CE INSTITUTE LLC BLOG

by Sandy Fritz

Currently the business of massage therapy along with many other occupations is adapting to find a way to move forward. The down time from the pandemic allowed for reflection.

Unfortunately, employers of all types are finding it hard to find quality employees that understand the dynamics of business balance. There is a cap on what a business owner can charge for services and products limiting business income.

Employees want higher income. The ratio for a sustainable business is wages being no more than 35-40% of gross business income.

The business owner has to cover wages for non-income producing employees such as receptionists and all payroll taxes and any benefits within the wage allotments.

When massage therapists ask for 50% + of the service fee, the business owner will not be able to maintain business viability. The business owner should be making 10% of business gross in profit. Many are using the profit to pay wages.

Business owners will not continue to work for nothing forever. This is just economics. Given this situation, unless the business owner is planning a larger business with multiple income streams and multiple therapists and services, I do not recommend that massage therapists in small practices become employers. You will make more income with less headaches maximizing your own solo practice in a small one-person space.

For those with larger facilities it is becoming common to rent space to solo practitioners. DO NOT DO THE INDEPENDENT CONTRACTOR THING. Become a landlord. You can rent space in many ways from by the day to long term lease.

Rent for space varies based on demographics but make sure you charge enough to cover your costs and make a profit. DO NOT RENT BY PERCENT OF FEES. Charge a fair but profitable rental fee. A landlord can control the facility, but not the renter.

Shared space can be tricky when there is a common lobby, reception and restrooms. If a common receptionist is used that is a fee over and above the space rental. I don’t recommend this. It gets messy and a solo massage therapist can now run a business on a smartphone or tablet.

Do not take money from clients. The money exchange is between client and solo massage therapists. The massage therapist pays you rent.

Do not provide supplies such as linens. Only provide basic equipment such as a massage table in the treatment area and only if renting by the hour, day or week.

Long term renters should provide their own equipment. Make sure the lease clearly defines facility use requirements such as when the building is open, noise and odor levels etc.

Also, eviction can be messy as well. Be prepared. Expect turnover. Being a solo practitioner is much harder than people think and until a solid retention client base is built, the income is not what most expect and the massage therapist often finds themselves over extended.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

by Sandy Fritz

Understanding the client's history, medical conditions, past and present injuries and so forth are most relevant for understanding what NOT to do instead of what to "fix".

Also remember that many clients have goals for massage that have very little to do with their "conditions".

Remember to ask, " What is the outcome for you today?"

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

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Sandy Fritz a well renowned massage therapist with more than 35 years of experience. She dedicates her time to writing massage texts for Mosby Publishing (Elsevier), educating, consulting, teaching, and providing massage to a mixed clientele. You can view or purchase Sandy's textbooks at: https://www.us.elsevierhealth.com/catalogsearch/result/?filter_multi_product_type=&q=sandy+fritz

Disclaimer: The opinions expressed in this blog are those of the author. They do not purport to reflect the views or opinions of CE Institute LLC.

#massage #manualtherapy #manualtherapist #LMT #bodywork #bodyworker #massagetherapy #scopeofpractice #certification #learning #education #health #wellness #goals #communication

by Sandy Fritz

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Sandy Fritz a well renowned massage therapist with more than 35 years of experience. She dedicates her time to writing massage texts for Mosby Publishing (Elsevier), educating, consulting, teaching, and providing massage to a mixed clientele. You can view or purchase Sandy's textbooks at: https://www.us.elsevierhealth.com/catalogsearch/result/?filter_multi_product_type=&q=sandy+fritz

Disclaimer: The opinions expressed in this blog are those of the author. They do not purport to reflect the views or opinions of CE Institute LLC.

#massage #manualtherapy #manualtherapist #LMT #bodywork #bodyworker #massagetherapy #scopeofpractice #certification #learning #education #health #wellness

by Sandy Fritz

Massage is one form of manual therapy. Massage Therapy can be considered a manual therapy specialization.

In the health and wellness sector, massage therapy can be a stand-alone approach to support wellbeing and self-care prevention and management of stress and stress related issues massage can be an autonomous practice. When dysfunction and pathology is present, massage therapy, within the broader manual therapy spectrum, is indicated within interdisciplinary medical care.

