Amy Bradley Radford (00:02.626)
Welcome to Massage Business Success. I'm Amy Bradley Radford, and this is the podcast for massage therapists who want to grow their business, strengthen their skills, and create a career they love. Let's get started. Well, welcome back to the podcast. Before I get into this little mapping concept we are going to be talking about today, I want to back up just a little bit because I think there's something I need to establish first about who this episode is really for.
In my massage your market class, I talk about the three main reasons I think people seek out massage. The first is relaxation. That's the person who really wants the massage experience. They want a full body massage. They may want the aromatherapy or the scrub or whatever enhancements you offer, and they simply want to just check out and relax. They want to be pampered. And they and there are massage therapists who are absolutely wonderful at creating that experience.
I am not one of them, however, but I do like to receive that type of massage. And then there's stress reduction. This is the person who has the weight of the world sitting on them, and they just want someone to take some of that pressure off. They literally feel like they are under pressure and they need a very specific kind of pressure to counteract that pressure. They just need to be squished. That broad, firm,
compressive pressure where you almost feel like you're squeezing the toothpaste out of the tube. There's some pretty incredible things that happen to the nervous system when you get squished that counteracts those feelings of pressure or stress. And my gosh, it's so relieving. And then there's pain management. And this is what we're going to talk about today. This client is coming in with a goal. Their shoulder hurts when they do something and they want it to feel better. They can't turn their head and they're tired of it. Their foot hurts every morning
When they get out of bed and they want it to stop. And they've had this pain for six months and they want to know if you can do something to help them. There's something very specific they want to change. And this is my favorite client. So today we're going to be talking about the pain management client and a concept I call mapping. And I just wanted to make sure that if that was something that interested you, then you come with me on this journey on the podcast today. And if it's not, then we'll see you next week.
Amy Bradley Radford (02:19.288)
But I figured out pretty quickly in my career that those were my people. Give me the person who has something going on that they haven't been able to figure out, and my brain immediately wants to dive in and figure out why. I want to put my hands on their pain. I want to understand what's happening, and I want to see whether I can facilitate some kind of change with them. It is a challenge that has never grown old for me. So that's the kind of massage therapist I became. And you know, I I actually believe there's a business piece.
This too, and I've talked about this for years in my classes because, in my experience, pain management work can give you a different opportunity when it comes to what you charge for your time. The client isn't simply comparing you to another 60-minute massage anymore, they're looking for help with something very specific that's affecting their life, and as your knowledge grows and you become more effective at facilitating change for these types of clients.
I think there's more room for your price to reflect the value of your expertise. To put it plainly, I think you can charge more. But if pain management is the direction you want to go, then successful applications of your skills is required to maintain your clientele. You have to be effective. What you offer actually needs to create the outcome the client is looking for. And in our field, it's hard to know when that truly happens. Really, when you ask somebody if they feel better and they say,
Yeah, I do. How do you measure that to know that things actually changed? How do you measure success? How do you improve it? And how do you know whether the massage you just gave actually worked and for how long? With every single client. And I ran into that question really early in my career because I started out working in a physical therapy office. And right from the beginning, I was working with a lot of people who were there because they were hurt and not just a little bit. They had injuries. They were recovering from.
Surgeries and ongoing deterioration. They were trying to get back to doing something they couldn't do or simply learn to live with their pain or manage it somehow. And there were so many, there's just so many people hurting out there that it's just crazy. And a lot of times I got the leftover crowd, meaning that the people who got on my table had graduated from PT but weren't out of pain. Their range of motion was better, but they still hurt. Or they ran out of money, or their insurance said they couldn't come back.
Amy Bradley Radford (04:40.566)
And so they would get referred to me because I was a much cheaper option than trying to go to PT three times a week. And so I got to see a lot of really hard cases right from the get-go. And while working there, I helped the physical therapist sometimes when they were overloaded. I would simply help set up patients in rooms, or sometimes I would just help them count and walk through their exercises in the gym if I had a space or an opening. And one of the things I paid attention to that I was actually a little jealous of.
was how the PT could measure successful treatment. They would assess their patient, gather information, measure the client's ability or inability in really specific ways, and come up with a plan based on what they were going to do to correct the issue and put the patient through that work and then measure again to know if what they were doing worked for that person. And they had a system to apply and validate their treatment. And I wanted something like that for my clients at the massage table. I wanted
I wanted something more than what my hands felt. I wanted something to validate what I was trying to accomplish so that I knew and I really knew what my work was doing. I mean, think about what we do. You it's so hard to measure the outcome besides subjective data of what someone's telling us. We can't take a slice of someone's muscle before we work on them, put it under a microscope, look at what's happening inside of it.
Do the massage and then take another little slice and put it under a microscope and say, okay, here's what changed. We we don't have that ability. And even then, it's not going to show us what the massage accomplished. I think that's the hard part of trying to validate massage through research. What do you measure? Because our approach is holistic. It's more encompassing than the physical therapist. Our clients' expectations are also different. What they want is this multifaceted approach to their body. Reduce my pain.
Help me relax, make me feel better, work on me for an hour or two. It's this hodgepodge of so many things that it's hard to make sense on top of, gosh, like myself, six months of basic training. And you know what a lot of this struggle I had was that it just lacked direction and purpose. And there was a big dose of randomness in terms of what we should do or what the outcome should be as a massage therapist. It's not always clear. But what I did know at the time was that.
