial Massage therapists is to keep our clients injury free. One of my athletes has shared some good training advice on how he stays injury free which is simple and effective. He uses massaged to gauge how his muscles are handling the hours of training, as well as keeping

sportsmassage massage therapists guide to marathon runners

them flushed and finely tuned. Also, he trains just until he reaches his optimum level and then rests. The resting period is very important, it allows his muscles to continue the building process, giving them time before moving onto the next level of training. Beginners can be a bit misguided and believe they have to train until they drop and then they can rest, (for some, rest is not in their vocabulary). Training to a point of total exhaustion and then resting to recover has negative effects. This creates a situation wherein the tissue is struggling to repair, rather than building new tissue to support the level of training. In a recovery situation such as this, in which the tissue is having to deal with too much micro trauma, this can over time lead to injuries. Encourage your new runners to listen to their bodies telling them when to stop and how much they should be doing. Better to do less and stay injury free than to push it too far and be forced to pull back due to injury.

Post Marathon Massage

Event Advice

It is a rewarding experience to do volunteer to work at events, but there is something extra special if you are planning to massage at the London Marathon. The atmosphere is inspiring, the stories are as varied as the people, and no one forgets their experience of that day.

Running shoes: keep a rotation of 3

As a Sport & Remedial Massage therapist, we can wear many hats. One of these areas is addressing the psychology of the client. In circumstances such as the marathon, it is equally as important what we say during our massage sessions as what we do. When therapists find areas of tension, trauma, or imbalance, how we verbalise what we find can have a significant impact. Comments should be made in such a way that they have a positive effect. In other words, when you find tissue trauma, adhesions, or a problem developing, be careful not to emphasize, or focus disproportionately. It is alright to acknowledge what your hands are telling you about the person, but try to focus on the solution, ie "this is a bit tight" what stretches are you doing? This will create an awareness which is usually enough to prevent an injury, without hindering their training or diminishing their confidence. As in all therapies, it is equally important to recognise when something is beyond your remit and refer when appropriate.

Muscle Cramps

Post event massage usually consist of good basic strokes that flush the muscles in the legs, and sometimes around the shoulder area. It can last anywhere from 10 minutes to 20, any more than that is stressful on an area that is already stressed. If you are working with a charity, usually they will have someone from a medical team assessing each person for injury before they get to the massage area. Sometimes someone does slip through and you need to be aware of symptoms for hyper and hypothermia, heat exhaustion, heat stroke, & dehydration.

pairs at different stages of wear, an older pair, medium wear, and a new set. There is a big difference in how the shoe functions between new and old. In order to adjust to the differences, it is best to break in the new ones, while you are still training with other shoes at different stages of wear.

Clothing: always make sure that they have already run long distances in their chosen outfit of the day. Do not wear anything new as chaffing is a big problem. It is usually from a bit of new gear that has been put aside for the special day and has not been tried and tested.

During a post marathon massage, it is not unusual for a runner to suffer from cramps. This can be due to: fatigue, dehydration, electrolyte imbalance (calcium, potassium, magnesium), muscle strain and injury.

Treatment

Susan Findlay is the Director of North London School of Sports Massage & the Institute of Sport & Remedial Massage.

1. Bring origin and insertion of muscle closer together. 2. Stretch 3. Direct pressure may also help. 4. Ice massage 5. Replace fluids and electrolytes Most runners while having their massage post race say they will never do it again, but are glad they have done it. Then a week later they will start talking to you about the next one they are planning to do. It is a bit like giving birth, we soon forget the pain and just remember the joy.

Originally from Canada, she has a BSc in Nursing and has headed numerous health & fitness programmes in conjunction with GPs. Susan lectures on a range of courses at the NLSSM & LSSM. She also has a busy clinic in North London. To contact Susan you can visit:

www.nlssm.com or email:

apply@nlssm.com

February/March 2007 M|W

Saving Your Wrists his series of articles are extracted from a forthcoming book on Dynamic Bodyuse for delivering Effective Strain-free Massage which is designed to promote good bodyuse as an integral part of doing massage. It presents guidelines on how to reduce poor working habits that take a cumulative toll on the practitioner’s body.

More than many other activities, doing firm massage requires you to apply consistent compressive pressure through all of the joints of the upper limb, from your shoulders down to your digits. The most vulnerable areas are the wrists and thumb, and these are the areas that massage practitioners most commonly strain. You are more at risk if you have small or slender hands. If small discomforts in these areas are not tackled, they can accumulate and lead to long-term damage. The previous articles looked at how to protect your thumb and fingers when applying pressure. The next articles other cover common ‘tools’ used to deliver massages - your knuckles, fist, forearm and elbow. Future articles will cover using the rest of your body to back up those working ‘tools’. This article focuses on practices in your massage studio that will minimise long-term strain on your wrist.

Straining the wrist Muscles in the forearm flex and extend the wrist and are the activators of the fingers and many of the movements of the thumb. The tendons of these muscles are held in place by retinacula as they pass over the wrist. If the flexor muscles are consistently overused, their tendons can swell up, pressing on and affecting the nerves and blood vessels which pass with them under the flexor retinaculum. Tenosynovitis is inflammation of the inner lining of the tendon sheath which is generally caused by overuse, especially when working awkwardly and/or repetitively. It is most common in the tendons of the wrist and hand, where it can cause tenderness or pain in the tendon, often gives rise to swelling, and can lead to restricted movement. It can also lead to carpal tunnel syndrome, in which pressure on the median nerve as it passes through the carpal tunnel causes numbness, tingling and/or pain in the thumb, index and middle fingers. In the worst situation it can also lead to loss of control in parts of the hard.

Dynamic Bodyuse for Massage Practitioners by Darien Pritchard

Wrist problems are not unique to massage practitioners. Any activity which involves the hands in constant, regular or repetitive activity can lead to problems. February/March 2007 M|W

newtechnique saving your wrists Tenosynovitis at the wrist and carpal tunnel syndrome are common occupational problems for hairdressers and musicians, for people doing regular computer work (which is very widespread these days) or involved in building work or factory work (particularly on production lines). If you are a massage practitioner and also using your hands consistently for other activities, such as typing, gardening, DIY or playing musical instruments, you need to be especially careful of your wrists.

Wrist problems in massage It is primarily the cumulative effect of techniques that involve pushing or pressing that cause problems, especially if you are doing them with your wrist bent. Pulling techniques, which put much less pressure through the wrists, generally only lead to problems if they are done with the wrist consistently bent. However, even with the best positioning of your wrist, there is still quite a pressure passing through it, so learning to use your forearm and elbow is also very helpful, particularly if you have small hands or slender wrists.

Pulling techniques, which put much less pressure through the wrists, generally only lead to problems if they are done with the wrist consistently bent. 18

M|W February/March 2007

Bear in mind that if you are straining your wrists and/or hands, you are also likely to be tensing your shoulders as part of an instinctive body reaction. You may also be holding your breath and stiffening your back. In fact you could be unconsciously tensing throughout your body, which is likely to cause more strain and thus feed back into this cycle of pain and tensing. Therefore, if you are changing the way that you use your wrists, you need to consciously relax the rest of your body (particularly your arms, shoulders and upper back) to ensure that these associated tensions don’t draw you back into your old habits. Do not continue doing strokes that strain your wrists. Find alternatives. Rest them.

If you have persistent pain, especially if it persists when you’re not working, seek specialist help. Regular massage can help, preferably as a preventative measure but also by giving some relief from the pain/tensing cycle if there are already problems. Many people find that acupuncture and osteopathy/ chiropractic/ physiotherapy can reduce an established problem and sometimes relieve it totally. A reminder here - it’s always useful to prepare for doing massages, and to release any accumulated tensions afterwards, by doing simple exercises to mobilise your shoulders and arms, exercise your wrists, move your thumbs and curl and uncurl your fingers.

