SPRING 2013 ISSUE

CONTENTS
Features
Ethics, Boundaries
and Common Sense
6
p8
Despite Our Differences 8
2013 Business Supplement 11

p11

Departments
p16 From the Editor 5
Resource Directory 29
RMT Tech Talk 30
Relocating Your Practice 24
Assessment Made Easy 26

MASSAGE THERAPY CANADA • SPRING 2013 3

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Editor
Spring 2013 - Volume 12, iSSue 2
Maria DiDanieli • mdidanieli@annexweb.com
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massagetherapycanada.com
from the editor
I
s massage therapy a complementary and
alternative (CAM) specialty?
In health-care literature, scientific or other-
wise, authors often classify massage therapy (MT) as CAM. This is certainly
the case when they are not MTs themselves, but is true even when they are.
Furthermore, when medically based researchers – even those who position
themselves as advocates – give presentations relating to MT, they use the
term CAM to describe the profession. It seems that the tendency to slot MT
into the category of CAM has become ubiquitous.
So what, you ask?
Linguistic theories suggest that the terminology used to describe an entity
– for example the classification of massage therapy as complementary or
alternative, as opposed to simply referring to it as a manual therapy – relates
to society’s impressions of that entity and perhaps even influences how it is
perceived (and therefore, when it is sought out or offered). And so, although
MT has a very rich history of clinical experience and a growing body of
research demonstrating how it can integrate into mainstream health care, I
would argue that when medical professionals – especially massage therapists
themselves – persist in referring to it as CAM, they encode in the minds of
the public, and the profession, biased notions of limited utility.
We have, in our pages, often discussed massage therapists taking the reins
and becoming leaders in the process of their profession’s growth, working
from within to educate one another, the medical community and the public
regarding the benefits that MT can offer. Even with MT evidence being in a
relatively early stage, it is possible to offer solid arguments, backed up by initial
findings, for its safety and inclusion in treating patients in a variety of clini-
cal situations. The groundwork is there for the profession to springboard its
way back into mainstream health care, where it flourished throughout many
periods in time, and in a number of cultures! This leap will involve shifting
the opinions of health-care professionals and the public regarding MT’s role in
today’s health and wellness strategies. Why not lead the way in this process by
dropping the inherently restrictive CAM nomenclature?
The time has come for you to redirect the perception others have regarding
what you do and its role in health care. This involves educating those you
aspire to work with, but you must begin by rethinking how you define your
own level of value. You are part of a health-care approach that could work
in concert with other disciplines, in either a supportive or a leadership role
depending on the situation at hand.
The next step is to take control of all aspects of your message so that some-
body else does not have the opportunity to do so. As such, to confine your-
self – or to allow the greater health-care community to confine you – to the
category of an adjunctive therapy, or among a lost-and-found of curiosities to
explore if nothing else works(!), is not only selling yourself short and restrict-
ing how you’re perceived by other practitioners and/or the public. . . it’s also
depriving potential patients of the opportunity to access the very real benefits
that can be derived from what you do.
So, are you CAM? Whether you, and others, see you that way . . . is really
up to you!
Bien à vous,
MASSAGE THERAPY CANADA • SPRING 2013 5
Feature
BY JONATHAN MAISTER, BSOCSCI, DIPSIM, CAT(C), RMT, SMT(C)
Ethics, Boundaries and
Common Sense
Merging the clinician and human within us
M
any are the challenges of a career in health care. Ethics – in particular, boundaries – is one
area that is intangible yet cannot be ignored under any circumstances. If this area is neglected,
the professional’s entire practice may be compromised and the patient harmed.
This raises the question, how does one define something as eso-
teric as boundaries in a form that can be clearly recognized and
then effectively implemented? This scenario is often compli-
cated further by the vast array of cultural backgrounds of both
professionals and patients. Furthermore, the emotional status
of both patients and practitioners differs at any given time and
must also be considered.
This article serves to offer that elusive template that will guide
the health-care practitioner through this muddy macrocosm.
RECOGNIZING THE BOUNDARIES
Boundaries are divided into five distinct groups: physical, emo-