Amy Bradley Radford (06:59.426)
We have our hands and what we can feel going on underneath them. We have we have what the client tells us. We can look at movement or range of motion when that's appropriate. And we can touch and palpate something before we work it and go back and then palpate again, checking for change. And as you get more experienced, your hands get really good at recognizing very small things inside those changes. But I wanted something more concrete that I could compare before and after. Progress. And even so far as progress that
taught me more about what I was trying to do with massage. I was trying to create something or find something that could teach me more while I was in the process of doing massage. I was still figuring out my hands while trying to earn a living at it. And that's the hard part, right? You know, you're expected to help all kinds of people and problems with very limited amounts of experience. And and I often have said it was like being thrown into the deep end of a swimming pool while you're barely learning to swim. Welcome to massage therapy.
But anyways, I continued my own training. I decided to study trigger point therapy and neuromuscular therapy, which kind of overlapped quite a bit. But in my neuromuscular therapy training, I learned how to measure posture on a chart and and mark it out on a body diagram on paper. And we were we were looking at where, you know, like the head was sitting, where the shoulders were level, where what the hips were doing, knees, so on and so forth. And we could take those measurements before we worked, which was simply just drawing a line at angles on these charts.
chart them and then look at them afterward and chart any of the changes from the work we've done. And you know, I learned something really fascinating from that. I could take someone, someone's body who was whose posture was clearly off. I could work with them in the way that I learned how to do that, neuromuscular therapy. And afterward I could get them so much closer to what I had been taught we were looking for, level. Their shoulders might be more level, their head might be more level.
Visually, I could look at the before and after and say, okay, I created some positive change because we went from this place where we didn't want them to a more neutral position. And there were a lot of times my client felt better, but there were also a lot of times they didn't. And I I could get someone looking straighter and make their pain worse when I was done. And you know what? That actually really confused me because my goal was to help everyone achieve a better sense of being.
Amy Bradley Radford (09:23.65)
Their pain was lower by making them stand up straighter. Because I had learned a measurement system, very similar to the physical therapist. It was something I had wanted. And it was something that I had learned that could successfully change the thing I was trying to change. But when the person standing in front of me was telling me that the outcome wasn't better, which was to reduce their pain and hadn't improved with it, that really confused me. Because now I had a measurement system, something I had wanted.
that told me I had successfully changed the thing I was trying to change, but the person standing in front of me was telling me that the outcome I actually cared about, which was reducing their pain, hadn't improved it. So postural measurements were gosh, they were so valuable to me. But what they couldn't tell me was why something didn't work for changing their pain. I equated improved posture to changing their pain, and it worked for some and not for others.
And it was the people who didn't respond the way I expected them who caught my attention. There was obviously something else I needed to learn. And those have always been the people I have wanted to figure out, partly because I was one of them, partly because when you applied some of this work to me, sometimes it worked and sometimes it didn't. And I wanted to understand for myself. And you know, I understand those clients very differently now. A lot of what I was seeing in these particular people, I would now recognize through PPS as a body dealing with a much
higher level of inflammation. And the massage application I used, while it was good for changing posture and postural measurements, sent their inflammation soaring. And I didn't have that understanding then. I just knew that sometimes I could take the measure I could make the measurements look better, but it increased the client's pain. So I started thinking, okay, maybe I need to figure out how to measure the thing I'm actually trying to change. If the reason this person is on my table is because they're in pain,
I need to know how to chart their pain. And that's that's where charting became something very different for me and became something I now call mapping. Instead of simply asking somebody where they hurt and having them put an X on the body diagram on their health history, I started having them actually draw their pain. I I would have them mark and scribble and and and color in areas of their body that hurt because I wanted to know exactly where it was before I touched them.
Amy Bradley Radford (11:45.836)
And then after I worked them, I wanted the client to draw it again to show me outside of what my hands could feel, what they felt, I wanted them to show me what their pain did. And that gave me something I could compare. I could see what they came in with, I could see what they left with, and I could start putting that next to what I'd actually done with my hands. And that's when things actually got really interesting for me. But I'm gonna jump back to the beginning of my career.
And talk a little bit more about that before we dive into mapping. Because at the same time I was working with postural analysis, I was also really interested in trigger points. I had studied the Trevell manuals, and I mean studied these books. They were nicknamed the Red Bibles by some of the massage therapists I knew at the time. And these were heavy. If you've never seen them, these are heavy, big, thick books, and they have tons of anatomical and medical jargon in them.
And it was complicated and I didn't have Google to look at at that point in my life and career. And so there were lots of times that I was reading through this data and information with a medical dictionary sitting next to me while I was trying to figure out what I was reading. But but you know what fascinated me was how they were consistent from person to person. Since I was dealing with pain, and this is basically a huge map of pain, I wanted to understand those maps a little more because there was a consistency component to it.
So they were a method and measurement all of their own. And at some point in my career, they just ended up being really expensive picture books that I used with my clients. I would take those books into the treatment room with me and have the clients look at those pictures because the pictures meant more to my client and myself than even the words did. And I had all the pages marked that had pictures on them with the trigger point patterns. And I had these little small sticky notes and they were written on.
