In the real world, when I'm not busy writing about Harry Potter, I'm a massage therapist. I work very hard to be an ethical practitioner. This means that I don't go beyond my scope of practice. I make no claims about curing disease, releasing toxins, etc. What I do is make people who hurt feel better. And, I'm pretty blunt about how I can't always do that either, but I'll try, and if I can't, I'll work with you to find someone who can.
Legally I'm not allowed to diagnose conditions. In that I've got 600 hours of training in all things medical, this makes sense. However, (behold the beginning of the rant) my job would be quite a bit easier if those who legally can diagnose did a better job of it. When I started practicing if the patient told me they had been diagnosed with carpal tunnel syndrome, I took it at face value they had carpal tunnel syndrome. I have since learned that unless the condition is something like cancer, that I need to ask, "How were you diagnosed?"
For those of you who can diagnose, (you know who you are) please pay more attention to your clients. Especially when it comes to certain pain causing conditions.
Carpal Tunnel Syndrome is not diagnosed by wrist pain and too much computer use. Yes, the person may indeed have carpal tunnel, but judging by the number of people who are walking about with scars on their wrists from Carpal Tunnel Surgery, and no pain relief, a bit more work on figuring out what is wrong would be nice. Among other things, if you can reproduce the pain by palpating the forearm, or neck, the problem isn't likely to be not enough room for the nerve between the carpal bones. Another hint, if a muscle relaxer makes the pain go away, but an anti-inflammatory doesn't, don't schedule surgery. I'll just end up working on a very irate person who will never see a doctor about anything again.
TMJ is not a clicky jaw and headaches. Once again, the person may indeed have TMJ, but it is often not the cause of the pain. I've seen more people with useless jaw surgery than any other condition. If neck and scalp palpation recreate the pain pattern, don't start looking for someone to clean out the cartilage of the joint. Also, if the pain is coming from jaw dysfunction, it's unlikely that a muscle relaxer on its own will ease the pain. If it does, it's time to start thinking that perhaps the muscle tension is causing the jaw dysfunction, not the other way around.
Stop telling women who are 35+, with pain (especially localized), and sleep problems that they have Fibromyalgia. Some people do have genuine Fibro and it's a mess. But the number of women I see who are mainly stressed, who have been told that there is nothing that can be done, they will hurt forever, because they have Fibromyalgia, is unconscionable. If you don't know what's wrong, tell them that. Please, learn to tell the difference between a tender point and a trigger point. I can make a trigger point better, tender points don't respond to any yet known treatments. I have seen everything from stress, to Lyme's disease, to Narcolepsy diagnosed as Fibromyalgia.
Here's a hint, she hurts all over, it never really stops, pain can be elicited on palpation of at least 11 of 18 standard spots (and if any of those spots radiate pain, they aren't tender points) she can't sleep/never feels rested, her digestion is awful, she gets sick all the time, and usually runs a fever, it's likely she's got Fibro. If we're looking at a woman who is tired, has headaches all the time, palpation finds head/neck/shoulder tenderness with referred pain, and is otherwise healthy, don't tell her she's got Fibro. She's most likely stressed.
Arthritis is not diagnosed based on age of client and joint pain. At least check and see if there is some swelling in the joint. Remember that's what itis at the end of the world means! Same with Bursitis. Stop telling clients they have Bursitis until you've seen the damn thing. Likewise Tendonitis. Find the swelling first, then diagnose. Massage shouldn't cure Arthritis, Bursitis, or Tendonitis. It may, due to endorphin release make the condition feel better for a bit. But if you get a series of massages (3 or 4) and it makes the pain go away, and stay away (I mean for weeks or months, not hours), you probably didn't have any of those conditions to begin with. But it can do wonders if the pain is actually caused by trigger points. Another hint, if any of these conditions don't respond to anti-inflammatories, you've probably got the wrong diagnosis.
Speaking of conditions massage really shouldn't cure: Sinusitis. There is no reason on earth my massaging the muscles of the face should make sinusitis go away, and stay away. There are very good reasons why a snort or two of Affrin should alleviate the pain for a bit. Please stop medicating people with clean sinuses for sinusitis.
Stop telling patients who come into the emergency room for a sprain or strain to put heat on it when they go home. Please! Especially don't give them a cocktail of muscle relaxers, anti-inflammatories, analgesics, and then tell them to put heat on it for twenty minutes every hour for the first two days. In case of sprain or strain all the muscle relaxer does is make the patient loopy. If they've torn a ligament then the relaxer is useless, if they've torn a muscle, once more useless. You aren’t treating a muscle spasm if you’ve got a tear. The anti-inflammatories are great, but when you've got the person putting heat on the area, it cancels out the anti-inflammatory. Analgesics are great, make sure they get good ones. Heat is stupid, not just cause it cancels out the anti-inflammatory, but because it makes the area feel better for a little while, increases blood flow which then stagnates in the muscle, causing stiffness and more pain. I've gotten a reputation as a miracle worker by telling clients to switch from heat to ice. Also, basic first aid, RICE Rest, Ice, Compression, Elevation. Note: Heat is not on that list.
I know that it is not easy to be a doctor. I know your time is short, and your patients don’t always know what to tell you to get a good diagnosis. I know that some of the clients I see are dopes and just didn’t understand what was said to them. But since a good 80% of my client base are people diagnosed with problems that miraculously get better through massage therapy, I have to assume they can’t all be idiots. Likewise, after more than five people tell you the same practice told them to do the same thing for the same condition, (heat for sprain) and no one has ever reported that practice telling them to use ice, you’ve got to assume that said doctor just doesn’t get it.
So please, make my job easier. Take better histories. Learn to ask the questions your patients don’t know are important. Palpate! Your fingers will tell you wonderful things. Your patients will love you for your concern, and will be much less likely to sue if something does get messed up. And, I’ll be able to look at my intake sheet, see Fibromyalgia, and treat accordingly, without having to spend the next hour trying to figure out if I’ve got someone who really has it or not.