tional, sexual, intellectual and energetic.1 All are to be respected.
The word “respected” is used by design, for there may be
situations where boundaries are semi-permeable and the health-
care practitioner, as a compassionate entity, may be required to
nudge across the line and do the right thing by the patient. For
indeed, we, as massage therapists, live in two universes: that of
the (ostensibly) dispassionate clinician, and that of the compas-
sionate human being. Hence we must acknowledge the bound-
aries, uphold their barriers, but know if and when, on that rare
occasion, we can shift across the threshold, albeit briefly, for the
patient’s benefit – not ours! This will be explained later in this
discussion.
Physical
In daily life, the physical boundary is the most obvious one and
is continuously adjusted depending on the situation. Mainly
subconsciously, we alter this boundary depending on whether
the other person is a stranger or a familiar person, unkempt or
neat, and whether the respective moods of the persons invite a
closer physical space. Clearly, in the presence of a foul mood,
both persons will likely keep a greater distance. In the medical
environment, the physical boundary is clearly much closer than
in normal circumstances and absolutely involves a large measure
of trust. It also varies depending on circumstances, whether we
are referring to contact made during treatment or a handshake
greeting in the common waiting area.
6 MASSAGE THERAPY CANADA • SPRING 2013
Emotional
The emotional boundary defines people by their emotions,
and how closely they allow others to be privy to their emotional
status. Once again, trust is paramount because we are sharing
that which is supremely private with another person. This is
exquisitely so when a patient discloses his or her personal details
to the therapist. The degree of comfort and trust we have with
the other entity will determine the permeability of our emotional
boundary.
Sexual
The sexual boundary determines the sexual limits between two
people. For example, as a platonic relationship evolves into a
romantic one, the sexual boundary shifts closer. This boundary
must not under any circumstances be violated when there is a
clinician-patient relationship. The laws stipulating the limitations
of a romantic relationship in this context – which for health-care
personnel in our country typically is defined on the level of zero
tolerance – must be adhered to beyond any negotiation!
Intellectual
The intellectual boundary reflects one’s beliefs, opinions and
thoughts. These, in turn, define our identity and distinguish us
from others. In essence, if our “universe” and its belief systems
are affirmed or respectfully challenged, we are validated as people.
Conversely if our “world view” is mocked or denigrated, our
comfort with ourselves is threatened and, clearly, we will avoid
giving the other party access to our thoughts. Simply put, how
permeable, or how solid, our intellectual boundary is to the
other person depends on her/his responses to our world view. As
health-care workers, our openness to our patients’ “world view”
could impact the nature of our relationship with that patient.
Energetic
The energetic boundary is probably the least obvious, at least
initially. Therapists will become increasingly aware of it over time
as their intuitive senses evolve. From our first-year physiology
classes, we know that humans are biochemical entities. As our
body processes unfold, we generate an electromagnetic field. Just
as we adjust our emotional, physical and other boundaries, so too
it is wise we protect our own bio-electric field from those of our
patients. Often our patients, experiencing health challenges, emit
what is described by Ronan M. Kisch, PhD, as psycho-physical
toxins.2 These impede the health of our own fields and, if left
unchecked, are deleterious to our health.
Exploring boundary models further and how they evolve is
beyond the scope of this article. These are excellently investigated
by Ben E. Benjamin, PhD, and Cherie Sohnen-Moe in their out-
standing book The Ethics of Touch (2003: Sohnen-Moe Associates
Inc.).
TWO SCENARIOS
I differentiate a “boundary violation” from a “boundary cross-
ing.” The former is unwanted, possibly offensive and conceivably
damaging at a physical or emotional level. The latter is usually
non-threatening to either person, not damaging to the profes-
sional relationship, and may even be invited.
Applying these premises to real-life scenarios in health-care
practice yields some interesting results. Over the 19 years of expe-
rience as a health-care professional, I have been privy to moments
when the dispassionate clinician in me is apparently in conflict
with the compassionate human.
I recall two parallel situations that illustrate this dilemma. With
both examples, there were middle-aged female patients who
at some emotional level, I felt, needed a physical response, for
example, perhaps a hug.