And hi had kind of memorized the outline of of the book so I knew where different pieces of anatomy and pictures were at and in what order. And somebody would be really specific and draw where they hurt, and I would start flipping through the manual and matching it up with what they drew for trigger point or referral patterns. And then I would show them the book and I say and I would ask them, is this what your pain feels like? And sometimes it was spot on. They'd be like, yes, that's it. And other times they'd say,
Amy Bradley Radford (14:06.07)
Not not quite. And so then I would flip to something close to it and similar and ask them again. And I would do that until they would say, yes, that's my pain. And what I what I started learning from this little experiment was how incredibly specific I needed to be when asking where or what their pain was. Because somebody saying my low back hurts sounds like they've given you or I useful information, but they really haven't given me very much information at all.
I can have five people tell me their low back hurts. And when I actually have them show me, draw exactly what it is and explain to me, I have five very different pictures. One person's pain might follow like a quadratus lymborum trigger point pattern on one side. Somebody's might actually be bilateral. Another person might draw something that looks like an SI joint pattern. And someone else might be having pain that's associated with a bulging disc that they haven't told you about.
And then another person can be feeling that pain all the way across their lower back. And that's a rectus abdominis referral pattern. And you know, that last one is a really good example of why I became so particular about this. Because the rectus abdominis is in the front of the body, but it can refer pain to the back of the body. So that client can point right at their low back and say, this is where I hurt, and that's where they're feeling it, but that doesn't necessarily mean that's where I need it to work.
So if I hear low back pain, let for example, like let's say you hear low back pain, you put them face down and spend the next 20 or 30 or 60 minutes working over all the muscles and structures of their lower back because that's where they said they're hurting, we could actually miss completely what their pain is trying to tell us. And I'm here to tell you if you start doing a bunch of QL work on somebody whose low back pain is following a rectus abdominis referral pattern, it will most likely make them worse because it was on the wrong side of the body.
And I needed to be working on the front of the body. And I found this referral pattern with a lot of people. They said their lower back hurt, but when they drew it, it was a rectus abdominis referral pattern. So those little differences in how someone drew their pain changed what I worked on and why. And using what they drew in detail compared to the images in my trigger point manuals changed how I worked. That large X on the body chart stopped being good enough for me.
Amy Bradley Radford (16:30.978)
You know what I'm you know the X I'm talking about. You hand somebody a health history body diagram and they put some big X somewhere on their lower back. Okay, their back hurts. But I wanted to know exactly what that pain looked like. And to take it one step further, I wanted to know if it looked like the trigger point pattern. So I asked them to stop using X's. I asked them to color it in and all of their pain everywhere. Because sometimes people would only draw what they wanted you to address, even though there was more.
going on with their body. And that information was actually just as important. I wanted my clients to give me as accurate a picture of their pain as they could because as you've heard already, two people could use exactly the same words to describe where they hurt and be showing me two very different things. And once I once I started collecting that kind of detail, the body chart wasn't really just a body chart anymore. For me, it was becoming a way to map pain.
My client was generating something specific enough that I could actually begin comparing what was there before the massage with what was there after. And once I did that, I now had a way to measure pain constructively and figure out what changed it. I had a way to see if the massage work I was actually applying did work, if it changed the pain. So once I started asking people to actually draw their pain, this whole process started to evolve on its own.
And I want to say that where I started with mapping and where I am with mapping today are very different because the maps themselves became my teachers. And they started giving me information that I needed to understand. And the more I did this process, the more it taught me. And today, before I start a massage, I hand my client a a paper chart. I still use paper that has two sets of body diagrams on them, one above and one below, exactly the same.
And I have the client draw their pain in red on the top diagram, and I want to know every bit of it, just like we talked about. And I also want them to give me a pain level now. I ask my client to rank their pain on a scale of one to ten, just like if you're in the hospital or in a medical setting. And then based on what I see on that map, I do the massage. And when we're finished, I give them that red marker again and I have them draw their pain on the second body chart that's directly below the first one on the same page.
Amy Bradley Radford (18:53.794)
So the before picture is on the top and the after picture is right underneath it. And both of us get to look at what's changed or not changed and then talk about it. One of the things I learned during this process of mapping is that most people forget pain really quickly when it isn't there anymore. They'll look at what they drew before and say, yeah, that did hurt and now it's better. And then they'll move their arm or turn their head andor move their leg and check it. And sometimes they're actually really surprised because that piece of pain isn't.