Having the wrist bent Many techniques involve varying the angle of your wrists within the stroke. This is fine for light strokes such as ‘brushing’ across the tissues. And if you are doing percussion strokes, it’s important that you keep your wrists supple and able to move. However, the greatest strain on your wrist in massage comes from having it consistently bent when you are applying pressure. Even when you are only applying light pressure, it’s a good to cultivate the habit of keeping it relatively straight. And, when you are applying sustained pressure, it’s crucial to minimise the bending of your wrist, which is not shaped to work powerfully at an angle.

newtechnique saving your wrists Figure 1

Figure 4

Having the wrist bent when applying pressure

Flexion of the wrist when applying pressure

To feel this, try pressing through the heel of your hand with your wrist bent at 90˚. You’ll probably be able to feel a niggle of strain in your wrist as you do this.

Having the wrist flexed when applying pressure can also cause problems over time. It’s less common, but often occurs when the practitioners tries to reach too far along the client’s back with the fist (figure 4).

Figure 2 Squeezing muscles with a bent wrist

Finding the best angle for your wrist If you start from the position described in figure 1, and begin to straighten your wrist, you’ll feel that at a certain angle the strain will disappear from your wrist.

Figure 5 Applying pressure through the heel of the hand with the wrist straighter

Figure 3 ‘Knuckling’ pressure with a bent wrist

You’ll certainly be able to feel the strain if you try squeezing muscles (figure 2) with it hyperextended like this. Unfortunately, many people also work like this without realising it when doing ‘knuckling’ strokes (figure 3).

For most people this will be somewhere between 30 and 60˚, as long as your hand remains quite relaxed (figure 5). Don’t tense your shoulders to deliver the power, as this would also lead to further tensing your wrist. Instead, press down by leaning your weight forward. As long as you don’t use this way of working too much, and monitor your wrist carefully when you do use it, you’re unlikely to have problems from the massage.

The greatest strain on your wrist in massage comes from having it consistently bent when you are applying pressure. February/March 2007 M|W

newtechnique saving your wrists (However if you regularly have your wrist bent while driving, typing etc as well, you are more likely to develop problems.)

Figure 6 Keeping the wrist straight when applying pressure

Supporting the straight wrist However, your wrist still has to provide stability for your massage technique in addition to receiving the force of the pressure being applied. You can further reduce this demand on your wrist by resting your supporting hand/forearm on the client’s body.

Figure 8 Resting on your other hand to support your wrist

The Beautiful Music of Tim Wheater Founder and Director of the Wheater Academy of Sound Healing Popular and Critically Acclaimed CD titles suitable for massage, meditation, yoga, relaxation and healing. Golden Light In Unity Fish Nite Moon Invisible Journeys Into the Healing A Calmer Panorama Sound Medicine Man

However, even with your wrist at this angle, you’ll probably notice that a little strain returns if you start using your fingers to take hold of muscles or apply pressure through your fist. You’ll need to straighten it further to avoid this strain (figure 6). So the best idea is to try to keep your wrist as straight as possible. This is the most effective way of transmitting power through your wrist with the least strain.

You can rest your supporting hand on the client’s body to provide a static or moving platform for your working hand from underneath (figure 8).

Holding the straight wrist There’s two simple ways of supporting your straight wrist with your other hand/ arm in order to reduce the pressure on it.

Figure 9 Resting over your other forearm

Figure 7 Holding the wrist to support it

• Talks • Performances • Workshops • Sound Therapy

www.timwheater.com Tel: +44 (0)1566 86308

M|W February/March 2007

You can use your other hand to directly hold your wrist.

If you can use your forearm to support the working hand (figure 9), this will take the pressure completely off your supporting hand as well.

newtechnique saving your wrists

Conclusion So the angle of the wrist and support for it are important. It’s also crucial to keep your hands as relaxed as possible. Monitor your wrist use carefully, so that adapting to any discomforts becomes an integral and automatic part of doing massages. And remember to vary your massage techniques. Even with best practice - a straight, supported wrist - there is still pressure on your wrist. So it’s wise to include pulling, lifting and stretching techniques in your massage treatments, whenever possible, to lessen the compressive forces that are going through your wrist. And to save your wrist entirely, whenever you can, by learning to use your forearm and elbow skillfully.

Darien Pritchard has thirty years of experience as a bodyworker, including twenty-five as a massage trainer. For twenty years he has run professional development training for qualified massage practitioners in UK, Australia and Scandinavia. With Su Fox, he co-authored Anatomy, Physiology and Pathology for the Massage Therapist (Corpus Publishing, 2001), a textbook for massage students and practitioners in their early years. Dynamic Bodyuse for Effective Strain-Free Massage will be published in early 2007 (Lotus Publishing, UK; North Atlantic Books, USA). CONTACT DETAILS: T: 029 2045 4506 E: darien.pritchard@virgin.net W: www.dynamicmassage.co.uk

Seated Upper Body Massage for All by Andrew Sceats A new book and DVD are now available for MassageWorld readers for a special price of £16 for the book and £13.50 for the DVD. A special combined price of £24 for both. Available from www.pressuredown.net.

The Book Aimed at Therapists, Health Care Practitioners, Disabled, Carers, Workers and Sports people. Describes how massage can be made more easily available to many disabled people, especially wheelchair users and partially sighted, and their carers. Contains over 150 photographs and helpful illustrations demonstrating this unique massage sequence. Advises on many business queries raised by therapists using this therapy in the workplace and elsewhere.

The Omni Massage Roller

Use it at the Office, at Home, or in the Bath. The Omni Roller is the most versatile tool on the market today. Use it at the office to relieve the stress and stiffness associated with long hours at the computer.

USED BY PROFESSIONAL THERAPISTS

Complements the DVD ‘Seated Upper Body Massage’ which demonstrates the sequence he has taught nationwide for 5 years.

The DVD The DVD has a running time of 35 minutes and shows the massage sequence taught to over 500 students in the UK. The sequence covers the back, neck, shoulders, arms, hands, scalp and face as well as acupressure. It also emphasizes the importance of stretching and deep muscle vibrations. All prices include p&p. Cheques made payable to: Andrew Screats, 12 The Dell, Bicton Heath, Shropshire SY3 5HG.

Email: andrew@pressuredown.net

Omni Massage Systems Ltd PO Box 11889 Park Way Birmingham B45 9ZN

Tel: 0121 453 1194 or 020 7900 6194 Email: customerservice@omnimassage.uk.com

www.omnimassage.uk.com

February/March 2007 M|W

MUSCLE OF THE MONTH 24

ur journey up the back with the erectors and splenii muscles in previous issues has now brought us to the scalenes, a group of muscles very much involved with both stabilising the cervical vertebrae and elevating the ribs to assist breathing. Coming out to the side of the neck with the middle and posterior and to the front with the anterior scalene, this group mirror some of the functions of two sets of muscles of the lumbar spine.

Actions Unilaterally - lateral flexion of the neck (and therefore also the head) to the same side - ipsilateral rotation (rotation to the same side) Bilaterally - elevate the ribs in forced inhalation - cervical flexion

Working unilaterally the middle and posterior scalenes will produce side flexion similar to the role of the quadratus lumborum, bilaterally the anterior scalene will produce a cervical lordosis as it travels from the back of the body to the front in a similar fashion to the psoas in the lower body. These are muscles we’ll come to shortly in this series but if you’re not familiar with them look them up quickly in any anatomy book and see how this analogy works.

