When you massage the glutes....

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NewHorizon
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Post by NewHorizon » Tue Jun 06, 2006 6:26 pm

janalta wrote:It's amazing how every school seems to teach their students so differently !
Judging from the posts, it seems to be more of a US vs. Canadian (or also from the 'older way' of training thing)- here in Ontario we are taught the same as you in Alberta. Some of the suggestions here are great, but I am glad we are taught this way-"covers" all points!!
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Post by fudja / aka Greatlakes » Tue Jun 06, 2006 6:56 pm

Just got back from a Migraine and other headaches seminar. WOW

The instructor told us that tight glutes can trigger migraines!! Reason being, because a tight glute can put a diagnal pull on the opposite side of the body, works its way to the lower traps, works it's way up to the upper traps and BAM!! Migraine trigger!! Can also cause tension headaches.

He has me rethinking glute work!! He asked the group if we knew what the "caring stroke" was. Thirty people in the room, and no one knew!! He told us it is a basic swedish stroke and that most schools fail to teach it for fear of law suits. Damn, it is like icing on a cake!!

For those of you who do not know what it is, let me explain. The client is prone, fully undressed under the drape. The back is exposed, a leg, and one glute is fully uncovered. Be sure to cover the glutial cleft!! One long stroke all the way down by the foot all the way up to the neck!! I was shell shocked by this one!! It must feel grand to be the recieiver of such a massage stroke!!

I am seriously concidering doing a newsletter on draping and how benificial massaging the glutes directly can be.

Christine

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Post by renauddv » Wed Jun 07, 2006 5:21 am

More of a description please...

Sounds similar to what I've seen in Lomi Lomi, and in Shiatsu I do diagonal stretches... one hand on opposite scapula, on hand diagonal to lateral on glute along with point pressures over the insertion.
On the table doing Swedish, I do a long stroke that starts with both hands on the glute, and progresses with slow pressure in opposite directions. One hand up through the lumbar region, one hand down to the back of leg, grasping and applying pressure down the biceps femoris.

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Sherry Dudik
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Post by Sherry Dudik » Mon Nov 06, 2006 9:56 am

Hey, GreatttLakes!

I know this was in an older post, but could you give a slightly more detailed description of the "caring stroke" you learned in the migraine/headaches workshop?

Is it one-handed or two-handed? Do you start at the feet and go up to the neck or vice verse? Could you do it going both up and down? I have quite a few headache sufferers as clients and though they have all improved incredibly, I think this would be a wonderful technique to add!

Thanks! Always look forward to your posts! :)

Sherry
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Post by fudja / aka Greatlakes » Mon Nov 06, 2006 10:24 am

Hi Sherry,

When he showed us the "caring stroke," he wasnt teaching us a headache stroke. He was just commenting on a basic stroke that isnt taught much in schools any longer because of law suits. He was going off on a tangent.

But anyway, here is how the stroke was performed.

While the client is face down, the sheet was on the client so that only one leg and one glute was covered. The full back and one glute and same leg was totally uncovered. The stroke starts at the foot and follows up the leg, over the glute, and onto the back. You can do this stroke in one fell swoop, or slowly work your way up, doubling up on strokes, working the insides and outsides of the leg as you work your way up.

Hope that helps.

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Sherry Dudik
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Post by Sherry Dudik » Mon Nov 06, 2006 3:45 pm

Thanks, Greatttlakes!

That explains it perfectly.

Just out of curiosity, why would they be concerned over lawsuits with this particular stroke? Am I missing something here??? :oops:

Sherry
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Post by fudja / aka Greatlakes » Tue Nov 07, 2006 5:12 am

Sherry,

The instructor claimed it was because it is such an exposed stroke. That it leaves to much uncovered for the average american. I usually warn clients before I do this particular stroke and I have never performed it on a male client.

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Post by jasond » Tue Nov 07, 2006 9:15 am

Great discussion I've got a lot from reading everything. The discussion has focused on how the client feels assuming that the therapist feels good about working glutes. But I think their are quite a few therapists for whatever reason who just don't feel comfortable working the glutes. Its amazing.

I think our comfort level on working a bodypart comes through to the client. If you feel uncomfortable working the upper pecs, well guess what its going to come through that way to the client. Same with the glutes.

Thats why its important for bodyworkers to get regular massage to help us feel more comfortable with our own bodies and the techniques we use.

Jason

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Re: When you massage the glutes....

Post by NC_kneader » Sun Jun 15, 2008 9:32 am

karminstant wrote:...then tell them to lower their underwear halfway...
So what have been your experiences?
This happened to me as a client, just a week or so into massage class and I found it a very awkward and embarrassing maneuver to accomplish lying prone. I would never ask a client to do it.