isn't there anymore. But I have to cue them in to remember what hurt an hour ago so I can get the data I need to track if that was a successful treatment. And you know, some of the things you could see is, you know, maybe that pain cover this whole area is so much smaller now. Or maybe something that was running down their leg now stops at their knee or their hip or part of it's disappeared or all of it's gone. Or maybe it moved to the muscles next to it. Maybe it didn't change at all. And
This one is where things started getting really interesting to me. Maybe they leave with pain somewhere they didn't have pain when they came in. So what does that mean? And you know, at first you can look at that and think, well, crap, I made them worse. That's what I thought. But I stopped I s I started learning not not to think that way and to s not stop there. I had people who would get off the table and tell me they felt so much better, but now they had a headache. They didn't come in complaining of a headache. That
That wasn't anything, there wasn't anything up around their head that they drew on the original map, but after I worked on them, there it was. And over time I started realizing that actu that actually wasn't random information. And it wasn't because they didn't have enough water. Maybe. Maybe they needed more water, but it was actually trying to tell me something. Sometimes that new pain was simply pointing me towards something I had missed or something that was actually causing the pain lower in the body I had been working with. In this for this particular instance,
Typically, there was something higher up in that person's pattern that was a driving force in the overall picture of their body. I had also realized at that point in my career as a massage therapist that I had a much greater opportunity to change what a person was complaining of because we could work the entire body if it if needed. The limitations of physical therapy, at least from what I had observed, was that they could only work on what was prescribed to be treated. And to take that even further, well
Amy Bradley Radford (21:21.122)
They could only bill for insurance for the area that they were told to work on. So to work outside of an area prescribed could potentially be time wasted and not be paid for. So if the patient came in with low back issues, then treatment needed to be maintained to the low back. So if something, as I was observing, was originating in the neck and had compensated into the low back, what the body needed to change at that point couldn't truly be addressed. Maybe that's why they were on my table.
You know, something else became apparent as I started using paperwork on a much deeper level. I realized that I wouldn't have had the information if all I asked at the end of the session was, Do you feel better? Because most clients will tell you, yes, they feel better. You worked, you touched their pain. So yes, I feel better. But sometimes I think clients tell you what you want to hear to not disappoint you. Also, I I know I've done this. If you think about it, you've done this too. I've told people that was a great massage.
And then never went back because it was a good massage, but it didn't meet my expectations. It didn't give me the outcome that I so badly wanted. And so I went on to the next person to see if they could help me. But the map that I was using gave me more information than yes or no. Because after the client had finished marking on both of their maps, I could take a blue marker and I would add my information on top of that second diagram, the one with the pain that was left after the treatment.
And I would mark everything I did. And I I wanted the before and after pain map first because I wanted to see what changed. And then I wanted some time to go back and mark the areas that I had worked during the massage that I felt had created the ta the changes that I was seeking. And so I wasn't coloring the whole body blue just because I gave them a full body massage or touched most of their body during this session. I was marking the areas where I found myself spending time.
Where I sat and investigated something, or where I found something I knew had helped change their pain, or an area, a location that I had found that created change, but maybe I needed to spend a little more time with next time. And if I spent a lot of time in an area, it got a lot more blue. And if I just was in an area for a little bit, then it just got a little bit of blue. And I would leave out anything that didn't really matter or make a change, even though I may have touched it just a little bit. And what this system allowed me to see.
Amy Bradley Radford (23:41.644)
Was the pain they walked in with, the pain they walked out with, and where I worked that helped them. And it was so much better than charting out a sentence of what I did in the massage flow. And if I needed to, I could throw my postural analysis all on top of it just for fun to see what was going on. But for me, all of this was an incredibly powerful tool because I am a visual manual learner. I learn by putting my hands on something.
And by seeing it. I can write pages of notes about what I found and what I worked on, but those don't stick in my brain the same way a picture does. And I think a lot of you are that way. A massage therapists are visual manual learners, at least most of them are, the ones that I've trained. And we chose a profession where we can learn through our hands and we learn better by watching than hearing. So now that I have this picture, I can start asking both my client and myself some questions.
Things like, okay, so I worked here and something over here disappeared. Or I worked directly where they hurt and nothing happened. Or I changed this part of their part of their pain, but now something else showed up. I could look at the blue and then I could look at what happened to the red. And over time I could start seeing things that would repeat from client to client. And that's really where mapping became much more than documentation for me.
I charted my clients' treatments this way for years. I didn't sit down one day and invent this system and sudden suddenly have something I call PPS. I started with a way that worked for me of measuring whether somebody's pain truly changed, and then I kept using it. And as I kept using it, the way I mapped evolved because of what it taught me from using it. And I started seeing that certain pain patterns responded when I worked in certain places. I started seeing how trigger points.
were telling me a story about the body, not necessarily asking to be worked on. And I started recognizing some very specific behaviors in the muscular system around surgical scars and other scar tissue in places that seemed to matter to those areas of pain. And then I started seeing those relationships repeat in other clients. And you know that low back and headache connection.
Amy Bradley Radford (26:00.14)
I'm just going to give you the answer. And a majority of the time, those clients had a prior whiplash that over time the neck had well resolved somewhat, but the injury had moved lower down into their back. Talk about not working the right place at all, but how do you explain that? How do you explain that connection? All I knew years later, and thousands of bodies later, was that one of the components behind unresolved back pain was a previous whiplash accident. So if the back still hurt,
Well, if you could work the neck in a specific way, voila, things started changing and they started healing. And you know, that's where all of this started getting much bigger for me. The mapping didn't create those relationships. I had already spent years finding relationships with my hands through trigger point work, neuromuscular work, and everything else I was learning and trying. But the map gave me a way to see them all in one place.
And I think that's why I believe this way of mapping is incredibly useful in the application of massage for pain management. If you're doing pain management massage, you need some way that makes sense to you to know whether what you did created the change you actually thought it created. Because the data we have been trained to collect is sometimes not enough to prove effectiveness. We can't take that slice of muscle and prove that it changed.