Scope of practice respect and violation needs consideration. In an interdisciplinary team, the professional with the broadest scope of practice and the most education required for entry level practice would be responsible for the plan of care and delegation of portions of the treatment plan to the specialists within the team. Remember, massage is the massage therapist's specialization.

The various occupations using similar manual therapy methods need to determine who is best to perform the assessment and specific intervention and refer if another professional is more specifically trained and experienced. For example, in a health and wellness setting a massage therapist may incorporate aspects of fluid movement (example: lymphatic focus), BUT this same method would be out of scope for a massage therapist if pathology exists unless part of an interdisciplinary team and delegated to perform the method.

Another example: In a general massage session a massage therapist can incorporate safe stretching methods BUT in a sport and fitness setting the athletic trainer is better trained and should be professional providing stretching as an intervention.

It is ok to learn and augment massage therapy with other manual therapy approaches so long as scope of practice is respected. And the manual therapy methods other than massage SHOULD NOT replace massage as the primary approach used by massage therapists.

If you want to call yourself a "manual therapist" and you are working under a massage therapy license and scope of practice, I would suggest that there is an ethical concern.

If you want to practice autonomously as a manual therapist, but do not want to practice massage therapy, then maybe actually committing to the academic training to become a physical therapist, chiropractor, or osteopathic physician is the ethical thing to do or practice massage therapy as part of an interdisciplinary team.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

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Sandy Fritz a well renowned massage therapist with more than 35 years of experience. She dedicates her time to writing massage texts for Mosby Publishing (Elsevier), educating, consulting, teaching, and providing massage to a mixed clientele. You can view or purchase Sandy's textbooks at: https://www.us.elsevierhealth.com/catalogsearch/result/?filter_multi_product_type=&q=sandy+fritz

Disclaimer: The opinions expressed in this blog are those of the author. They do not purport to reflect the views or opinions of CE Institute LLC.

#massage #manualtherapy #manualtherapist #LMT #bodywork #bodyworker #massagetherapy #scopeofpractice #ethics #massageethics #health #wellness

by Selena Belisle, Founder/Instructor, CE Institute LLC

Evidence Informed Massage Practices

LMTs can share research and evidence to support the validity of massage work on websites or with clients, such as Swedish massage can be used to treat headaches.  That in-part is of an evidence-informed practice when you have that research.

Evidence-Based Massage Practices

Using the actual hands-on massage protocol itself, from the research for any type of beneficial outcome, creates an evidence-based massage practice. 

Massage-related Research which includes Machine, Equipment or Product Use

Some massage-related studies use machines, equipment and products because their manufacturers usually have larger budgets to produce research, to demonstrate efficacy for sales.

Practicing massage with manufactured items would require additional information and/or training for manufactured item use and more considerations beyond anything discussed in this article.

Other Variables

There are other variables and considerations that can be applied to define evidence-based and evidence-informed practices.  These two explained above are simplified examples for evidenced massage therapy practices.

Practicing Evidence-Informed and Evidence-Based Massage
Sometimes a massage instructor will collect published research study data and provide the information in a neat, consolidated presentation.  And there are plentiful industry trade articles available free of charge for LMTs to learn more about research terms and language, on their own.

In Summary

We hope this brief summary helps clarify the difference between evidence-based and evidence-informed massage.  You can this and more by registering for training with us at:  https://ceinstitute.com/

by Selena Belisle, Founder/Instructor of CE Institute LLC

All CE Institute LLC hands-on classes are taught from an evidence informed and evidence-based stance.  It is important to practice from evidence and research to validate the work itself.

Here are some tips for practicing massage from evidence:

Seek Large Sample Size Research Studies for Use

When using researched protocols for hands-on practice, one recommendation is to review studies with large subject numbers. Following hands-on protocols that are provided to a large control group is preferred to using something practiced in a single case study.

Unfortunately, usually due to budgetary constraints, most massage studies are researched with exceedingly small subject numbers. However, in research, there are other studies called a meta-analysis and systematic reviews. These can collect similar massage studies, regardless of size, to review their data in totality to provide a broader and enhanced picture of results and outcomes from similar studies.

