Before & After.

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BeforeBefore the arrival of the client is one of the most underrated parts of being a Massage Therapist. 
There are many things you need to prepare before the client steps into your place of business. Just think of the worst case scenario and multiply it by two and that makes you be more aware of not becoming a procrastinator.

CancellationsUse a pencil when taking appointments, because some will cancel and then you can erase and have the spot open for another client. First thing you need to do is arrive at least 30-60 minutes before your time that your business is open or your first scheduled appointment. The reason for arriving early is so you can check for any cancellations; if there are any cancellations, you can free up your schedule and return phone calls of clients that might want to receive a massage today. 
Clients will leave a cancellation on the answering machine usually if they know they are canceling within a 24-hour period so they do not have to talk to you. Just make sure you leave them a message if they would like to make another appointment, because they might feel guilty that they canceled and never return to receive a massage from you again. Most places of business require at least a 24-hour notice, but some clients seem to forget that statement, emergencies, and problems do come up. It is up to you how to handle cancellations within a 24-hour period; some therapists only hold appointments with a credit card. Other therapists just let it slide, but the problem with that is some clients can take advantage of you leniency; the other thing you need to consider is that you are loosing money with them canceling. Some therapists give a warning and explain the consequences if they cancel again. If you have to cancel an appointment after 24-hour notice, give them a discount the next time they come in or give it to them free (If you do not follow the 24-hour cancellation policy, why should they). Give the client a call at home if he or she is 15 minutes late or more.
Open hoursAnswering the phone in a professional manner is the first impression over the phone. Make sure do not tell the client over the phone all the hours you have available, the reason is that if you have a lot of openings it may seem to them that you are not that good if you cannot be booked most of the time.
There are three different ways to explain your availability to the client:
*First is to ask them when they want to come in for a visit.
*Second is to only tell them a few openings.
*Third is to have them leave their name and number and I will get back to you (the client) as soon as an appointment opens up.

If you have a receptionist, they have to be kept up to date as to your schedule and educate them on the following; schedule back to back massages, do not give you a break during the time you are there and not asking the client to arrive 10-15 minutes early to fill out a health form. Blocking out time in your appointment book is a very good idea and it forces you to take a break.

Returning phone callsMake sure you have a caller I.D. and an answering machine at your place of business; sometimes it is hard to understand the phone number, they give you. When returning phone calls make sure you get their full name and a number, they will be available (In case you need to use one of the three C’s: Change/Cancel or Confirm their appointment). It is always a good idea to give a reminder call for a first time caller, but make sure you tell them that you will be calling to confirm their appointment. For the first time caller it will cut down on No-Shows and it will help weed out the problem clients. Always repeat the time at least twice to the first time client and ask them if they know how to get to your place of business. Also, explain the new client to arrive at least 15 minutes early to fill out a health form. One very important question to ask is what the reason for getting a massage is; many questions can come from this (Ex. I was in a car accident a today, I need to relax, or I have a gift certificate). It will help you better prepare for the client and help you think of more questions to ask, it will also help you determine if the client should receive a massage or not. 
Start an information card on the client so you can have some information on them when they come in for their appointment, what are they contacting you about, what is their physical complaint, who referred them? Always make sure you schedule 15-30 minutes in between massage sessions, the reason for that is so you have time for cleanup, checking messages, charting, getting ready for the next massage appointment and to see the current client out the door.

Room appearancePeople say: “First impressions make a lasting image.” Your area needs to be spotless and clean from clutter and make sure you vacuum before your first appointment or after your last appointment, it does not necessarily need to be done every day, but more is better. Clean all garbage cans, some clients want a garbage can near them while they are receiving a massage so they can throw Kleenex away when they are congested up or have a runny nose. Do not have the appointment book visible to the public and make sure all client files are properly placed in your business area (Confidentiality). When you arrive early, you can check to make sure you have enough supplies (Oil, clean sheets, change for the massages…). The temperature of the massage room should be 70-75 degrees and have extra blankets available for the client incase. The way to have you feel comfortable is to have a fan on the floor directing straight so it does not hit the client.

Self-appearanceSome therapists do not believe in a dress code and they want to be more close to nature with not wearing shoes or socks. It all depends what your clientele is and if you are working for someone to abide by his or her rules. The clothing you wear while giving a massage should be comfortable but respectable. Your clothes could make noise; so give a massage to a friend or relative to test them out (Wind breaker pants, certain shoes, corduroys…). Wearing perfume is not acceptable, because it could aggravate some people’s scent of smells and could trigger a migraine. Your nails should be cut short and nicely trimmed so that you do not cut or scratch a client. If you have long hair it might be a better idea to put your hair in a pony tail, so you are less likely to touch the client with your hair and less likely to keep moving your hair from your eyes. Take anything out of your pockets that could make noise (Change, keys, cell phone…). Massage therapists do sweat while giving massages, but the ones that sweat a little more should use a headband to make sure sweat does not touch the client (Sweat has a different temperature and the client will feel the difference). 