So for me, that piece of paper with the red and the blue gave me a picture that I could understand. And after enough of those pictures, I wasn't just seeing whether the pain changed anymore. I was starting to see how it changed. And the before and after pain levels started to validate some treatment. So let's talk about that just a little bit. You know, once once I could see how pain changed, I started really paying attention to how much it changed.
And what it did after the client left my office. And this is going to sound really familiar to a lot of you, because someone could come in at a at an eight out of ten, leave it a seven, and tell you that they felt better. And they do feel better. But I started noticing there was a difference between creating enough change that somebody noticed it when they got off my table and creating enough change that their body seemed to pick it up and continue with it after they left. And I didn't figure that out while they were standing in my treatment room.
Amy Bradley Radford (28:21.12)
I figured it out when they came back. I thought about my own experience and how I had reacted to good work, but not enough change in my body. I would have someone get off my table and say, my gosh, I feel so much better. And I would be like, Awesome, this is so great. I'd feel so good about what I'd done. They would leave, they would come back for their next appointment a couple weeks later, and I would ask how they did after the last after the last massage. And they would say, Well, I felt really good when I left.
When you left. Okay, so how long did it last? And sometimes the answer was an hour. Sometime it was sometimes it was until that evening. Sometimes they made it through the next day and then everything came back. And wow, the session that I thought was a good session wasn't as good as I thought it was after all. So I started putting that information next to what I had seen on their map when they left. If somebody came in at an eight and left at a seven,
Yes, they absolutely could feel the difference. They felt better because they'd been worked on. But after all this experience, I learned that a one point change didn't hold very long for anybody. And then I started noticing something different when I was able to create a larger change. If somebody came in at an eight and left at a four, or came in at a seven and left at a three, those were the people who were more likely to come back and tell me the change lasted several days. Sometimes it lasted most of the week or even two.
And that's when I started using a four-point reduction in pain as a way to track and chart better treatment and progress. And I want to connect that to PPS for a minute because this is actually one of the most important principles I teach when it comes to mapping and pain management. PPS is as much theory people as it is hands-on. It's a it's just, it isn't a collection of techniques or a different way to massage a client. It's a way of thinking about pain and understanding what the body is doing.
And realizing it's actually telling you what it wants you to know through pain. And then using what happens to the pain to help determine what you do next. So one of the principles I teach inside PPS is that the work you do, whatever work you do, needs to create at least a four-point change in pain for me to consider it's effective.
Amy Bradley Radford (30:41.302)
I also learned through mapping and pain level tracking that if a client's pain level could get to a five or below and stay there, then that's when the body can begin moving into a better healing response on its own. That's when inflammation starts changing, in my opinion. And one of the last things about using a pain scale was actually a relief for me. I actually have high expectations of myself. And so when I couldn't do things that I thought I should, I took it really hard. And
The reason the pain scale was a relief for me is it became this profound realization for both myself and the client to realize that zero is not a realistic expectation for pain management. I, when I thought of helping people with pain, thought I had to go to zero. So I would try harder and harder. And it seemed like the harder I tried, the worse I made it.
If you've ever listened to this podcast and thought, okay, but what would Amy tell me to do about my situation? That's exactly what coaching is for. We take everything you're learning here and apply it directly to your business. I love to help therapists who are ready to take what we talk about and put it to work and find their own massage business success. If that sounds like you, I have a coaching request form linked in the show notes.
But if I strived for a four-point change, that four points compounded over time and it would create the possibility for real pain management. To go from an eight to a zero is just trying to force the body to do something it's incapable of doing. We have our hands. That's it. This is a holistic approach. You're not going to fix somebody overnight. You're not going to fix somebody in three sessions, but you can track it in four-point increments to get to the change. It compounds.
But you have to be able to track it to get it to compound in the right direction. I learned that my job was to simply facilitate enough change to give the body the opportunity to take over. If I can use whatever technique is appropriate for that person, create enough change to bring the pain level down and then help keep it down, their body finally has the opportunity to continue doing what it already knows how to do. So mapping and pain levels taught me and the client.
Amy Bradley Radford (33:03.276)
when and how frequency can matter when we're working with their pain. It's not just about convincing them to get back on the table because more massage would be better for them. I'm paying attention to whether the change is holding. If their pain starts climbing again, that gives me information about when they may need another session and whether we're actually keeping them in that lower pain range long enough for the body to continue the process. And the client also has that number so they can follow it and help themselves.
So it's about empowerment, empowering your clients to know how to help themselves better and to use your services as part of their own health and you not being responsible for it. That's a huge one, people. So tracking the pain became really important in overall success. And once I understood the value of that four-point marker, it also gave me something to test my work against. And I started testing it, not just before and after.