In the first instance, I had been treating the patient for various
physical issues. Parallel with this, she had, in months preced-
ing, been dealing with profound medical challenges of her own.
Serious health concerns had unfolded with two other people who
were close to her, one of which had resulted in death in extremely
tragic circumstances. She was a courageous individual but con-
fessed to having moments of weakness – understandably. Post
treatment, one day after a particularly intense catharsis in con-
versation, I felt an overwhelming urge to hug her in the empty
waiting room prior to her departure. The human in me felt com-
pelled to show my support as “one human being to another” in
a tangible way. At a deep level, she had given me access beyond
her emotional boundary and, clearly, trusted me. Would my
response be a violation of her physical boundary?
In the second instance, another usually cheery and gregarious
patient silently entered my treatment room looking extremely
sad and sullen. Preceding any history or greeting, she blurted
out, “I need a hug.” I was taken aback. We had had a wonder-
ful professional relationship lasting years, but this was the first
such request. This was one human crying out for support from
another. In essence I was being asked to shed my clinician per-
sona briefly, then having hugged her, readjust to my usual clini-
cal identity. Knowing my professional boundaries, this was not
something I took lightly.
I was, in both instances, facing a dilemma. In both situations
the human in me felt I should hug my patient, yet the clinician
in me felt I should remain aloof, albeit not detached.
TWO SOLUTIONS
I believe I made the correct decision with both situations.
Understanding boundaries, yet using the premises of “Do no
harm” and “What would any rational person do in this situation?”
and simple common sense, I did as follows:
In the first instance, I did not make any physical contact with
my patient. I allowed my voice, my compassionate words and
my body language convey my sentiments. At some deep level,
I sensed that a hug in those circumstances was for my benefit
rather than hers. And that was the defining factor.
In the second situation, I did as my patient requested. I
stepped forward, put my arms around her while minimizing
actual body contact, and held her for five seconds. She appeared
marginally less distraught, and we proceeded with the history.
Her situation involved severe abdominal pain. Ultimately it was
due to kidney stones or a hernia. But her concern, until she
received the diagnosis otherwise, suggested a possible aggres-
sive cancer. But my hug gave her some physical comfort. Once
again, the notion of rational, common sense coupled with the
overriding premise that this is for the patient’s benefit, prescribed
my course of action. My physical response did not, in any way,
disturb our clinician-patient relationship.
Boundaries are strict thresholds that must be respected.
They are clear guidelines that primarily protect the patient,
but also assist the health-care practitioner in making wise
decisions. Boundaries and rational common sense almost
always work together flawlessly. However, there are those
few moments when an apparent contradiction occurs. These
moments are rare but they do happen. At those times bound-
aries shift – they do so very briefly, and then only to meet the
patient’s needs. In essence, it might even be more accurate
to define the boundary as having shifted rather than been
crossed.
The passage of time, both as a therapist and even more so
as a sensitive and rational human, yields many lessons. For
this reason, it would be true to say that one becomes a supe-
rior therapist. This is so, not only because one adds to one’s
repertoire of treatment modalities, but because increased life
experiences gives one a greater range of life contexts to draw
from. When these unexpected human situations occur, they
are far easier to deal with.
Over the years I have acknowledged that the “dispassionate
clinician” and “compassionate human” need not be a contra-
diction. By applying the guideline of boundaries, and rational
common sense, I like to think of them as merging.
REFERENCES
1. Ben E. Benjamin, PhD, and Cherie Sohnen-Moe. The
Ethics of Touch: The Hands-on Practitioner’s Guide to
Creating a Professional, Safe and Enduring Practice. 2003:
Sohnen-Moe Associates, Inc.
2. Ronan M. Kisch. Beyond Technique: The Hidden
Dimensions of Bodywork. 1998: BLHY Growth
Publications.
Jonathan Maister is a Canadian trained Athletic
Therapist, Massage Therapist and Sport Massage
Therapist. He is in private practice in the Markham
area and has lectured on a number of sport mas-
sage and sport medicine topics across Canada. He
has authored articles that have appeared in various associated
journals across North America. He can be contacted at jmthera-
py@jonathanmaister.com or 905-477-8900.
MASSAGE THERAPY CANADA • SPRING 2013 7
Feature BY DON DILLON, RMT

