Massage & Bodywork

JULY | AUGUST 2020

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client satisfaction, and give us confidence that we are using the best possible practices in our profession. In January 2018, I had the opportunity to discuss the "Missing the Mark" concept with Haley Winter on his How's the Pressure podcast. 2 We named the episode "Failure," knowing it would be provocative, as a direct response to the relentlessly upbeat and positive ways our work tends to be presented. Though neither of us thought of it at the time, Haley was the perfect person to have this conversation with. Before becoming a massage therapist, Haley was a professional athlete who pitched for the Seattle Mariners. As he reminded me in a recent conversation, "Baseball is a game of failure." Even the best players fail a good percentage of the time. His decades in baseball primed him to expect to miss the mark and to deal with failure in ways that built his resilience, allowing him to learn quickly from mistakes and then show up fresh in the present moment, ready to fully engage. "About the only problem with success is that it does not teach you how to deal with failure."—Tommy Lasorda On the podcast episode, Haley asked me if I had ever hurt anyone on my table. I took a deep breath and answered with an honest, "Of course I have." There are instances I know about, where I was misattuned with my touch or spoke words that were damaging, despite my best intentions. I'm certain there are instances I don't know about, where I never had the chance to learn or to make amends. I am keenly aware that no matter how much I aim to partner with my clients, a power differential exists in my work. This is true for all of us. We are seen as the experts—the ones who know best. And because we are not in our clients' lived experiences, we cannot always judge how a technique, a spoken phrase, or some well- intentioned "homework" will be received. We would all do well to assume that, at some point, we will do harm. Our conversation led Haley to ask all his future guests about their "favorite failures." He was pleased to observe that these leading lights in the industry were, to a person, delighted by the question. They valued the opportunity to speak frankly about missing the mark. Many of them revealed deeply personal stories and hard-won lessons. Shedding light on the ways we bodyworkers miss the mark will help us personally in our own practices. It will also help us collectively as we develop an evidence base that is tailored to the bodywork field, rather than one strictly in the medical model. Just as M&Ms help drive the practice of medicine forward, reckoning with our failures can lead to research that truly reflects how we work: practitioners who have expertise using their hands to address the body's varying densities of tissue and fluid, providing individualized treatments to clients. Let's take a look at some ways we miss the mark in manual therapy and bodywork. Physical Injury or Harm We miss the mark when we cause tissue injury from poorly executed technique, when we misuse equipment or our equipment fails us, and when we cause injury or a flare-up of a condition because we don't recognize a contraindication or caution. We also miss the mark when we work outside our scope of practice, no matter the outcome. This could be when we recommend supplements or dietary changes without appropriate training and certification in nutrition, or prescribe exercise without specific training to teach and supervise it. These ways of missing the mark are commonly seen in insurance claims. One of the most common claims is for exacerbating symptoms of a herniated disk, often from chair massage. Some therapists don't adequately screen for cautions, and in their zeal to provide value in a short session, go too deep too fast, or take clients in unsafe ranges of motion. This could be largely avoided with a brief intake (yes, even for a 5-minute chair massage), so we can do our best to ensure our technique is appropriate for the client in front of us. Another common claim is for injuries sustained when a table or massage chair collapses. 3 So I ask you: When is the last time you checked your table legs? I've had colleagues recommend yoga asanas that are clearly inappropriate for clients we have in common. These colleagues don't recognize that the poses are contraindicated because while they attend yoga classes themselves, they don't appreciate that knowing how to perform a pose does not mean they understand how to teach it or when it would be useful. Our shared clients have experienced nausea, dizziness, and shortness of breath from these well-meaning but misguided attempts at instruction. 62 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 2 0

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