But while the person was still on my table. So if I was working with three or four different areas of pain and I needed to know if I was being successful in one area before going to the other, like let's say somebody came in with neck pain at seven, and I might do whatever I thought was appropriate for that, I would have them move their neck again and tell me, you know, what's your pain now? And sometimes they'd say seven. And I'd be like, well, that's kind of crazy, because underneath my hands, their tissue has changed. It felt softer, it moved differently, maybe their range of motion was a little better, and all of those things.
you know, were changing, but the pain hadn't. And so that started teaching me that I needed to ask my client to participate a lot more during the session for the outcome to improve. I needed pain scale ratings as I did my work to know what I was actually accomplishing, which meant I had to tell my clients to expect to participate and talk during their sessions with me. If they want to sleep, we can schedule another session for that. But I'm not the therapist for them if they want to sleep because we are going to work together
in this solution for their body. So one of the things I also started doing when I needed to find what could change that pain level. Like I had exhausted my knowledge. So what was I going to do? I actually started to use my hands as research. So I would take my hands and I would compare the two sides of whatever it is I was working on, left to right. One side would be the side in pain, the other was the the side not in pain and I would assess what felt different.
Amy Bradley Radford (35:30.998)
Between those two parts. So left shoulder, right shoulder, left hip, right hip, right ankle, left ankle. I would go in and I would just feel everywhere because there had to be something. And if someone was lying on my table telling me that their neck still hurt, and I'd already worked with the muscles I thought should be involved without getting the change I wanted, I would start feeling everything and comparing it side to side. And this included the muscles, but it also included surfaces, things like the head, the face.
The chin, the anterior neck, the clavicles, the sternoclavicular junctions, the AC joints, the spine of the scapula, because that's where all these muscles attach to, right? So I started calling this bilateral assessment because because it gave my hands information. It gave me something I was trying to find something and I didn't know what I wanted to find. I didn't know what I needed to find. They were still hurting. I had done what I could, I I'd gone to a different area and come back and you know nothing had changed. And so I was assessing
To see if I was missing something. And you know what's crazy is many times after assessing this way, I was able to perceive a really obvious difference where I couldn't see or feel something before. When I would assess this way, I could tell when I when I came upon an area that felt thicker or more stuck or bound. And the client would say, and almost inevitably, the client would say something like, yeah, I totally forgot all about that.
I separated my AC joint riding my bike ten years ago. Okay, that's an injury that's probably binding up some stuff, all kinds of stuff. Muscles, attachments, ligaments, fascia, all of everything. So maybe I'd work across the top of the AC joint where it was separated, the clavicle, the spine of the scapula, and I would break up the tissue so that it started to match the other side. And we would check range of motion and pain levels, and it typically started producing the change that we were both looking for. That's why the muscles didn't change the pain level.
Everything was stuck where the injury was. It was still stuck. And I later learned that what I was feeling in many of those places were it was just scar tissue that it had been created as part of the healing process, but it was binding up tissue. And as I was releasing the muscle further up, it was actually pulling down, which is why the pain wasn't changing. You know, and I didn't know that when I started. I just knew one AC joint didn't feel like the other one, and pain changed when I worked over an injury, even if it wasn't simply muscles.
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So I'd work with what I found, making the wrong side match the correct side through massage work, bilateral assessment, having them move their neck again, and getting a pain scale. And a lot of times they would say, my gosh, that dropped four points. Because I had spent all this time working with the tissues I'd been trained to associate with their neck pain, and I could feel those tissues changing under my hands without getting much change in the pain. And that's how I started playing on surfaces I hadn't really been trained to work with.
That way in massage school. You know, bone was a big one, tendons, ligaments. I started comparing those surfaces from side to side and paying attention to places where there had been old injuries. I started asking about injuries and where I could feel a buildup of something that was different from one side to another. And as I came to understand scar tissue better, I began recognizing that some of what my hands were finding was scar tissue left behind through the healing process.
So I'd work with what I found, try to make one side match the other, or smooth out an area to make all of it kind of match and test it again. I'd have them move again, I'd check pain levels again, I'd look at range of motion when it was helpful, and sometimes nothing happened. Then I knew I needed to keep looking, but many times I'd work on one of those surfaces and suddenly get a three or four point change that I had been trying to create. And when that happened, I tracked it all.
Then the next person would come in and I would see something similar on that person. And I would try this whole process again to see whether I would get changed through the muscles or changed through these other structures. So the larger pain map gave me the picture of what happened from the beginning of the massage to the end. But my client and I were gathering information together all the way through this massage. And I would work and test and compare and work somewhere else and test again. And over time, all of these things started repeating.
And that's where I really started moving beyond only thinking about you know pain as muscles. The pain was simply showing me that sometimes the muscular work wasn't enough. And when it wasn't enough, I needed somewhere else to go. Where else? At the time I wasn't always sure, but I was willing to listen. And once I saw success with some things that were kind of odd, I guess, I was willing to listen more. So in the end, I followed what changed pain. And eventually some of those surfaces, the bones, tendons, ligaments, old areas of injury.
Amy Bradley Radford (40:13.848)
Places where I kept finding differences from one side of the body to the other started becoming part of what I now understand and teach inside PPSS Scar Tissue platforms. I didn't have that name for them when I started. I was just trying to understand why working on one place that wasn't a muscle could create change somewhere else. But but at least now I had a way to test it. And the more I tested it, the more I started seeing the same things happen over and over again. And this is where mapping eventually became something much bigger for me. Although I I don't want to
make it sound like this happened quickly because it did not. This developed over 25 years or more of working with people, testing what I was doing, paying attention to what actually changed in their pain. And it's still developing. But in the beginning, it almost became more like a matching game to me. I would have someone come in with pain that wasn't responding to more traditional bodywork.