Despite Our
Differences
MTs must band together to move forward

I
n the massage therapy profession, we seem to disagree a lot. We argue whether or not spa therapy
has value compared to rehabilitative massage (both approaches serve entirely different markets), if
practice should be guided by evidence instead of traditional knowledge and experience (why not
both?), and if we should advance our credentials via a degree-level program in anticipation (and a
great deal of assumption) of attaining more credibility and better positioning in a resource-strapped
health-care system.

Practitioners yearn to dialogue and debate the jugular issues.
Our training colleges can fail to maintain contact with their
graduates, other schools, the professional association or regula-
tory body. These profession stakeholders, in turn, are just as
guilty of fraying the lines of communication. Opportunities to
apprentice, to collaborate as part of a team, and to debate the
fundamental problems facing massage therapists on a day-to-
day basis are few and far between.
Entry-level massage therapists with few contacts and little capi-
tal or business experience rely heavily on practitioners with estab-
lished practices – or managers of spas and rehab facilities – to
show them the ropes and create opportunities they themselves are
not yet capable of creating. Financial ignorance, transience, fear
of the regulatory body and distain for impotent representation by
some massage therapist associations compounds the problem.
Remarkably, despite the privation of fertile ground to cultivate
massage therapist practices, we somehow forge ahead. Massage
therapy remains an underdog in the convoluted and tightly
wound medical hierarchy but remains high in public appeal
nonetheless. Despite competition from better-organized, better-
resourced and more mature disciplines in both Western medicine
and the complementary and alternative medicine (CAM) fields,
massage therapy remains buoyant.
We should not rest on our laurels, for the existing threats
mentioned above have magnified in the turn-of-the-century
depressed economy. In the name of professional preservation,
there has never been a more acute time to pool resources and
get organized.

8 MASSAGE THERAPY CANADA • SPRING 2013

 Whatever fractures us as a profession – ideology, bureaucracy,
provincial boundaries, isolation – let’s agree to find common
ground and support practitioners. Whether rehabilitation, spa,
workplace wellness, complementary and alternative/integrated
medicine . . . massage is coveted, is demanded by the market-
place and has a real contribution to make to society.

STRATEGIES FOR IMPROVEMENT

“If I were King of the land,” here are the steps I would mandate:

Cultivate thought-leaders
I think we should focus on bringing our brightest together in a
physical or virtual symposium to discuss the key issues: finding
viable business models, determining how to support RMTs-
turned-business owners; learning how to manage multiple
identities/market sectors served; ensuring the quality of training
colleges, accreditation and interjurisdictional competencies;
mitigating incredulity with government, insurance industry,
gatekeeper disciplines and pubic/media; and advancing regula-
tion and research. The objective of this think-tank: put forth
tangible solutions to address core profession issues head on.

Our rich, interwoven, multifaceted

history requires a different future
than other professions.

Involve all stakeholders

Once initial recommendations are formed, we would share
the findings with massage practitioners across the country for
their reflection, input and to enrich the plausible solutions put
forth. Educators and training school administrators, regulators,
researchers, suppliers, publishers and employers would all be
invited to help us shape our direction.

Get to know ourselves

We need to poll practitioners across the country on key bench-
marks – net income levels, work capacity compared to actual
workload, type of practice/market sector served, age, gender,
rural or urban, perceived obstacles to work (physical, busi-
ness or manual/technical expertise, resources), years of practice
and employment status – employee, self-employed or business
owner of group practice. We will need a lot more information
regarding the health and demo/psychographics of our practi-
tioners if we are to support them in building practices.