Anterior Scalene Origin Anterior tubercle of transverse processes of C3-C6

Insertion First rib

Middle Scalene Origin Posterior tubercles of transverse process of C2-C7

Insertion First rib

Posterior Scalene Origin Posterior tubercles of transverse processes of C5 and C6

Insertion Second rib

M|W February/March 2007

As you can see from figure 2, the scalenes are intimately linked with the brachial plexus making palpation quite challenging for the novice practitioner, care must be taken not to impinge any of these delicate structures. It is good practice to first explain to the client where you are going to work and if they feel any nerve tingling, pain or pins and needles to alert you to the fact in order that you work cleanly and without causing bruising to these pathways. Similarly, if the therapist feels any interesting pulsing sensation under his or her fingers it may be that they are pressing on the subclavian artery and, perhaps, it would be a good idea to move the pressure slightly to one side or the other. Whilst the attachments of the scalenes can vary from person to person once you know what your looking for and how they should feel, accurate and sensitive palpation is quite straightforward. The middle and posterior scalenes come down to the ribs pretty much either side of the midline of the neck. By folding your fingers around the front edge of the trapezius and staying anterior to the levator scapula, lightly strum your fingers along the underlying tissue and you should feel them bump along a couple of "guitar strings". Explore around these for a moment and you should be able to distinguish the middle and posterior. To feel them contract and to ensure that they are the scalenes ask your client to take a deep breath, you can feel them contract on the last 10% of inhalation when she tries to levitate the ribs for that extra portion of expansion into the lungs.

Scalenes Finding the anterior scalene can require a little more accuracy and patience, tucked in under the clavicular portion of the sternocleidomastoid and close to the neurovascular bundle of the thoracic outlet the therapist needs to be gentle at first until she builds confidence in going into that space. Remembering to alert your client to the possibility of impingement, fold your fingers under the lateral edge of the SCM and press down toward to the first rib. By asking your client to once again take a deep breath you are feeling for the tissue to contract under your contact as she elevates her ribs.

This little explored group of muscles is very important in many of the pain and postural patterns you’ll see coming into your clinic every day and whilst they may seem hidden and create nervy feelings sometimes it is worth persevering to gain confidence in reaching into those gaps to find them.

Locating the scalenes like this can give you plenty of scope then for applying techniques such as myofascial and soft tissue release to open them up and neuromuscular technique to rid them of any trigger points. Common complaints which would alert you to the possibility of trigger point in this group of muscles would be painful or restricted movement of the head and neck, pain may be referred to the areas of the medial border of the scapula, triceps and the back of the thumb and index finger or onto the front of the chest, over the deltoid and biceps. Release of trigger points in the scalenes has also been found useful in the treatment of phantom pain. The referral pattern into the arm and particularly onto the hand can often be mistaken for entrapment of the brachial plexus, known as thoracic outlet syndrome. This can be caused by shortness and restriction of the anterior and/or middle scalene and will lead to pain, tingling and/or numbness along the ulnar aspect of the arm and sometimes accompanied by swelling into the hand. The middle and posterior scalenes can get messed up with trigger points and imbalances for a number of reasons. As they’re involved in neck and head stability they will adapt to help correct any postural imbalances coming from the lower body. For example if the pelvis is tilted it will create a curve in the spine affecting the thorax and once the thorax is brought off centre then the scalene equilibrium will be compromised in order that the neck adjust to keep the head somewhat straight. Of course there are many other potential postural deviations that will affect them as well and they will often compromise this group as they adapt to maintain the head in a relatively vertical orientation. The anterior scalene is most often shortened through anterior head position, or "pokey out chin" as a recent student preferred to call. This is probably the most common postural "fault" we see in our clients, or anybody else for that matter, and whilst the anterior scalene may or may not be the cause of it this muscle will need to be released in order to allow the head and neck to move back. Other aggravating factors include whiplash type injuries, faulty breathing patterns, holding the phone, watching tv or reading books at odd angles, even sleeping on pillows that are not of the right height or shape for your neck can create problems for them.

REFERENCES Travell & Simons (1999) Myofascial Pain and Dysfunction The Trigger Point Manual Vol 1. Upper Body 2nd Ed. Biel, A (2005) Trail Guide to the Body Finando, A & Finando, S (1999) Informed Touch James Earls is a massage and structural integration practitioner working in Belfast, he is also director of Ultimate Massage Solutions importers of a wide range of high quality bodywork related books, videos and DVDs and provides expert postgraduate workshops. You can contact him on +44 (0)7774 183458 or at www.ultimatemassagesolutions.com. The diagrams are taken from "Trail Guide to the Body" and has been used with permission of the publishers, Books of Discovery.

February/March 2007 M|W

productreview Products Portalite Delta Massage Warehouse £229.99 inc delivery * This couch is as light as it is strong, weighing only 11kg it has an aluminum frame and is a generous 30" (75cm) wide, with height adjustable from 23 to 33 inches (58~86cms) using quick release push buttons. The table has an adjustable face cradle which has an ergonomic arm sling underneath so the client can rest their arms with ease and give you more access to the scapula, rhomboid and trapezius areas. It is a very high quality massage couch with 3 inches (8cms) of multi-layer foam underneath a stain and spill resistant layer of vinyl leather giving exceptional client comfort and support.

Light enough to carry in one hand while travelling to out-calls yet as sturdy as a table twice its weight due to its aluminium frame and leg system, it can take up to 200kgs (31 stone) of working weight. It also towers over other professional massage tables in its category because it has a full-size bed (35 inches) and 3 inches of multi-layer foam . There are other lightweight tables in the market but they compromise and have a smaller bed area and a thinner foam layer to cut down on weight. You also get a carry case, couch and head rest cover and brushed cotton sheet set thrown in with the package so all you have to do is pick it up and go to work. *Special offer exclusive to Massage World readers: Quote Massage World Magazine and get £30 off this package.

www.massagewarehouse.co.uk

A f f i n i ty P u m a M a ssage Chair Therapy Essentials

The Affinity Puma Massage Chair is aptly named as it is sturdy but silent even under strong lateral movements – just like the animal. It’s aerodynamic frame is sleek but strong and has over 140k (3001bs) dynamic strength. The design of the Puma Chair is modern and stylish with excellent adjustment facilities for the cradle, height, chest and armrest. For the client, the ergonomically shaped three ply Therafoam gives maximum comfort. The Puma sets up in seconds but is sturdy yet light to carry, setting new standards in portability at an amazing 7kg. It comes in at a very competitive price for the quality and is definately a model to test drive if you are thinking of purchasing a seated massage chair.

www.therapyessentials.co.uk 26

M|W February/March 2007

productreview Products no overpowering odour. You do not have to be an elite athlete to benefit from its powers, it is suitable for use on sore muscles and joints and is particularly useful to warm up these areas in the cold weather or after physical activity. The gel is very easy to apply and quickly to absorb. There is a sense of cooling around the area treated that is soothing and makes it an ideal medium to use on your post-marathon clientele.

Blue Active Gel Muscle and Joint Rub Pioneer Trading 50ml - 300ml from £7.95 Most of you in the sports and remedial fields will by now be singing the praises of Golden Emu Oil. Now Blue Active have combined the oil with Glucosamine, Chondroitin, Witch Hazel, Aloes and essential oils, producing a very effective lotion with

www.pion-tc.co.uk

CDs Namaste - True Champissage MG Music MGCD90 CD £10.99

Secrets of Faeries Neil H - MG Music MGCD45 CD £10.99

As it says on the cover, "Three masters of their art, one singular purpose, to craft dedicated holistic music that is true to the therapy that the album represents.". This music is a collaboration by three known musicians, Paul Lawler, Peter King and Medwyn Goodall, and the outcome is background for Indian Head Massage treatments on a level that has not been achieved before – outside of India of course! Each track is mastered for the therapist to work alongside on time and intensity with the UK master of the art, Nerendra Metha’s blessing.