The massage was done by a professional with many years experience. At the time I went along with it, even though it felt like a breach of my boundaries. After a bit of schooling, realized that it was because of the fact that I was in a parasympathetic altered state that I complied with the request.

As a MT? yes, I ask in advance as part of the informed consent process. When a client is aware of work needed in that area, s/he usually removes the underwear; if not, I work through the drape.

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Post by GreenDragonfly » Sun Jun 15, 2008 12:50 pm

These posts are awesome!

All the different perspectives and scenarios.. I love it!

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Post by ALMT » Wed Oct 22, 2008 4:26 pm

Regarding the "caring stroke" ... I didn't learn anything like it in school, but during the only professional massage I had while I was *in* school the therapist did a similar stroke on me, only using Myofascial Release. He started at my shoulder and sunk into the fascia, then did a very long, slow stroke all the way down to my ankle, then redraped and switched sides. It was a revelation. I've used this as a myofascial stroke on the occasional client (male and female), always someone I've worked on before. Everyone has loved it!
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speaking of draping

Post by eyesofblue » Thu Oct 23, 2008 9:15 am

does anyone know of any good videos that show different draping techniques? it would be great to actually "see" how people drape. I learned to undrape the glutes similar to the OP except for the asking of lowering the underwear, but it never feels quite right and I'd like to see some alternatives

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Post by NJHands » Wed Oct 29, 2008 3:42 pm

I would reiterate what some have already expressed here. First and foremost, it seems (honestly, I'm trying to be diplomatic here but trying to share as one professional to another), aghastly UNprofessional to ask someone to "lower their underwear!"...ACK!...I would vehemently say no since, if I decided to keep my underwear on, I would expect the therapist to respect that boundary.

Further, at the BEGINNING (yes, at the beginning) of the massage session, during the INTAKE, a professional therapist should ALWAYS inquire as to the various features that would be included in that massage session. One of those critical questions should include, 'what areas would the client like to have focused on,' AND 'are there any areas that the client would not like to have massaged...for example face, gluts...?" (I say this because there are a good amount of clients that prefer their face not to be massaged and its simply considerate and professional to ask these things in advance). Imagine (I'm trying to make an analogy here) if you went to a physician's office and did a personal exam and never told you what you should expect during that exam?...ahem...that's what I equate it with...

This would eliminate any further issues and I always include gluts and oftentimes (it seems like there's a lot these days) both men and women keep their underwear on...I simply work through the sheets and honestly, you can get a better hook that way anyway. Intention, sensitivity, directness and confidence will always assure your client while they are on your table, that you know what you are doing. If you feel nervous or afraid, I wouldn't want anyone working on me that way...been there done that...don't want to do it again. :) 8)
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Post by JasonE » Wed Oct 29, 2008 10:06 pm

If a waist-band is in the way, I gently inquire, "May I move this an inch or so?" So far everyone has given me permission, without any weird vibes. I tuck the sheet into their waist band and slide it slightly out of the way.

People that feel more comfy in their undies don't always have an aversion to letting you work the area. Sometimes their undies just cover more territory than they are actually concerned about.
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Post by NJHands » Thu Oct 30, 2008 7:18 am

just from my perspective, I don't like any therapist taking the liberty of tucking sheets into my underwear...it is a liberty...and simply again. not entirely professional. I've actually stopped a therapist from doing so...just not appropriate...a line of demarcation is a boundary and though many clients will not say so, its one of those 'minor' things that will keep them from coming back to you since another therapist will respect that boundary. Again, this comes from 'communication' (as another therapist so aptly put it), IN ADVANCE of the massage session to find out those things in the intake...I feel that its simply respecting my clientele and they truly do appreciate it.
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Post by shivashiva » Thu Oct 30, 2008 7:26 am

I do the same as JasonE and have had the same experience. A lot of people wear those "granny" underwear that come up to cover most of their QL. To me that is taking away about 1/3 of the crucial area of the back to work. I say "Can we move these underwear down an inch or two so that I can reach the tailbone area?" This is always done in the first 5 minutes of the massage, so the person is not in that completely relaxed state yet. If they are a new client, or appear nervous before getting on the table, or request lower back work, I will explain this to them before they get on the table. In none of these scenarios have I ever gotten a weird vibe.

I don't ask them to move their underwear to work the GLUTE area. I do that with my elbow, through the sheet if they keep their underwear on.
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Post by EgoMagickian » Thu Oct 30, 2008 4:13 pm

I don't ask them to move their underwear to work the GLUTE area. I do that with my elbow, through the sheet if they keep their underwear on.

Yup, this is my M.O. as well.