ARRIVAL OF THE CLIENT

IntroductionAlways introduce yourself and use their full name unless they specify otherwise. A handshake and eye contact explains a lot about a person. Make sure you have any new client fill out a health form, some places do not require a client to fill out one or even chart on them. It is many therapists opinion to have the client fill out a health form and to chart on them (Charting is very important, if anything it gives you that extra memory chip you need when you have not seen the client in a few weeks and hate asking all the same questions over again). Always ask questions out of the view and sound of other people (Confidentiality). Sometimes you might have to ask questions in the massage room to make it more private. Clients are more willing to explain in detail about there problems.

Going over the health formIt is always important to ask questions about what they filled out on the health form. There will be many times that you will find health problems about the person when they are on the table. The client sometimes does not understand the contraindications with massage. There will be times that clients do not check any of the health problems, many of the times they think because it happened so long ago it does not matter, but it does. Medications are the tricky part of the health form; you will see medication names that you never heard of. Always ask what they use their medications are used for and ask questions. Make sure you have “Referred by” on your health form, it will help you keep track with your advertising budget.

ExplanationsFor the first time client ask them the reason they are coming today and what type of treatment they would like (Make sure you can explain the different types of treatments you perform in more layman’s terms). Always with a first time client explain what to take off and what areas you massage, it is so important that the client knows what to expect (I usually show on my body what areas I work and what areas will be covered). After you are finished explaining what areas you massage ask them if any of those areas they would not like massaged (Most common areas not to be massaged are: stomach, glutes and adductors). Another point I would like to make is: if a client wants mostly a certain side or part of the body massaged, make sure you make a mental note of that or write it down. There has a time or two when the client states “do not massage my left arm” and then you are all turned around when they are in the prone position and then you end up massaging it anyways. It is always important to massage the majority of the body, so give them options. More and more therapists are not massaging the stomach, glutes, and adductors (Sometimes the therapist might think the client does not want those areas massaged or the therapist does not want those areas massaged on him or her and they relay it to the client). At least offer those areas, the client can sense if you feel uncomfortable with massaging those areas.

Pain questionsDo you want to make your job easier, well most of you will explain yes. The questions you ask the client can save time and frustration. If you ask the client where they think the headache is coming from and they say their left side of their neck, well you can start in that area to save time. Body posture evaluation is also a very valuable tool that very minimally used in the massage community. You can find out so much about a person on the way they stand, walk, and lift. If one side is higher than the other side, more than likely the contracted side needs more work.

In the massage roomMake sure you show the client were they can place their jewelry and clothes. A couple mistakes therapist’s make is to not explain to the client what direction to lie and they do not instruct the client to get under the sheets or towels. If you do not explain the client; they can lay on top of the sheets naked or be facing the other direction. If you start the client supine, make sure their head is not lying on the headrest, it is more difficult to access the neck, and the life expectancy of the headrest is cut short.

Pay before?If you have a problem remembering if the client paid you after the massage, it would be a good idea to have them pay before you start the massage and some clients prefer it because they are so relaxed, but some include the tip into the payment. Some therapists include sales tax into the massage and others have it extra (It is still work both ways but make sure you only pick one way).

ChartingA great time to start your charting is when the client is getting undressed; it usually takes a few minutes to get undressed. If you follow the SOAP Charting format, you can complete the “S” (Subjective). Some therapists will chart right in front of the client and some just take notes to transfer later onto their file.

DURING THE TREATMENT

PositionsDuring the massage is your time to shine. Everybody performs massage a little different and that is what makes us special. You can have the client start in a supine or prone position, but some 
therapists tell the client what position to be. The benefits for starting in the supine position is you 
can start with the face and not have to wash your hands after you are done massaging the feet and another benefit is the client is more likely to talk when supine and then they can relax more when they turn to the prone position. The benefit with starting the client in the prone position is that most clients want their back massaged the most, sometimes clients will just tell you to massage their back for the whole hour.

DrapingDraping is very important, if you do not feel confident with it, the client can pick that up. Some therapists want to tuck the sheet all the time and others just let it lay. If you are going to perform any stretching with your massage, tucking is the only way to drape. The trick of draping is to perform it in a reasonable period and do not expose any private areas or have the client feel air.

BolsterThe bolster is used to take tension of the hamstrings and low back region. When the client is in the supine position, the bolster should be placed under the knees. If the client is in the prone position, the bolster should be placed under the ankles. Always take the bolster out when turning the client, so the client does not get tangled up with it.