From a healer and holistic therapist’s point of view this album is exquisite. The music is mesmerising, gentle and graceful. It is created to heal, nurture and relax and so is ideal for background to Reiki, Yoga and massage. The compositions are flawless and the haunting piano together with soft keyboards and flute are beautifully complemented by the cleverly placed "fairy sparkles" throughout. This CD will definitely inspire, uplift and calm. Don’t be put off by the "faeries" in the title, it is just right for taking away the worries of the working day and deserves to be Neil H’s biggest selling album to date.

www.aquavisionmusic.co.uk

February/March 2007 M|W

MASSAGE WORLD The Massage and Body Therapists Magazine

Subscribe and receive:

calendar of events 24-25 March 2007

20-21 May 2007

6 Bi-Monthly issues a year

Mind Body Soul Exhibition

Olympia Beauty

Money Back Guarantee if not satisfied after first two issues

Brentwood

Olympia, London

A very popular annual event combining free workshops, lectures and exhibitors in the fields of alternative therapies, personal growth and spiritual awareness.

This year, the show is poised to be even bigger and better than ever. With a myriad of essential exhibitors, tantalising treatment ideas as well as the latest and greatest education options.

T 01787 224040 • W www.mbsevents.co.uk

T 0870 4866 815 • W www.olympiabeauty.co.uk

11-12 March 2007

26-27 May 2007

CNM Green Day

The 4th Breath of Life Conference

London W1

London Its purpose will be to facilitate debate and provide the opportunity for therapists of all disciplines to widen their exposure to new and established approaches to holistic healthcare.

Training Details ......................................................

The College of Naturopathic Medicine are holding their first ever "Green Day" on Easter Sunday, an event for therapists and those interested in complementary therapies. The CNM also train in homeopathy and acupuncture and will be extending their curriculum to include massage, reflexology and other natural therapies. It will be a stimulating day and I am sure they will turn a blind eye to an organic easter egg or two!

............................................................................

T 01342 410505 • W www.naturopathy-uk.com

Dates and venues correct at time of going to press.

■ ■

■

No risk of missing an issue

■

Keep you informed with the latest in the massage world

I want to subscribe! If you would like to take advantage of this special money back guarantee subscription offer just fill out this form (or a photocopy) and send to the address below: Please tick appropriate box

❏ UK/EU ❏ Rest of World ❏ UK/EU Student

£25 for 6 issues £40 for 6 issues £20 for 6 issues

Name .................................................................... Address ................................................................ ............................................................................

To publicise your event/conference/exhibition on our calendar page email:

massageworld@btconnect.com

Postcode .............................................................. Telephone ............................................................ Email ....................................................................

Simply Therapy

Occupation .......................................................... Suppliers of Complementary Therapy Products

Method of Payment I enclose a cheque/postal order for £ .................. made out to Massageworld.

INSTANT HEAT PACKS Ideal for the massage therapist. Simply click the metal disc and the pack crystalises becoming hot instantly, anywhere. Ideal as part of a Hot and Cold therapy treatment. USES INCLUDE (but not limited to):

Please debit my credit/debit card with £ .............. Type of Card ........................................................

• Ease of Arthritic Pain • Menstrual Cramps • Back Aches • Stiffness • First Aid • Sports Injury Therapy

Card Number ........................................................ Issue Number for switch cards only ...................... Expiry Date .......................................................... Date ......................................................................

SMALL HEAT PACK / HANDWARMER Ideal for localised areas or for use as a handwarmer. Approx 10cm x 8cm.

LARGE OVAL HEAT PACK Ideal for arms, legs and torso areas and for back ache and PMS relief. Approx 23cm x 14 cm.

Signature .............................................................. Subscribe on-line at www.massageworld.co.uk or www.giftsandcrystals.co.uk Alternatively telephone 020 7387 9111 with your credit card details or email us: massageworld@btconnect.com MASSAGE WORLD PO Box 54879, Howick Place, London SW1P 9FW

www.massageworld.co.uk

T 020 8460 2122 W www.breathoflifeconference.co.uk

LARGE RECTANGULAR HEAT PACK Ideal for neck and shoulders and for wrapping round limbs. Also good for back ache and PMS relief. Approx 27cm x 13cm.

Tel: 01784 458 939

A case to consider: Allergic Reactions

by Charles Wells

forty minutes of massage with sweet almond (Prunus amygdalus L.), benzoin (Styrax benzoin Dryander), eucalyptus (Eucalyptus globulus Labill. ) and Roman chamomile (Chamaemelum nobile (L.) All.). She was advised to shower immediately and take one of her Piriton tablets.

I wondered if you could possibly shed any light on a continuing problem I am encountering with a client who, despite every effort, continues to have moderate allergic reaction after every massage treatment using carrier oils and some essential oils, emailed Diane Oldridge. The client is a 30-year-old female who has Therapeutic/ Remedial massage every 7-10 days, following a climbing accident a year ago. Although she is responding well to the treatment and exercise advice, the source of her allergic reaction is not apparent. However it is known that she is allergic to lignocaine, which causes stomach cramps, nausea and vomiting, and she suffers mild hayfever. During her fourth treatment the client reported developing very swollen lips and eyelid after the previous treatment, and then promptly developed a raised ‘nettle-sting-like’ rash behind her ears and down her neck. This was after

At the time benzoin was suspected [which would have been my first thought], although she had had no reaction to a bath blend containing the same oils until sandalwood (Santalum album L.) was substituted for benzoin [this does baffle me]. However a further reaction occurred after using sweet almond and calendula (Calendula officinalis L.), but without any essential oils. At this point a nut allergy was suspected [I would think the same], and the client informed. The bath blend was exchanged for one using grapeseed (Vitis vinifera L.) instead of almond. In the following treatment grapeseed oil with arnica (Arnica montana L.) was used, but again the client experienced the rash, itching and a swollen eyelid and part of her upper lip. Contamination from the bed or couch or face cover was considered. On the next treatment new towels were used, the couch and accessories had been cleaned and the face cradle and couch cover had been washed prior to treating the client. New face cradle and covers were ordered, and to be kept strictly separate. Grapeseed with calendula was used but again, after forty minutes of treatment, the client experienced tingling lips and eyelid, both of which swelled up.

February/March 2007 M|W

Most recently all the bedding was brand new, including the face cradle, and the couch and accessories had been cleaned before use. Grapeseed and freshly macerated (in organic olive oil) arnica were used. After 30 minutes the client had no symptoms. The treatment finished with massage to the neck with no problems. However, minutes later the itching started and the client experienced widespread ‘nettle-rash’ behind the ears, down the neck and up into the neckline. The rash was raised, red and hot to begin with. It consisted of raised areas, some areas at least the size of a 10p piece. She reported the area feeling numb. Once the skin had stopped flaring up the areas turned white and remained raised. Interestingly, the client has not experienced any symptoms on her torso or limbs except after one treatment when her wrists itched. Can you offer any insight into what on earth could be causing her reactions? Could it be Arnica, or........?