Ensure resources for professional associations

In order to function at optimal levels, our associations need
to hire great support staff and ensure sustainable funding
for operations. Associations can pool resources and lever-
age power to obtain preferred pricing for member services/
products, launch a national public/media relations cam-
paign, offer excellent professional development programs,
support research, exert political influence on government
health-care and taxation policy, improve insurance industry
and gatekeeper health practitioner relations while dealing

MASSAGE THERAPY CANADA • SPRING 2013 9

with exploiters and profiteers, and continue to poll mem-
bers as to viewpoints, professional practice benchmarks and
emerging expertise.
Collaborate
RMT association representatives would identify shared
resources, craft strategic plans and take initial steps to actu-
alize the objectives in tandem. Inherent in carrying out the
strategic plan is the convention that common operations
can be better served through national collaboration rather
than reinvent-the-wheel, “made-in-so-and-so” policies.
Raise the bar on education
We need to support training college accreditation, compli-
ance with interjurisdictional competencies and health-care
regulation and support evidence-based practice.Admittedly,
we need to dovetail these objectives while acknowledging the
diversity of practice and holism of philosophy that constitute
massage therapy’s identity. We are not physiotherapists or
chiropractors . . . our rich, interwoven, multifaceted history
requires a different future than other professions.
Provide a hand-up to practitioners
We should continue to strengthen RMT practice with men-
toring, semi-annual virtual symposiums and community
groups. RMT practice can be isolating – RMTs must get
together more for dialogue and debate. The eventual and
10 MASSAGE THERAPY CANADA • SPRING 2013
hoped for result . . . innovation and evolution.
Join forces
Eventually the organized and united massage therapy pro-
fession could consider partnering with major CAM profes-
sions and corresponding industries in fitness and wellness
to exponentially increase marketplace presence and power.
Common objectives include training and education, research
and developing evidence-based practice, lobbying govern-
ment and insurance industry for more favourable policies
and compensation, and financing strong public and media
relations. Combined efforts would help to position health
and well-being as a societal ethos . . . something that is part
of the culture and fabric of society.
Despite our differences, I know we can find common ground
in our objectives and make a pact to see things through.
Don Dillon, RMT, is the author of Massage Therapist
Practice: Start. Sustain. Succeed. and the self-study
workbook Charting Skills for Massage Therapists. Don
has lectured in nine Canadian provinces and over 60
of his articles have appeared in massage industry pub-
lications in Canada, the United States and Australia.
Don is the recipient of several awards from the Ontario Massage
Therapist Association, and is one of the founding members of
Massage Therapy Radio www.massagetherapyradio.com. His web-
site, www.MassageTherapistPractice.com, provides a variety of
resources for massage therapists.
 2013 Business Supplement