So I would start doing the things we talked about in that last section. I would investigate. I would compare one side of the body to the other. I would try something different. Then I would test it again. Then somebody else would come in with pain in the exact same place. And I would apply what I learned on someone else's body. And I could research that same area, work with what I found, and see if their pain changed too. And if I got a four-point change in pain that stayed, now I had seen matching of pain to specific areas repeat itself.
Once I could repeat this match on a variety of people, I started putting everything I had that worked into written and drawn protocols. And then I started organizing them and started putting them into a binder and separating them by areas of the body, like the head or the neck or the shoulder or so on. And that was really the beginning of what eventually became the PPS mapping manual I use today. You know, but what fascinated me was what all of those maps started teaching me about pain itself.
Trigger points had taught me to be very specific about pain. They taught me the location of muscle, where that highly irritated point was within the muscle, and the pain associated with it. But after all of this tracking, I started to use that pain differently. That active trigger point for those clients who needed a different solution was more like the end of a chain reaction where the pain became the clue. If somebody hurt in a particular place and direct work wasn't changing their pain,
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And I had repeatedly found that working somewhere else changed that pain, then that X on the map was saying, don't work on me, I'm just the messenger. It was saying, if the pain is here, that means go work over there. And I could use the location of pain to help lead me toward the thing that might actually change it. And that's what I mean when I say I learn to read pain. The trigger points, they were only the beginning of that. As I kept mapping, I realized that pain could be all kinds of things.
And in all kinds of places and associated with things more than just muscle. It could be a joint, it could be nerve, there could be a torn ligament or tendon, muscle pain, or trigger point pain. But the pain itself didn't have to be a trigger point for its location to give me information. So what I was developing became much bigger than the reverse trigger pointing concept I originally called it earlier on. It became pain patterns and solutions because it's all pain and all solutions to that pain that I have found.
Over years of mapping these relationships, testing them, watching them repeat, I eventually developed solutions. There's about 115 pain patterns that I developed solutions for. And those patterns began organizing themselves into groups and levels of force. And these are things like I call reversals, transfers, prime mover systems, so as line and the eye platform. And there are specific scar tissue areas and forces associated with each of these groups.
So today when somebody puts an X on one of my maps, I have years, years and years of information behind that X. I can look at that pain pattern, understand which group it belongs to, and have a much better idea of which scar tissue areas I need to search for first. And that gives us more effective ways of progressing through treatments. It also means the pain has order. And that's something else we'll talk about another time. But I didn't know any of this when I started. And I learned it because I started mapping out.
Pain. And what mapping eventually taught me is one of the principles I teach. Pain is information. It's not an invitation. The pain isn't necessarily inviting me to work where it hurts. Sometimes, sometimes it is. Sometimes it's simply telling me where it's coming from. And I think that's where I want to leave the mapping and PPS part of this today.
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If you're working with people in pain and you want to be successful with working with people in pain, I think you need to start being able to see what your work is actually doing. That takes us all the way back to where we started this podcast today. How do you know that what you changed was valuable? How do you know that the massage you just gave actually changed the thing your client came in asking you to help them with? Mapping gives you a way to see that, regardless of the kind of body work you do.
And this is where I want to be pretty bold and tell you that you can do this for yourself and maybe buy my PPS education later when it's ready. Because I'm reorganizing it from my last test in a mentorship group. And there's a lot of work to do still. And I need to finish that work before I push it out into the world. But these conversations I have with you every month are laying some groundwork for both you and I. I want to open your eyes. Your eyes have to be opened to see something different.
And I can do that without you ever being in a PPS program. And quite frankly, that's actually more important to me at this moment than selling you an educational system. I want you to start trying this with yourself. I want you to start having your client draw their pain in red before you start. Have them give it a number, one to ten. Then do the work you already know how to do. If you're trying to change something specific, test it while you're working it. At the end of the massage, have them draw their pain again in red. Give it another number.
And then add your own treatment information in blue on top of that second body diagram after. And now you have something you can actually look at. Maybe they came in at an eight and they're leaving at a three. A big area of pain they drew before the massage is almost gone. And that is amazing information for both of you. Maybe they tell you they feel better, but when they actually draw their pain again, it hasn't changed. And that is great information too, because you need to know that.
offer them a better solution. Or maybe the pain changed location. Maybe one part disappeared and something else showed up. Maybe their range of motion improved but their pain didn't change much at all. Or maybe you did everything you thought should work and nothing actually changed. And all of that, good and hard, is information you need to know if you're truly trying to help someone with pain management. Because if you truly want to make a difference with people who are coming to you because they hurt, you have to be willing
Amy Bradley Radford (47:09.806)
I think this is hard sometimes. You have to be willing to find out when what you're doing isn't working. That doesn't mean you aren't a good massage therapist. It means the work you just did didn't create the change this particular person needed and now you have the information that can help you decide what to do next. Maybe you change treatment. Maybe you investigate something different. Maybe you use another technique you've learned. Maybe you start on some old injuries the client has or some old surgical scars.