Arnica

The perennial herb arnica, sometimes called Leopard’s Bane, Wolf’s Bane or Mountain Tobacco, grows to a height of about 0.6m and is native to the mountainous regions of Europe. It contains up to 1% of a viscous volatile oil about half of which is composed of fatty acids, with palmitic, linoleic, myristic, and linolenic predominating. Aromatic constituents present include thymol and thymol derivatives. Other constituents are the coumarins scopoletin and umbelliferone, the flavonoids betuletol, eupafolin, 6-methoxy-kaempferol, hispidulin, tricin, and others, sesquiterpene lactones such as helenalin and dihydrohelenalin derivatives, and the bitter principle arnicin. Arnica has been reported to increase the resistance of animals to bacterial infections by stimulating phagocytosis of the bacteria involved, particularly Listeria monocytogenes and Salmonella typhimurium [H. Buschmann, Fortschr. Veterinarmed., 20, 98 (1974)]. The sesquiterpene lactones helenalin acetate and 11,13-dihydrohelenalin have antibacterial and antifungal activities in vitro [G. Willuhn et al. Pharm. Ztg., 127, 2183 (1982)]. Numerous esters of helenalin have been shown to have anti-inflammatory activity in mice and rats [I.H. Hallet et al., Planta Med., 53, 153 (1987)]. Arnica is believed to have wound-healing and stimulant properties. However it is an irritant to mucous membranes and ingestion may result in fatal gastroenteritis, muscle paralysis (voluntary and cardiac), increase or decrease in pulse rate, palpitation of the heart, shortness of breath, and may even lead to death. Helenalin is 30

M|W February/March 2007

stated to be the toxic principle responsible for these effects. In herbal use arnica is stated to possess topical counterirritant properties, and has been used for unbroken chilblains, alopecia neurotica, and specifically for sprains and bruises. It is used mainly in homoeopathic preparations. Externally, arnica is poorly tolerated by some people, precipitating allergic reactions in sensitive individuals. It should only be applied to unbroken skin and withdrawn at the first sign of reaction [British Herbal Pharmacopoeia. Keighley: BHMA 1983]. Sesquiterpenes, especially helenalin and its derivatives, are believed to be the sensitizers [H.D. Herrmann et al., Planta Med., 34, 299 (1978)]. The chemistry of arnica is well studied. Anti-inflammatory properties associated with sesquiterpene lactones probably justify its use in aromatherapy, although allergenic and cytotoxic properties are also associated with this class of constituents, but it can cause an allergic reaction. Thus far I have been unable to discover anything that implicates either grapeseed or calendula but, what do you think? Meanwhile I was interested to note Diane’s comment about lignocaine, a local anaesthetic of the amide type which acts by preventing the generation and transmission of impulses along nerve fibres and at nerve endings, because I have read of erythema and pigmentation of the upper lip in a child following local dental infiltration of lignocaine which was attributed to a type of fixed drug eruption [Curley, R.K. et al. An unusual cutaneous reaction to lignocaine. Br. Dent. J. 1987; 162: 113-114]. Is the client, I wonder, still using any anaesthetic?

A line on linseed

Interestingly, others have suffered similar allergic reactions to latex, essential oils, and even some non-prescription drugs. Nevertheless, I was not entirely surprised that some suggested honey as a possible curative, because it does have an enviable reputation for healing cuts and sores. However I would not have thought to mix it 50:50 with linseed/flaxseed oil (Linum usitatissimum L.), as someone suggested, although flaxseed’s specific name is so coined to acknowledge its great utility. The use of bruised linseed was a recommended medicament of Hippocrates. Among the medicinal uses of flax are emollients, the crushed seeds have been used as a poultice, and the whole seed as a laxative. The word liniment, describing a topical application, has its origin from ‘line’. Medically, linen has been used for bandages and dressings and linen ligatures have been popular for surgically securing large blood vessels. All of which leads neatly to a favourite subject of mine - etymology. Etymological inquiry often reveals certain, albeit speculative, traces that the past has left. The Compact Oxford Dictionary is considered as the most reliable source on the linguistic

origins of words; it provides several for flax. One simple example is the origin of the word linnet, which appears to be old French, and means "the bird which hovers feeding on seeds over flax fields", an image secured by common observation. The fact that the language of origin is old French, implies that flax (and linnets) were commonly seen in old France. Alternatively, linguistic diversity leaves common traces. The word ‘line’ has many linguistic roots, Old English, Old High German, Middle High German, Old Norse, Swedish and Gothic, all implying its descendance from a Latin or Greek ancestor, linum, meaning flax. A common origin and antiquity are clearly implied. Flaxseed has a long tradition of use in folk medicine; internally flax was used as a cure for gastric disorders: indigestion, stomach and duodenal ulcers, and diarrhoea. Its laxative properties have been confirmed in well-controlled human trials [Cunnane, S.C.M. et al. 1995. Am. J. Clin. Nutr. 61:62]. The mucilage, abundant in the seed, is thought to be the active ingredient in such applications. Flaxseed oil is used in the treatment of skin conditions, such as eczema, acne, and skin dryness, and is also used in skin cleansers and liquid soaps. Flaxseed oil was also used in folk medicine for burn treatment (mixed with calcium oxide). A decade or so ago, SmithKline Beecham patented a cosmetic preparation based on flaxseed mucilage as a topical application for the skin or mucous membranes. They claim a very broad range of application, including use as artificial mucous and/or lubricant for the skin surface, the ocular, nasal, oral, vaginal, and anal cavities. The preparation may be used for treatment of dry-eye, xerostomia, and radiotherapy-induced secretory cell disorders.

the time of the Pharaohs to the present day. The people of India consume flaxseed oil in cooking, and the people of China also consume flaxseed domestically in the diet predominantly as oil. If all these ancient cultures have traditionally used flaxseed, why have the Europeans incorporated it less frequently into their diet? Can the answer to this question lie in the varied additives used to hasten drying properties of flaxseed oil for industrial use and hence the seed’s guilt by association? Owing to the oil’s ability to bind with oxygen to form a hard film, it is called a ‘drying oil’, which makes it of use in paints, varnishes, printing inks, brake linings and linoleum (oil of lin)! Boiled linseed oil dries more quickly than the cold-pressed oil because boiling partially oxidises the oil. This could, in the absence of comprehensive labelling, present a potential health hazard to the unwitting consumer. However, despite the interest from the health foods market, there are significant difficulties associated with processing traditional flaxseed to obtain a high quality oil for human consumption. Although processing and bottling steps now minimise exposure of the purified oil to heat and oxygen, the rapid rate of oxidation and rancidity on storage at room temperature means that the consumer has to take special precautions to avoid intake of an elevated level of peroxides. Linseed deteriorates much faster than other oils and, even when kept cool and tightly sealed, will lose its nutrients after four months. Light, air and high temperatures destroy its ALA very rapidly, and ideally linseed oil should be kept in the fridge and used within six weeks of opening. Ultimately, this problem will probably continue to restrict the market for bottled flaxseed oil but should not affect the use of encapsulated flaxseed oil by those choosing this product for health reasons.

Ingesting linseed oil - make sure it’s fresh! Linseed oil contains mainly Omega-3, and some Omega-6 and Omega-9 fatty acids. It is a rich natural source of the Omega-3 essential fatty acid alpha linolenic acid (ALA) which can, to a small extent, be converted by the body into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are the Omega-3 polyunsaturates found in fish oils. Flaxseed was used as a food by the Ancient Greeks and Romans. The Egyptians have consumed the oil in their traditional food from

You can contact Charles Wells at: Essentially Oils Limited 8-10 Mount Farm, Junction Road, Churchill, Chipping Norton, Oxfordshire OX7 6NP Email: sales@essentiallyoils.com Tel: +44 (0) 1608 659544 Fax: +44 (0) 1608 659566

February/March 2007 M|W

The Journey of Hands– working our way around the world of massage The eleventh stop on our world clock takes us to the North Eastern edge of Europe and the Baltic State of Estonia.

For over forty-five years the Baltic States of Estonia, Latvia and lithuania remained hidden from the world under the republic of the Soviet Union. Since their dramatic and successful bid for independence during the late 1980’s, each country has rediscovered its former culture, history and language. During the fifteen years since independence, Estonia has transformed itself into a dynamic western European country with a capital city, Tallinn. The number of spa tourists has been healthily growing year by year, but for Estonia, this type of visitor is certainly nothing new, Since the 1820’s, foreigners made their way to the western town of Haapsalu to ‘take the waters’ and dip in the mud baths. This thrived throughout the years and since the post-Soviet 1990’s other spa towns including Parnu and Kuressaare have risen in popularity.