Business and CONTENTS

growth in 2013
T
he “bottom line” is on everyone’s minds, these days, as we
Canadians hopefully continue to pull out of the global reces-
sion. While the Canadian public needs massage therapy and
all its benefits more than ever, during tough economic times,
they are careful with their dollars. And although the value of mas-
sage is becoming increasingly recognized in managing and treating
many conditions – stress relief of course among them – massage
therapists must continue to market their services, and ensure their
business practices are optimal as well.
p16
12
While Massage Therapy Canada continues to offer you important business-related arti- The Key to Financial
cles in each edition, in this issue we’ve put together a special supplement of business- Success
related articles on a variety of critical topics. Donna Micallef on consistency and
Lior Samfiru and Chuck Tahirali of Samfiru Tumarkin law firm provide an in-depth lessons learned
look at why determining the therapist-clinic legal relationship is so important – and BY TREENA HEIN
how to do it. If you aren’t careful about nailing this down, you leave yourself open to
the possibility of costly mistakes. 16
Semi-retired commercial real estate/business appraiser and financial analyst Lloyd Practice Management
Manning explains how a practice valuation is conducted; this article will be of interest Software
to those of you who are thinking of selling your practice for whatever reason – now, Why it’s important and what to look for
soon or far in the future. BY LIZ PRIDHAM
Donna Micallef, the co-owner of one of Canada’s most successful massage therapy
product businesses, shares the lessons she and her business partner have learned over 18
the years, and also presents her ideas on the keys to financial success for massage therapists. My Massage Therapy
Timothy Feher, the creative director at Blue Bear Media and Mission to Vision Practice
Communications, examines how the business plan is critical as your road map to suc- What is its value?
cessful business development. Feher is frequently called into organizations large and BY LLOYD MANNING
small to assist with development issues and he’s continually surprised at how many are
suffering because they don’t have the strategic focus of a current or comprehensive busi- 20
ness plan. Don’t let your business be without it. The Business Plan
We hope you enjoy these articles – and most importantly, we hope you learn some- Your road map to successful business
thing valuable. We look forward to your feedback as well. development
BY TIMOTHY FEHER

22
Therapist-Clinic Relationships
Associate editor, They may not be what you think
Treena Hein BY LIOR SAMFIRU, LLB, AND CHUCK
TAHIRALI, MIR