I'm not sure why there's such diversity of approaches to teaching glutes... although I know I completely melted down at school the first time I had to practice sidelying glutes outside of class... the female practice subject who I didn't know very well left her underwear on, and I had NO idea how to handle it/proceed.

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Post by tranquilspirit2006 » Sun Nov 02, 2008 7:45 pm

I guess it's just me but I pretty much leave undergarments right where they are when I'm working on a client. I figure they've left them on for a reason and I will just work around or over it to the best of my ability. I have an older lady who was a victim of some horrible sexual abuse as a child (by her parents). It was a HUGE step for her to come get any kind of bodywork as she has disassociated from her body. I feel highly honored that she comes to me and I respect her boundaries. She wears very high waisted undies and keeps her bra on - she was very anxious about possibly having to remove it and I assured her that she could keep on whatever she wanted and I would work around it. Now to be honest, I hate working around bras and I don't have as much open back area to work on her as I would like. But I will not ask her to lower her underwear or unhook her bra and I will not do it myself. I just do compressions or work over the sheet or on whatever area I can for her. It's a barrier for her, a safety net and I just have to respect that and do what I can, even though I know my work would be more effective without that barrier. It's her boundaries that are the most important, and having her feel safe and secure with me.
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Post by JaeMarie » Sun Nov 02, 2008 8:12 pm

What tranquilspirit wrote.

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Post by healingtime » Mon Nov 10, 2008 8:49 am

hi, this is a cool discussion, and i love hearing about the "caring stroke"..

but i have a question still about the communication with clients about glute massage while i'm in clinic, which i just started. i'm finding the communication awkward...

in clinic we have very little time to spend discussing things with our client. we look over the intake sheet before the massage, but the school's intake forms are extremely abbreviated. it basically tells me nothing other than major health conditions and if they have any specific areas bothering them.
no other specifics, and definitely no body diagram for them to mark.

then, when i take my client back i try to have the communication with them about areas they do/don't want covered and i've been approaching the glutes very matter-of-factly. i just have said, "would you like your abdomen or glutes worked on today?" one out of three clients said they had never heard of getting glutes worked on before! (and she is a regular at the clinic!) i felt a bit odd after she said that!

one other client requested no abdomen, wore no underwear, but i kind of felt the dialogue on her receptiveness to glute work was sketchy, but since she didn't wear underwear i went ahead and included them.

still one other client just kinda seemed to go with the flow of it and was unfazed about the glute work, but i'm not even sure if i offered abdomen work to her! she was my very first client in clinic.

anyway, sorry this is getting long...

so--to get to my point! we have very limited time to spend getting to know our clients in clinic and they have all seemed like they aren't used to a lot of pre-massage communication and very eager to just get on the table (understandably since it's only a 50 min session) . i'm very comfortable doing glute work, but not if the client isn't totally comfortable also. also, without the glute work i feel like the massage is kind of "disjointed" ? like i'm leaving a huge part of the massage out (which i am! lol)

so, since i may only see my clients in clinic one time should i just leave glute work out? or just address it depending on the complaint they come in with if it's glute work could be obviously connected to their issue? also, time is so limited, if i do glute work i can't spend as much time, for instance, on the back, which it seems is where everyone wants.

ok, maybe i've rambled on enough here to get some part of what i'm trying to ask out, hopefully without everyone skipping this entirely because it's so long!

thank you!

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Post by JasonE » Mon Nov 10, 2008 11:11 pm

I often have clients that are surprised at the level of communication I initiate prior to a session. Many are accustomed to an extremely brief, "so what do you want me to work on?" approach, with little in-depth discussion of their history or detailed concerns. This kind of dialogue takes a little extra time, but it provides a great deal more information to use for your clinical reasoning, and it also helps set the tone for the remainder of the session. You can use the information obtained to determine how to educate a client on what you think would be best, and whether you think it would be advisable to work the glutes, abs, hip flexors, etc.

IMO, most schools (that I have interacted with) fail to properly emphasize the importance of doing a good client intake, let alone an efficient one. It is less clear to me how well students are learning to develop good clinical reasoning. Developing these skills now, while you are in school, will help you throughout the remainder of your massage career. In particular, it will help you attract and retain clients, thereby increasing your level of income and professional success.

Don't let a miserable health history form set you back. Ask for the information you need, and don't feel embarassed to ask for more info than the client was expecting to provide.
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Post by healingtime » Wed Nov 12, 2008 6:30 pm

thanks for the encouragement Jason,

we have a dedicated class at school on assessment and documentation, so they cover it in that way, kind of. however, everyone pretty much left that class with a big question mark on their forehead, lol. gradually it's coming together though.

in a perfect world i'd like to be able to have at least a better intake form, and the fact that we don't is somewhat perplexing to me, which just makes the assessment class we received all the more confusing! but i am still learning a lot by the experience the way it is, i just hope it's not at the expense of anybody i'm working with. i think this will just help me hone in on my verbal (and reading non-verbals) communication with clients as i learn to gather info. in a relaxed yet quick and efficient manner due to time constraints.

thanks again, what you shared helps...

it is really exciting doing this work...i like and enjoy it even more than i imagined i would...4.5 more months and it will be the real, real deal, entirely out of the school environment!