Treatments

The Russian based techniques are still very popular including buckwheat massage that was featured in the June/July 2006 issue. The technique involves the use of cloth parcels containing buckwheat, combined with warmth and oils and used as a massage tool to bring relief, together with calming and cleansing properties. In its country of origin, it is used medically for many musculoskeletal disorders and even post-surgery. The massage therapy department is often the largest in hospitals and clinics because it is considered crucial to rehabilitation. The Eesti Massooride Uhing or Estonian Union of Masseurs has been established for several years now in order to self regulate and provide a network for the newly revived profession and Ullari Ots whose sports massage clinic is in the Olumpia Hotel, Tallinn is their Chairman. Eesti Massooride Uhing C/O Ullari Ots, Olumpia Hotel Rahumae tee 2/1-18, EE0034 Tallinn

They are generally divided into the beauty and health areas and are too many to list here. The common options on the clinical side are warm stone massage, hot paraffin treatments for joints and muscles, a salt chamber for improved breathing and cold chambers where the temperature drops to –140 degrees which is used in very small doses for specialised treatments. There is just about every kind of massage available that you can imagine and some such as chocolate massage that you cannot! February/March 2007 M|W

researchroomresearch An Introduction to Research The RCCM was founded in 1983 by a group of enthusiastic practitioners and researchers from both orthodox and complementary medicine. Their aim was to develop and extend the evidence base for complementary medicine in order to provide practitioners and their patients with information about the effectiveness of individual therapies and the treatment of specific conditions.

systematic way of gathering information and reaching an answer based on that information. It is worth remembering that research is only worthwhile if it gives useful information-positive or negative- which answers the original question to the satisfaction of researchers at large. For this to happen, the question must have been sensible and capable of being answered, the study must have been appropriate and powerful enough to answer the question.

What do researchers do?

What is research? To most people, the idea of research is 'intimidating'--it conjures up a complex and secret activity done on a grand scale in large institutions. In fact, it can be very simple and may involve nothing more than a therapist asking questions of his/her patients. Moreover, the question asked can be very down-to earth, such as whether cot deaths are reduced when babies are laid to sleep on their sides rather than on their backs. Formally, research is the activity of discovering things, supplying new information and increasing the understanding of the world. In medical or health services research, this includes a vast range of activities, from discovering ways to improve medical care and establishing new treatments, to monitoring the effect of changes to lifestyle and uncovering adverse effects of existing treatments. In essence the research method represents a

In essence, the researcher brings together, analyses and interprets information (data) in order to answer a research question. Thus, before starting an investigation a researcher has to be clear about the purpose of undertaking it. Table 1 shows the four basic areas of activity to which research is central: description, explanation, evidence-gathering and generalisation. It is worth noting that any one of these activities is not 'better' than the others: the one chosen depends on the question being asked. It is also worth saying what research cannot do: it cannot look for proof since it merely collects evidence for or against a hypothesis; and it cannot give an indubitable answer, merely the best evidence available at the time- future research will overturn the findings. Though the research method can be a superb way of moving medical knowledge forward, it is important to recognise that its just a method of investigation: like any other method it can be fraught with problems.

Table 1: What research can do

Purpose

Types of research study

Example

Describe the current situation

Descriptive studies (surveys of people or practice)

How many cancer patients have also tried homoeopathic remedies?

Look for an explanation for behaviour

Qualitative research (Interviews/surveys)

Why some cancer patients try current homoeopathic remedies?

Test a hypothesis based on a prediction

Quantitative research (Clinical trials and laboratory-based studies)

That classical homeopathy is more effective than single-remedy treatments for nausea.

Seek generalisations

Multi-centre trials and systematic reviews of controlled trials

Is classical homeopathy better than no treatment at all for hay fever?

M|W February/March 2007

researchroomresearch Table 2: Types of Research Study Study

Aim

Usefulness

Qualitative Research

Improve understanding (focus groups/interviews)

Starting point for further research

Case reports

Describe one case in detail

Useful when cases are rare or for side-effect monitoring but very limited value in defining causation

Surveys

Describe activity

Give snapshot of activity but subject to bias of sampling low response rates

Cohort studies

To assess the potential benefit of treatment intervention

Indicates treatment effectiveness but usefulness a limited by absence of control group

Clinical trials

To determine the specific efficacy of treatment

Give valid evidence of effect of treatment but expensive, intricate and time consuming

Systematic reviews

To collate results from many clinical trials to assess global efficacy

The most convincing form of evidence but only as good as the trials included

Table 2 shows the types of research study which can be carried out, and gives a brief indication of why each type is used. The differences between what each of these studies can do is perhaps best illustrated by an example. In the 18th century, a person with intermittent headache might take the ground up bark of a tree whenever a headache arrived. If the treatment seems to relieve headaches, she might recommend it to a friend: this story is an ANECDOTE. Before the 20th century almost all of medicine took the form of anecdotes, some of which had a basis in fact but most of which did not. The central problem is that, in a complex world, one report does not prove much. Later, when the value of recording begins to be instituted, an interested observer such as a local doctor might begin ground up bark to a variety of patients with headache. The result will be a number of CASE REPORTS documented by an independent observer, a CASE SERIES, which is more convincing than an anecdote on a scale of evidence. When it is later realised that the case series should be more rigidly defined, a COHORT STUDY might be instituted in which a group of very similar patients are given a properly specified dose of the 'active' substance which the bark contains. In this way, a group of patients with closely similar symptoms could be followed over time after a predefined course of treatment.

Though conclusions can now be more precisely drawn, because improvements might be due to other factors (e. g., headaches might go away of their own accord) a CLINICAL TRIAL, with at least a control and a treatment group, are necessary to discover the specific effect of the substance on headaches over and above these other factors. The most refined form of this is the RANDOMISED CONTROLLED TRIAL in which patients are randomly allocated to groups and the experimenters are blinded. If the true effect of the substance is relatively small, the results of a large number of RCTs will need to be pooled in a SYSTEMATIC REVIEW before this fact becomes convincingly apparent. Next issue we look at the details of types of studies and the factors involved in their success or failure info@rccm.org.uk © RCCM June 1999

February/March 2007 M|W

Rowers By Andrew La Bray

Before I decided on the topic I wanted to explore for my case history, I looked at various publications and spoke to several practitioners to get a sense of which area to focus on. As a health and fitness enthusiast, I was interested in how massage could benefit sports men or women who compete amateur or professionally. Having asked various health & fitness experts and acquaintances who compete in sports identify which clubs have therapy available, I was slightly surprised find that there is quite a few including Rugby, Athletics, Swimming, Basketball, Cricket etc. Within some sports clubs depending on if the sport is amateur or professional there can a variety sports therapies available including Physiotherapy, Sports Massage, bodywork, Reflexology and Shiatsu. My next step was to decide what I wanted to achieve from the project.

Aim To explore the benefits of massage on sports athletes

Objectives • To identify if massage can improve or contribute to better performance • To explore if massage can aid athletes in training sessions • To explore massage aiding athletes to better recovery post training/event

themselves came from different professions, with an age range form 21-48 years approximately. Their physical stature was quite amazing; they all seemed to be of height with broad shoulders and long legs. The members were also split in to teams of their abilities which were beginners, intermediates and advanced; this meant you could have different age ranges within teams but similar rowing abilities. The rowing racing seasons are split into 2, sprint season from May until August which involves 500 metres or 1000 meter races. The head race season starts from October until March, and is longer, from 4000 - 7000 meters.