Maybe what you're seeing tells you this person needs something outside of what you can provide, and it's time to refer them to somebody else. Maybe you just need to see this client more, and now you have the physical data to show them so they are more willing to help themselves. And because telling and seeing somebody that are very different motivators when it comes to spending money on health. But now you're making that decision with more information, and so is the client. And that's really what I want mapping to give you: a way to really know.
if what you're doing is working. Mapping doesn't only belong to PPS. It it came, PPS came from mapping. Mapping is a tool that lets you see whether you need to change what you're doing or keep doing more of what you're already doing. It's not specific to what I teach. It's a universal tool that I think can be applied to lots of different things. As we go to close this podcast, you know what's really interesting is as I look back through all the different things I've developed in my career because I have a busy little brain.
With almost everything I teach, it has some sort of map to it, a way of seeing things on paper. So in PPS, I learned the hundred and fifteen pain patterns people draw and the categories they sit inside of to know where to start the massage to be f more effective, to work with inflammation and pain. And that's that's a very sophisticated system, but it's still on paper. And it started with mapping someone's pain. And that's the place I start with my students, learning to see pain. But
I look through the other things that I have developed, the Massage Your Market class. So it has six questions that are outlined in a way that the answers, once your client answers them, it will actually kind of curve to one side of the paper or right down the middle. One side is all relaxation, one side is all pain management, and one side is straight down the middle for stress reduction. And it teaches you what kind of a massage, what kind of pressure and a massage the client is looking for. And if the client
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doesn't know exactly what they want, or they're scared of the experience, or this is all new to them, and it's time to educate your client, those answers will zigzag across the paper. And you have a way of seeing it right in front of your eyes that you need to take more time and talk to this person and outline some things. Or what you thought you could offer them isn't what the client wants and it's a way to open up that conversation. And
Th there's actually a line essential oils, which I haven't talked much about on this podcast because quite frankly, I haven't had time to address it. But but I have a line of essential oils, believe it or not. Wow, Amy has something else going on. I started using aromatherapy years ago. I fell in love with aromatherapy like no business. Like I love aromatherapy because it's vibrational medicine. And again, small changes can compound into large changes. But but it ended up being.
I ended up playing with aromatherapy for some very specific reasons that that had to do with pain management. Imagine that. Sometimes the pain you're trying to work with is gridlocked into emotions, things like fatigue, emission mental fatigue, emotional fatigue, depression, anxiety, fear, grief. And I started blending oils to calm those emotions, to just set them aside for a moment, so to speak, so that then I could have the opportunity to work with the with the muscles in the body.
And we know, all of us know, that pain includes all things, physical, emotional, mental, and spiritual. And to avoid me trying to guess if one of these oils would work with people, I created a chart. Imagine that. I created a chart of emotions that go with each of the seven oils I created. And when a client comes in, and I use aromatherapy on most of my clients, when a client comes in, I hand them the pain, the pain mapping chart, and I hand them this little chart. It's actually a dry eraser.
chart and it has six oils on it and they're named and there's emotions under each one of those names and the client can just select which emotions they're feeling that day. I don't have to get any deeper into that and I pick the oils they've picked. I use those at the beginning of the session, things calm and the session is more productive. It's simple, it's easy and it's addressed. But you know there's another theme here for myself. As an as an educator and as a massage therapist,
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I like information that doesn't stay inside my head. It all gets jumbled together. And I think that's I think that's part of having a busy little brain. But and I also don't want people's information to go through my filters and my experience for my answers. And I I know myself that the longer I have worked in this field, the more information I have collected and the more confused I can become because there's too many options and no system to understand why I would choose one thing or another. And I wanted something in front of my eyes.
So I could see things just a little more clearly. So I created these visual systems, solutions to problems we all see, but don't always know what to do with. And these tools help me. And I just want to share them with other people because I think they make a difference. So if you're listening to this and thinking you'd like to try mapping with your own clients, I I'm going to make the pain map I use available for you to download. I'm also going to include some simple directions and examples so you can see how I use it in my own practice and have something.
you can take straight to your treatment room and start working with it and just see what happens. So I'm going to put the link in the show notes. It's free. Grab it, print it out. Yes, you are going to have to print paper. Go grab a blue and red small dry eraser marker and go ahead and give it a try. I have another goal to also place a video a week on YouTube that demonstrates the outcome of clients' pain using these techniques. But I'm going to ask you to be patient with me if it doesn't happen every week. Again
If you've been listening, flexibility is required in my life and we just kind of roll with with what we have and what we don't have. But I will tell you, if this way of looking at pain and thinking through what you're finding with your clients is interesting to you, I just want you to keep listening to these conversations. I've already taken that group of therapists through the PPS mentorship, and I'm just reorganizing that material on what I learned worked and didn't, and figuring out the best way to teach it. And when it's ready, and I I do expect that to be in the near future.
I'll be able to share more with you about what learning PPS will look like. But for now, I'm going to start you the same place I start every one of my students. You're going to start mapping, and you will be amazed at what it teaches you. I'll see you next week. Thanks for spending part of your day with me. If today's episode helped you, please subscribe, leave a review, and share it with another massage therapist. To learn more about today's topic, explore continuing education, coaching,
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And free resources, visit Amy Bradleyradford.com. And until next time, keep building the business and the career you love.