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Post by Hands and Spirit » Sun Nov 23, 2008 8:34 am

Massage laws are regulated on a local level (counties, cities) in my area. In one county it is illegal to work on the glutes. (I know, the concept is incredulous, but it is a really conservative area)

Please please do not avoid the glutes. The more you work with what initially may seem an awkward situation, the easier it will get.

Gerry
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Post by JasonE » Sun Nov 23, 2008 8:12 pm

healingtime wrote:thanks for the encouragement Jason,

we have a dedicated class at school on assessment and documentation, so they cover it in that way, kind of. however, everyone pretty much left that class with a big question mark on their forehead, lol. gradually it's coming together though.

in a perfect world i'd like to be able to have at least a better intake form, and the fact that we don't is somewhat perplexing to me, which just makes the assessment class we received all the more confusing! but i am still learning a lot by the experience the way it is, i just hope it's not at the expense of anybody i'm working with. i think this will just help me hone in on my verbal (and reading non-verbals) communication with clients as i learn to gather info. in a relaxed yet quick and efficient manner due to time constraints.

thanks again, what you shared helps...

it is really exciting doing this work...i like and enjoy it even more than i imagined i would...4.5 more months and it will be the real, real deal, entirely out of the school environment!
Interesting that you are learning assessment and intake skills with a poor intake form. Haven't they taught you how to create your own thorough intake form? If you don't like the one you have, make a better one for future use in your own practice.

Even if you are stuck with a poor intake form in your future employment, you don't have to let that limit your effectiveness. Take good notes and "go outside the bounds" of that intake form by asking for additional information. Put that extra info into your session notes for future reference.

I've recently started teaching continuing ed classes for MTs. Though the primary interest of participants is learning the techniques for treating their clients, I strongly emphasize understanding the intake/assessment and anatomy/physiology aspects first. If you don't get those, the technique portion is little more than a random bag of tricks. But a good assessment coupled with solid understanding of underlying anatomy will enable skillful and efficient use of those techniques based upon sound clinical reasoning.

It's okay to come away from a class with more questions than you started with. Use those questions to direct your studies and the way you practice between classes. Discuss those questions and your experiences with your instructors and/or other experienced MTs. Plan to take continuing ed courses to help answer those questions and others that will arise over time.

In seeking answers, you will learn many useful things that are never mentioned in class. In applying the useful things you learn, you will develop confidence and professionalism. Never stop learning, and you will always be open to new growth.

Good luck in your continued studies!

PS - and learn to do good glute work. I work with more buns than a hot dog vendor, and it is often amazingly helpful for relieving a wide variety of complaints.
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Re: When you massage the glutes....

Post by [email protected] » Thu Dec 17, 2009 4:08 pm

The glutes can be a very sensitive subject for some clients, and a non issue for others, but I feel it is always important to work the glutes (with permission). During the client intake if the client has specific issues that glute work could address, I do mention that I can work that area for relief, and that they can choose to wear undergarments or not, their choice.

But I do state that not wearing undergarments is a non issue for me, and I will try my best to give them a great massage, regardless of what techniques I need to use. (Has anyone else ever used hot stones over the sheet in the gluteal area? Or just do some stretching, compression, NMT, triggerpoint? You could also use multiple tools to access the area without actually using your hands at all! Even some gentle rocking and compression would be better that skipping the area right?)

I also let them know that they will not have any areas exposed that are not for an expressly therapeutic massage.

I also follow the rule of never moving someone's undergarments, nor would I want to or ask them to after the session has begun. =)

If this is a very difficult decision for you, simply mention it prior to the session and ask if they are ok with the course of treatment. "Mrs. So and So, according to your intake form you are having lower back and sciatic pain in your legs. Low back, Gluteal and whole leg massage may be necessary to help relieve tension and create relief for your pain, are you comfortable with receiving this treatment course?" and "You may remove whatever underclothes are comfortable with, but if you leave them on, I can work around those areas to avoid oil or lotion from getting on them, or I can work over the garment and sheet. Which method sounds better to you?"

These are just suggestions, and you will find a way to breach the subject with clients. Just don't stress and don't be embarrassed, you are a healthcare practioner and it is part of our job to inform the public about the scope of our professional practice and knowledge.
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