• To explore massage helping minor injuries

Style and Technique

The Club

The number of persons in the boat is either 8 or 4, and they row in the sweep style. This style is two hands on one oar, producing higher stress on the arms and body, in an isolated repetitive movement, ultimately leading to injuries. Rowing is a combination of techniques, fitness and strength, with all these factors combined; there are some injuries more common than others. Particular areas of the body prone to problems are, back, shoulders and arms. Rowers are encouraged to warm up properly before getting into boats, because once on the river it is not a feasible option. This sport is extremely physical, and demands a lot of training and technique to perfect. There are a lot of demands on the body, which needs after care attention in order to keep in condition. I was in for a tough time!

A few days after ringing around a few sports clubs I had a conversation with one of my colleagues from work explaining to him my quest. It turned out that he once rowed for an amateur rowing club based in Hammersmith, London, and thought it may be good idea to give them a call and meet the rowers in order to see it they would be interested in taking part. Within a week I had made contact and set up a meeting with some of the rowers. It turned out the rowing club was an all male club, this was not necessarily a problem but I could already foresee a lot of hard work. The club had been competing for a few years and was quite established on the rowing circuit. The rowers

Client A

Client B

A 41 year old male with a healthy lifestyle, who has had shingles in the last six months and a slight neck problem he feels may be contributed to rowing. He trains 6 days out of 7 rowing, circuit training, cycling and sometimes running. Energy levels are good but he does get tired during a busy regatta season.

A 38 year old male with a healthy lifestyle, he has a supinated foot and suffers from hayfever. His weekly training program consists of 4 rowing sessions, 2-4 hours of rollerblading, 1-2 gym workouts and 1-2 circuit trainings. the client said his flexors and extensors get tight from rowing and needed attention. As with client A the first treatment was a full body relaxation massage with some focus on the forearms. He enjoyed the massage and felt it was of good standard. In subsequent weeks I focused on leg friction work and some back work. Sometimes I finished off massaging his feet. Client B developed a liking for his extensors to be massaged thoroughly and felt that much tension and build up of lactic acid was released.

The first treatment I gave an all over, relaxing body massage with attention to the neck area. The client felt his muscles were relaxed especially the extensors which are commonly fatigued post-rowing. As the treatment program progressed I focused on the upper back with some friction work some weeks and others the upper and lower legs. He particularly enjoyed the font of legs friction work.

Client C A 33 year old male with a healthy lifestyle, he has a slipped disc – L4 which has triggered the sciatic nerve, caused by rowing. He also suffered with asthma in his youth. Client C swims 2-3 times a week and performs floor exercises recommended by his physiotherapist every other day, for his lower lumbar region problem. The first treatment of a full body massage felt challenging with his medical history, plus the fact he is about 6ft 4” tall. I tended to concentrate on the lower lumbar region to complement the work of the physio. Some of the gluteus work was uncomfortable for him but he felt it would help him long term and wanted to continue. Client B was surprised that he was able to drift off in a state of relaxation even though he was sometimes in slight pain. Towards the end of the program I introduced upper back friction work and stretching of the scapula that he really enjoyed.

Client D A 44 year old male with a healthy lifestyle but low energy levels due to busy work and training schedules. He had slight nerve trouble in his lower back three years ago at broke his coccyx as a 17 year old but has nor problems presently connected to these two incidents. Client D would like use massage to help increase his flexibility, with a view to bettering his rowing performance. For the first treatment I applied a combination of effleurage, petrissage and kneading during a full body routine. Working on the lower legs, client D was surprised to realise how tender both his calves and forearms were and recognised that he needs to stretch both pre and post training. As the program moved forward, I used friction work on the lower leg and upper back and the client commented that he could feel looser in the upper back area. As with the others, he appreciated the extensors petrissage that released a build up of tension and lactic acid, a build up from rowing.

M|W February/March 2007

Conclusion This has been has been an interesting experience. Once I had got over the nervous part of meeting the rowers and introducing myself, I started to become more relaxed. Within the treatments I conducted, I was a little surprised to discover that some were not necessarily for sports injuries but related to the stress from busy day to day work schedules, or other areas of their lives. Some injuries were picked up from bad posture, as well as many hours spent in front of computers and work related. There were some themes in terms of injuries from rowing that came up. All complained about their Extensors being sore, this is a direct effect from rowing as one of their arms takes most of the weight distribution. During the treatments they all prompted me to massage their forearms, and all enjoyed the relief afterwards especially when they had their next training session. Another area they seemed to suffer from was tired and sore backs. All the rowers requested both lower and upper back friction work, which improved their flexibility as well as breaking down superficial adhesions that had built up. In particular a favourite of strokes was the scapula stretch, see-saw and rotation which improved their range when rowing. Another stroke they all enjoyed was corkscrewing up the erector spinae; the comments I received were about improved posture whilst rowing. Finally, they all enjoyed their iliac crest petrissage; this again improved range of movement and posture while on the river. Although I did not delve deep into the world of sports massage, I did however get a little experience of massaging athletes and treated their different problems and requests. My anatomy and physiology was sharpened in specific areas, imperative to treating the different injuries that can derive from sports. I have also seen the benefits of massage in prevention of injuries, as well as the day to day life of the rower.

Appendix Pocket Atlas of the Moving Body – Mel Cash A Massage Therapists Guide to pathology – Ruth Werner

faqs!faqs?faqs!faqs?

STUDENT Q&A

Let me introduce myself, I am Isabelle Hughes and will endeavour each month to answer all those questions that never seem to get answered or that you forgot to ask. You can write or email me at Massage World. Here is a selection of recent enquiries and their replies:

Q. Is there any difference between grapeseed oil in the supermarket or from a specialist supplier, I am curious as the price difference is around 4 times greater, is this due to volume sales or poorer quality? A. There is nothing wrong with using culinary grapeseed oil from your local store, you can get a cold pressed brand which is a little more expensive and lets face it, if it is good enough to ingest, it should be good enough for external use. Both types are refined and often have the same origins. As you correctly guessed, the volume purchases and power of the large stores reduces the price substantially, although grapeseed prices are increasing at the moment due to shortages which will ultimately also reflect in their prices. It is all a matter of taste as they say.

Q. I have a client who is a body builder, how often should I see them and how close to competition would you give a treatment? A. Massaging body builders may seem a gargantuan task but it is not that different to any other client, basic Swedish style massage perhaps with more pressure is sufficient. If you lower your couch slightly, you will be able to apply your own body weight more efficiently and effectively. Regular treatments will depend on your clients time and money availability, as for pre-event massage, there is a great section in Mel Cash’s book "Sport and Remedial Massage Therapy" that is worth a read. One bonus when treating body builders is the revision of your Anatomy and Physiology as all the muscles are so well defined!

Q. I have heard of Balinese massage but do not know what it involves or where I could get some information about it, can you help? A. Balinese massage is a combination of stretches, kneading and acupressure work using aromatherapy oils. It has same benefits as regular massage, plus it is believed to stimulate the flow of energy or Qi around the body. An ancient technique originating from the beautiful island of Bali that has its own unique culture. There is a training company in the UK called Indonesian Secrets if you want to find out more.

Q. Is Acne Rosacea classed as a contraindication to massage? I have a client who suffers from this when under stress.

Isabelle Hughes has been practising and teaching massage since 1989 and is also an external examiner for massage therapy. Drawing on her experience as an ante-natal teacher with the National Childbirth Trust, she currently runs workshops for practitioners on Massage for Pregnancy and Labour and has contributed to books on the subject.

A. Local irritable skin conditions are usually included under contraindications. Massage may irritate the condition further, it really depends on the medium you use and the technique applied. I would suggest avoiding the direct area until it has calmed down.