Finding Massage-Related Research

There are thousands of massage-related published studies with valuable information that can be used to improve massage efficacy, notably when using resources such as pubmed.gov. Unfortunately, there are still many massage topics that have not been studied or published yet, and when they are published, they might not provide the specific information you are seeking given there are millions of possible variables.

Do not let this information process frustrate you. Instead, we should all be grateful. There is a massive amount of available information, only seconds away at the stroke of a keyboard, which provides incredible and increasing access for evidence-based practices.

Sometimes you will find rare or unknown information while reviewing research because foreign published studies often fail regular massage keyword searches from language translations. Research can be a lot of fun, but it can also take a lot of time and practice to become efficient in finding what you need, if it is published.

I have spent decades scouring massage-related studies in both journals and online. Seeking usable researched hands-on protocols for evidence-based massage training can be long and hard work. However, it is always worth it when you learn something new.

What to do if a client is not Benefiting from Massage

Sometimes clients may not benefit from massage at all, regardless of research, training, protocols used or hands-on work. Every available method in your bodywork arsenal may not work! If or when this happens, the client could be suffering with an undetected underlying disease causing whatever prompted their reason to schedule their massage appointments.

Massage therapist should refer their client back to their doctor for further medical recommendations when the client is not reasonably achieving mutually agreed massage goals.

How to Learn which Massage Studies are Considered Better Quality

There are many industry trade magazine articles that provide language of how to read or interpret a research study.  LMTs can learn much of the language interpretation on their own with these magazines.

We now spend twelve hours teaching about this and more in an evidence-based massage CE course, so there are various opportunities available for practitioners to learn more about how to use research to establish an evidence-based massage.  You can this and more by registering for training with us at:  https://ceinstitute.com/

by Selena Belisle, Founder/Instructor, CE Institute LLC

Massage sheets are supposed to cover a client for warmth, modesty and protection.  Massage draping is provided to prevent nudity, excessive exposure and demonstrate a clear and professional line between a massage therapist and client.  There is no excuse to provide excess nudity in a professional massage therapy session when the draping itself is supposed to be a physical barrier to prevent it.

Massage Clients Who Do Not Want Any Massage Draping

So what should massage therapists do when a client doesn't want to be draped or use a sheet to cover themselves.  Massage therapists and bodyworkers should simply explain to the client that the draping is required as a professional standard and that the service cannot proceed without.

If the client requests to remove their drape after the massage has started, repeat the standard that it is required or that you can terminate the service if the client does not want to be professionally draped.

How to Drape When it's Too Hot

Women who are experiencing hot flashes, or any client who's overly warm can expose their feet, legs and arms to minimize the draping or heat, but removing the draping or using a hand towel should never be an option. 

An NFL Player Who Wanted Only Minimal Massage Draping

Recently, there were several massage therapists who publicly complained about an NFL player who only wanted to use a hand towel to drape himself, and he exposed himself to the therapists as well by removing the hand towel.  This is unacceptable behavior on the behalf of the client.  More so, the practitioner should have never started the service with just a hand towel over a client's genitals.

When a client is draped minimally with a hand towel, there is a larger chance that they could expose themselves, whether it was intentional or not.

A Doctor's Office Experience with Draping

Think about when you go to the doctor's office.  Your annual physical might be a lot more violating than a massage!  But what does the doctor's office provide you for your invasive exam?  Most clients are regularly provided a full paper gown and sometimes even a paper sheet to place on top of your paper gown.  

Doctor's could provide paper panties or a small paper towel if that was professional, but it's not.  It would be cheaper to give out paper panties or a paper towel but they don't.  So why would a massage therapist think it is acceptable for a client to drape themselves with a hand towel when this standard is not practiced anywhere in modern day medicine?  

Unacceptable Massage Draping Practice Standards

The NFL player who insisted on only using a hand towel and exposed himself to unsuspecting therapists stated he was allowed to do this with other therapists.  And indeed he was.  There were massage therapists that spoke up on his behalf, saying they were fine in just using a hand towel.  In our opinion, this is an unacceptable standard and practice.  Massage therapists need to provide more than a hand towel to provide comfort, warmth, protection and professionalism.