RoutineThe routine is probably the more difficult thing to master. There are so many options and you want to make sure all areas of the body have equal time being massaged. Some therapists will break it down to minutes for each part of the body, others will just massage, and it may equal an hour. The one main good reason for a routine is so that you do not forget a part of the body (When the client talks a lot, it is easier to get distracted). Some therapists even have a timer in the room to let the client know they are receiving the full hour. It would be a good idea to have a digital clock in the room but make sure it is out of the view of the client because some watch the clock. The client can get bored with the same techniques repeatedly, make sure you try to have a variety of the main five techniques and invent your own.

Table heightMeasure the table height with your shoulders relaxed and standing on the side of the table. The measurements you can use with you hand are: Palm (higher height), Knuckles (medium height), and Fingers (lower height). Other therapists just look at how many holes on the legs are open and measure it that way.
*If you have a larger client, lower the table.
*If you are going to perform a deep-tissue massage, lower the table.
*If you are going to give a relaxing massage, raise the table.
*If you have a smaller client, raise the table.

First touchStarting the massage is important because it is the first steps in letting the client trust you. A good way to start the massage is to either lay your hands on the client to get use to your touch or to massage the client’s body with the sheet on. It would be too shocking to the client if you started massaging right away, it does not let the client get use to your touch. When adding more oil to the clients body, always make sure you keep one hand on the client at all times (Some therapists do not agree with this statement, because they think the client and/or the therapist needs a rest). Others prefer to keep the rhythm of the massage with one hand, warm up the oil in the other hand, and gradually add the hand with the oil to the client’s body.

Starting the massageOne of the main rules with massage is to start out with light pressure, then gradually move deeper and then back to lighter pressure. The reason for starting out with lighter pressure is to warm the muscles before you start massaging them. It would send the client into a form of shock and it will be more difficult to use more pressure because the client is protecting their body from trauma. Effleurage is the main technique for applying oil or lotion onto the body; the gliding motions allow you to evenly disperse the oil throughout the body with rhythm. When massaging it is important to perform each technique, at least three times before moving on to another technique. The logic behind this theory is: the client starts to feel the technique, the second time they feel it more and the third time they really feel it.

Changing to a different body partWhen finishing with the right arm, therapists tend to use a lighter effleurage or nerve techniques to let the client know that I am (the therapist) done with the right arm and I will be moving to the left arm. When moving to the left arm, make sure you keep contact by keeping a hand on the client when moving to the other side or slightly nudging the table to let the client know you are still there. When starting the massage on the left arm, make sure you start slow with your massage techniques (You do not want to startle a client that is in and out of sleep).

Body mechanicsYou have probably heard the term “bend with your knees,” well the same holds true for giving a massage. Most of your pressure should come from your legs and not your shoulders and back. Try not to hyper-extend any part of your body. If you are performing any technique that involves pressure, try not to have a fast movement to it.

AFTER THE TREATMENT

FinishedA great way for the client to relax for a few more minutes is to lay a hot pack or some form of hydrotherapy on their back. Some therapists explain to the client when the massage is completed that they may rest for a few minutes. Also, explain to the client to sit up on the table for a minute or two and then slowly stand up.

Side effectsOne of the best feelings of a massage therapist is when the client gets up and walks out of the massage room; they seem so relaxed and calm. Meeting them right as they come out of the room gives you the chance to give them a glass of water and explain the benefits of water (Water helps to flush the toxins out of the body and hydrates the muscles). It is also a good time to explain the possible side effects that could happen (Headaches, soreness, dehydration and many others).

Continue with treatmentsOne of the main things massage therapists do not do is to recommend the client back on a regular basis, give them a treatment plan (1x wk / 4 wks = evaluation) and if anything try to get them to come back for a Maintenance massage (Every 4-6 weeks). The reason for the treatment plan is so you can be more aware of their problems and to see what works and what does not work; never use “High pressure selling techniques.” The reason behind maintenance treatments is for the client to be more aware of their body and to address problems before they become chronic. Ask the client what they liked in the treatment and what they would like changed for their next massage.

RecommendationsTherapists need to recommend things for the client to help himself or herself at home. We cannot recommend nutritional supplements or exercises. We can recommend hot or cold packs, mild stretches, and posture changes.

ChartingCharting can be finished while they are getting dressed or after they leave, but try to be outside the massage room when they leave the massage room. Try not to wait until the end of the day to chart on you massages you gave (Memory is very limited).

MoneyMake sure you collect the money, it sounds like a simple thing, but people forget. Some clients include the tip in the price of the massage, others will give you the tip, also they could leave it in the massage room (Always have the light on when cleaning your table) and others will never tip. Tips are great, but do not rely on them.

CleaningNow is your chance to clean the table, change the sheets and to run to the restroom. It works out very well when a new client is filling out a health form and then you can clean and tidy up. The sooner you wash your sheets, the better (Have your ever looked inside the cover of a washing machine, it says “No cooking oils”). Also, make sure there is no files lying around, sometimes you will go over their health history in the massage room and accidentally leave the health form in the massage room.