Q. Can receiving massage too regularly have an adverse effect? I have a client who visits two to three times a week and I am finding it difficult to bring him around after each session. A. I would even advocate a massage a day keeps the doctor away. Your massage obviously provides your client with the relaxation he requires but you may want to change your routine slightly, finishing with more stimulating strokes to ground him and bring him back to ‘reality’. If your client needs to return to work or to drive finish of with some tapotement strokes and then hold the feet for a few seconds before leaving him to recover. Some energetic thoughts may help too.

QA If you would like your questions answered, please send them by post or email to our address on page 3, marked Student Q&A.

February/March 2007 M|W

businesstools answer that phone

Answer That Phone How often do you phone a big company only to get an automated answering service? Irritating, isn’t it? Sadly it’s what we have come to expect from big business these days. But as a small firm or individual, you specialise in customer service, so how do you think your customers will feel when, instead of getting you, they get your answering machine? Worried? You should be. A recent survey of over 3,000 small and medium-sized businesses revealed that 69% of business callers hang up if they get through to an answering machine, and don’t ring back. Worse, 80% won’t phone again if they get a busy signal. But as the report says, up to a third of small to medium-sized enterprises are having problems answering every call that comes in. Not surprising when the average small business gets 15 calls a day.

Raised expectations Many is the one-person band like me whose business took off in the ‘80s thanks to the invention of the answering machine. Together with services such as BT’s Call Minder, which takes a message when you are busy on the phone and alerts you ten minutes later, they are a boon for freelances and small businesses, but they have their limitations. We’re all used to them now, and with familiarity, come intolerance. From your customer’s point of view, people prefer talking to other people, not an answering machine. But from your own economic point of view, your business just can’t support an extra full-time secretary to answer the phone. So how can you woo the customer to leave a message?

Automation to the rescue One way to deal with the problem is to refine your use of automation. It’s a boon when you’re working to be able to switch on voicemail so you can give an hour’s uninterrupted treatment. For a small business or individual, this can sometimes be the only way to do key tasks.

M|W February/March 2007

However, each time you do this, first record a personal outgoing message that gives as much current information as possible in order to reassure callers and encourage them to leave a message. If you ring Alastair Campbell, marketing manager of Voice Connect, and he’s busy or out of the office, this is the kind of message you’ll get: ‘Hello, it’s Friday 23rd November, this is AC, I’m in the office today but in a meeting till 11.30. Please leave me a message and I’ll reply as soon as I’m out of the meeting.’ He likens voicemail technology to the motorcar, ‘A wonderful thing if you use it the right way, but horrible if used the wrong way.’ Alastair encourages people to use the technology in a very proactive way in order to derive and pass on the maximum benefit. ‘Get into the habit of recording a new message when you come in for the day, and even during the day when you go out, he says. This way, callers will be more likely to respond because they’ll know: When you’re available; that it’s worth leaving a message; they can depend on an answer today or even within a couple of hours.

Calls that catch up with you Using the latest unified messaging service, you can even access calls from your fax or PC, or your mobile phone will beep to tell you that you ye got a message. You can have calls to your landline directed automatically to your mobile, and without even a telltale click to alert the caller that you are out of the office. Alternatively, if you aren’t going to be available, you can record a message for callers: ‘Please leave me a message and I’ll be notified immediately by text message’. No human message taker could match this for speed!

businesstools answer that phone

Service is a boost for business

Freeing up business people

Martin Curd of WPA National Healthcare is in no doubt that his business has grown, and will continue to grow, thanks to using a staffed answering service. He says cheerfully that he is "almost never in." but if a message comes it’s immediately texted out for a quick response. Martin maintains that after initial surprise at getting such a rapid response, customers have come to expect that this is what will happen whenever they leave messages. The more flexibility he builds into his answering service arrangements, for example by providing answering cover from 8am to 8pm, the more business expands as customers make use of the extra hours. He also points out that there is a noticeable and beneficial effect on people’s perception of your business. They notice that you are busy and staffed 12 hours a day and conclude, consciously or subconsciously, that you have plenty of business, and the experience and go-ahead attitude to handle it.

More text messaging than ever before is the order of the day. Many answering services will not only answer in the company name and take an important call for which they have been briefed, but patch a message through to anywhere in the world. This type of service is vital for the individual for whom doing business successfully means being out and about. The message is, don’t leave it to a machine to do the talking....

Useful Contacts BT Call Minder Tel: 0800 077 771

Voice Connect Web: www.voiceconnect.com

Armchair Answercall

Personal touch But a human message taker still has the edge, the personal touch. The sobering fact is that if you rely on automation, you’ll simply never know how many potential customers came up against your answering service and simply rang your competitors instead. A good compromise solution may be to use a call centre, but one specifically designed for the small business sectors. Neil Murphy of Armchair Answercall set up just such a call centre. His team takes incoming calls and handles the outgoing ones. When I rang on spec, the receptionist answered in a courteous and friendly way that is a world of difference from the ‘formulaservice’ you encounter when you are routed through one of the vast call centres used by big banks and insurance companies.

Web: www.armchairanswers.co.uk

AlldayPA Web: www.alldaypa.com

Kendlebell Web: www.kendlebell.co.uk

This article by Laura Pank was first published in Better Business No 91 Contact Email:

info@better-business.co.uk

Neil says that most call centres in the UK are cost-driven, paying employees by the number of calls handled. ‘This may work with large corporations, but the SME sector, where the average number of calls per day is around 15, need quality, not quantity. Small firms can’t afford to miss or upset even one potential business caller,’ he says. A similar service called AlldayPA offers call answering; call forwarding and ‘virtual’ secretarial services, including dictation. Charges for both call answering and secretarial services are per minute, with an addition for call forwarding to a landline and mobile. Kendlebell is an excellent service that is used to taking appointments for massage therapists and running an appointment diary. Each day they will feedback messages and your appointment list for the following day by whichever method you prefer, email, text or fax. You chose the level of service you require based on calls per month received.

February/March 2007 M|W

HEALTH PROFESSIONALS AND YOUR BUSINESSES

Pioneering insurance packages specifically designed for you

BALENS

Specialist Insurance Brokers

BALENS HEALTH PROFESSIONALS INSURANCE PACKAGES Offering you one of the widest Insurance covers available in the UK with competitive premiums to match!

Individual’s package Includes:-

Other packages available:-

» » » »

» Home Insurance – includes seeing your clients from home! » Therapy Room Contents / Surgeries Package » Commercial Businesses » Products Liability » Spas, Salons and gyms ...and many more

£4m/£6m Medical Malpractice £4m/£6m Professional Indemnity £4m/£6m Public & Products Liability £4m/£6m Liability for any one claim with an unlimited number of claims per year plus unlimited legal defence costs in addition » Taxation and Legal Package...& more

Balens are a 4th generation, ethical family business providing exclusive insurance schemes in the UK, Southern Ireland and Europe. Business Contents, Income Protection and Clinic packages also available. Balens are a one stop shop for all Insurance and Financial Service needs.

To view films from our 2012 and 2013 CPD Training Events please visit www.balens.co.uk/cpd

Telephone: 01684 893 006

Web: www.balens.co.uk Email: info@balens.co.uk Balens Ltd, 2, Nimrod House, Sandy’s Road, Malvern, WR14 1JJ are authorised and regulated by the Financial Conduct Authority

Caring for the carers

a weekend of learning FHT Annual Training Congress 19th and 20th July 2014

East Midlands Conference Centre, University of Nottingham Campus NG7 2RJ • Learn from industry expert speakers • Enjoy exhibition discounts • Drop-in for advice on membership, insurance, business and online • Attend a FREE yoga session • Stay at the brand new, eco-friendly Orchard Hotel - just next door.

Expert speakers include: John Brazier, Julie Duffy, Maggie Evans, Liz Hawkins, Jing Institute, Jane Johnson, Sally Kay and Peter Mackereth.

BOOK NOW at fht.org.uk/2014