Very large bath sheet towels are acceptable to use as a massage drape.  A hand towel is not.  Remember, draping is to prevent excess nudity, so proper and professional draping should be practiced at all times. 

Draping for a Professional Massage Therapy Session

Draping is provided for professional reasoning.  Draping is not a suggestion, nor is it a client dictated protocol.  Massage therapists must execute and reliably practice professional draping standards at all times if they want to be seen as massage professionals.

Professional massage therapy draping with a sheet or very large towel should always cover the buttocks, genitalia and the client's chest area.  The draping should be large enough to cover the entire client if so desired.

Therapists should only undrape the area that they are working on, and that area should be immediately draped and covered again, once the work has concluded in that area.

The Only Time a Hand Towel Could be Incorporated Into Professional Draping Practices

Practitioners may use a hand towel to work on a client's abdomen when a client is lying in supine position on the treatment table.  The hand towel would usually be folded in half long-ways or horizontally, depending on the amount of coverage required.  Then the hand towel would cover the client's breast area as the top draping sheet is lowered to expose the abdomen.  At no time should the client's breast area be exposed during this draping practice.

Massage therapists should seek additional training if they do not know how to use a second drape such as a hand towel to cover a client's breast while exposing the abdomen.

Business Standards with Draping

Massage therapists can incorporate a draping policy within their massage therapy or bodywork practice.  Adding a draping policy will help provide a standard that can be shared with clients if or when they are demanding something different.  

Preplanning ahead of time by creating a standard draping policy could help a therapist prevent an awkward situation by simply falling back on the policy. Therapists can always state they are simply following company policies whenever a client wishes for different draping, especially if it feels like the request is for nefarious purposes.  Citing a company policy may feel less confrontational or less uncomfortable than telling the client no for other reasons.

If a client continually requests less draping, simply inform them that they are requesting you to violate a company policy, which cannot be done.  The only action you have beyond breaking the company policy is to either proceed with the service in accordance with your policies, or to provide no service at all because their request cannot be provided within the company's policies.

In addition to adding a draping policy to your website, a practitioner could also print their draping policy on any standard client intake form or paperwork.  Having a standard preprinted policy in writing where it is accessible to the client may help prevent clients from approaching your business for something different than what is professionally practiced.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

#massage #draping #massagetherapy #massagetherapist #manualtherapy #bodywork #bodyworker #cosmetology #sportsmassage #massagebusiness #massagepractices #LMT 

Massage as a Health Care Service

Many massage therapists and bodyworkers view their work as health care practice, and tipping is not normal in most medical settings.  To start, we should be clear that massage therapy is health care.  In fact, massage can be used in both preventative and rehabilitative health care management which doubles its viable application. Even if a client schedules a massage on vacation for enjoyment purposes, the increased circulation and other healthy therapeutic benefits achieved in massage practice cannot be avoided.  Massage provides health care by almost any basic standard.

To answer the question of accepting tips, ask yourself:  do you consider your massage to be health care or service?  Most massage therapists will find it is both.  This places massage in two separate categories where tipping is accepted in service but not practiced in health care. This is what creates the dilemma.  How does a practitioner navigate tipping practices and policies when they simultaneously operate in two opposite worlds?

Is Your Massage Straight-up Health Care? Or is it Health Care Service?

Here’s an example of massage practiced as health care without a service-oriented approach: working in a medical setting where the practitioner applies therapeutic touch to achieve the best health outcome, at a health care office, weekdays only, Monday through Friday, between 9 am to 5 pm, during normal business hours.

A large element of service can be extracted from massage health care practice.  I am not suggesting that anyone should extract their service element but it can be done.  And it is your service element that should be considered if you are questioning whether or not you should accept tips, because it’s the service industry where tipping is normally accepted and practiced.  Providing a service element with your massage is commonly accepted and expected as an American standard. 

What Massage Looks Like When it is Executed with Service

Massage therapy service standards usually place a client's personal wishes and directions first. That in itself is service. And it’s the service industry where gratuities are normally exchanged. Accepting gratuities does not make you any less of a health care provider.  Its simply acknowledging that you are providing a high level of service with your health care.  

The following are some questions to help determine the level of massage therapy service provided. The more you answer yes to these questions, the greater level of service you are likely providing with your massage:

• Do you often work outside of regular business hours, sometimes providing appointments as late as 7 pm or later at night or on weekends, giving up valuable personal time with your friends and family to serve your customers' wishes and needs?
• Do you accommodate last minute emergencies, making a choice to cancel your plans to care for someone else's?  Massage therapists often serve their client's needs first because they recognize that their client reciprocally pays for their plans.
• Have you worked in temperatures or spaces that you would not find comfortable, to keep a client comfortable?
• Have you hauled massage stones or acquired other equipment to provide better service without charging extra for it?
• Do you offer a client a choice of working with oil, lotion, gel, cream, aromatherapy or anything else they desire?
• Do you provide whatever type of appointment a client wishes over the type of bodywork that you would prefer for that client?

These questions have been provided to help inspire thoughts to create your own tipping policies. Now ask yourself, does your massage practice lean towards a high level of service? Or is it a straight-up health care operation with normal weekday business hours and best medical objectives practiced at all times? 

Do No Harm While Providing Massage Service

All forms of massage are generally healthy, so there's usually no harm unless your client is asking you to burn them with rocks or apply more pressure than they can tolerate or lie prone and flat on the table while nine months pregnant.  As long as you’re practicing within normal service standards, there’s little harm that can be achieved through quality therapeutic massage or bodywork.

While its difficult to do harm with proper practice, there are many times that massage therapists do less satisfying work, not from our own volition but because of our client’s choices, and because we regularly provide our massage appointments as a service-oriented business.

Providing Massage Service Instead of Practicing for Best Medical Outcomes

There are times that a client does not want to receive the bodywork that I believe would be in their best medical interest, such as deep cross fiber friction to break-down scar tissue.  Instead, some of my clients have preferred a good foot rub or nice oily back massage.  All of this is health care, but I feel like I am providing more service-oriented treatment when I practice what the client wants instead of fulfilling what I think would be best for their medical needs. 

Of course, best medical outcomes with massage therapy could be highly subjective.  For example, some clients would prefer a nice relaxing generic full body Swedish massage when they are in pain because of their bad posture.  It would probably be best to try to improve their posture with more technical bodywork, but instead the client has chosen a different form of massage to temporarily mask or relieve their pain. 

Most of the time I would prefer to work for best medical outcomes that can be achieved with highly technical bodywork, but to provide the best service, I'll explain my bodywork recommendations, and then I'll let the client choose whatever type of massage they would like to receive.  That is providing a service.

Accepting Tips for Massage Therapy Health Care Service

My clients have recognized the many selfless contributions I have made to provide them exceptional health care service and they appreciate it. One of the ways they show their appreciation is through gratuities. And yes, I accept them, graciously.  I appreciate them.  Their tips are one of the rewards I receive for a lot of selfless work that could be easier or more rewarding, but sometimes it is not. 

I answered yes to the list of questions above, often working outside of regular business hours, following a client’s requests at all times I can reasonably provide them, and as long as I do no harm with their service directions. Their gratuity seems like a fair exchange to compensate me for my level of provision and service.

Setting Your Own Tipping Policies

Tipping policies are a personal decision that each therapist must make for themselves. There is no massage industry tipping standard nor should there be. If you work for an employer, hopefully your attitude regarding tipping matches theirs.  And just know that there is no wrong or right answer about accepting tips.  This is a personal decision that must be made in a manner that aligns with your practice and best serves you.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

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This article is written by Selena Belisle, the founder and one of the instructors at CE Institute LLC in Miami, Florida.  There, they teach massage, nursing and cosmetology industry CE courses. Selena has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.

#massage #bodywork #bodyworker #massage #massagetherapist #mt #LMT #tip #tips #gratuitites #massagebusiness #massageservice #healthcare #medical #medicalcare #serviceindustry #tipping