MASSAGE THERAPY CANADA • SPRING 2013 11

 2013 Business Supplement
The Key to
Financial Success
Donna Micallef on consistency and lessons learned
BY TREENA HEIN
T
“ he most important thing for thera-
pists to remember when building
their practices is to be consistent in
everything they do,” says Donna
Micallef. “This means the hours they keep,
the services they provide and their use – and
sales – of quality products. The general public
is very knowledgeable and demands repu-
table products, and the use of products with
integrity directly reflects on how a practice is
perceived.”
Micallef co-owns Know your Body Best
(KYBB) in Toronto with Constance Rennett.
It was Rennett (a full-time practising RMT at
the time) who had the idea in 1992 to open Donna Micallef, co-owner of Know
a retail store with Micallef for other therapists Your Body Best.
besides her clinic, and since then, the pair has
never looked back. The product supply business was a boom-
ing success from the start and kept the two so busy that they
sold the clinic shortly afterwards. KYBB now sources, whole-
sales and ships internationally, supplying massage therapists,
physiotherapists and spa operators, as well as the general
public.
“Prior to KYBB there was no full-service supply store in
Canada for massage therapy or other complementary thera-
pies,” Micallef notes. “The industry really needed a company
dedicated to providing therapists and their clients with qual-
ity products.” She adds, “With Constance being an RMT,
and me having many years of business experience, it was a
great fit for both of us in the beginning and still is today. We
feel that our efforts over all these years have contributed to
massage therapy growing to where it is right now.”
From the start, Micallef and Rennett travelled to places
such as California to educate themselves on the best and
newest products on the market. “From the beginning,
we also wanted to have an educational component, offer-
ing books and anatomy charts,” says Micallef. Their large
product line helps therapists meet the needs of their clients,
ranging from pain management and mobility products to
12 MASSAGE THERAPY CANADA • SPRING 2013
relaxation and feel-good items. They offer
herbal bath products, relaxation CDs, candles,
slippers, bath robes, inflammation and pain-
reducing lotions, as well as a range of hand-
held tools to increase circulation, stimulate
healing and more.
HELPING OTHERS BUILD THEIR
BUSINESS
But the owner and staff of KYBB support the
massage therapy profession by doing more
than just selling products. “We wanted to
develop a business that helped other people
build their businesses,” says Micallef. “We
always have an eye on selling products that
massage therapists can trust are safe and ben-
eficial for patients, products that help them
maintain integrity in their business practices.” From time to
time, Know Your Body Best runs in-house workshops and
seminars and Micallef and Rennett are available to talk to
RMTs in other ways as well. “We’ve featured Don Dillon
who teaches practice management and Paul Lewis who teaches
various advanced massage techniques,” Micallef explains.
“We’ve also had suppliers do presentations, teaching the value
of using their products in treatment.”
Micallef and Rennett make sure their staff is knowledgeable
and skilled about each product, with each person able to pro-
vide the right guidance and advice on which products would
work best for each customers’ needs. “Customer service is
number one in our minds,” Micallef says, “and we work hard
each day to give the help and advice that is needed.” New
staff members spend the first four to eight weeks working
with a senior team member, learning about each product and
how the business systems work. “They do a lot of reading,
feeling, smelling and experiencing the great products,” says
Micallef. “We make training very interactive.” She says new
staff members are chosen for their good character, commit-
ment to customer service and love for the industry, along with
their individual skills that will complement the existing team.
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 2013 Business Supplement
CONSISTENCY IS CRITICAL
Micallef can’t stress enough that consistency is the num-
ber one key to financial success for massage therapists.
“Inconsistency is a very common pitfall that can be easily
avoided,” she says. “Because therapists are self-employed,
they can find it easy to take time away from their schedules
and not provide consistent hours and services. They not only
must not do this, but be consistent about marketing their
services, and working their referral networks to maintain and
grow their client base. It’s about regular general discipline.”
She says marketing and networking should include regular
visits to other therapists in the area to help find your “dif-
ferential advantage” – what you do that others don’t. Micallef
also recommends working together with other professionals
as a community dedicated to providing great care. “In this
way, you can share clients, build a full spectrum of services
and consider advertising together,” she says. “Introduce
yourself to other therapists, get known and capitalize on your
differences.”
Beyond offering quality treatment products, KYBB puts a
focus on patient safety as well. “For the safety of patients and
to avoid liability issues, quality tables are a must,” says Micallef.
“CSA-approved electrical products are a must as well.”
Micallef adds, “Clients will feel well-taken-care-of when
your linens are good quality and clean and fresh. And offer-
ing a selection of quality lubricant products allows them
to customize treatments to what they prefer – gel or oil or
lotion – which in my experience, they greatly appreciate.”
Micallef strongly believes that offering a selection of prod-
ucts to treat a problem area at the end of treatment is a car-
ing touch that massage therapists should provide – one that
also brings back clients for follow-up visits. “Having these
products for sale to your clients is a convenient and thought-
ful service to offer and adds to your profit,” she says. “You
should definitely consider having on hand a few thermo-
phores and antiflamme, or pain creams, for pain relief. Your
customers will be grateful. By using quality, reputable prod-
ucts and equipment, your image will only be enhanced but
so will the image of your entire profession.”
Treena Hein is a freelance writer and editor based in
Eastern Ontario. She has also created educational
resources and runs her own seasonal historical walk-
ing tours. Treena is the proud winner of two awards:
the International Federation of Agricultural Journalists
“Star Prize” and the Canadian Farm Writers
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 2013 Business Supplement

Practice Management
Software
Why it’s important and what to look for
BY LIZ PRIDHAM

W
hether you are setting up a brand new
clinic or enhancing an established practice
location, there are many priorities compet-
ing for your available budget dollars. One
of the best investments you can make for your practice is
a good Practice Management Software (PMS) program.
There are many different systems available: some basic,
some with an assortment of bells and whistles. The fol-
lowing tips and ideas will provide you with information so
you know how you can profit from a practice management
program and what to look for in your software. Making an
informed choice is key to ensure your program will give you
the information you need to help you make better business
decisions, and also to help you provide high-quality service
to your clients.

FIRST IMPRESSIONS COUNT

As a health-care professional, you want your clinic’s first
impression on clients to be professional. Your clients want
to be in an environment that is professional and caters to
them. By introducing practice management software into
your clinic, you will be adding one of the components of a
positive client experience. Whether it means you are able to
schedule appointments more quickly, give your clients state-
ments for extended health care or provide reminders and recalls,
PMS is a tool to help you enhance that client experience.
EFFICIENCY, EASE AND SUPPORT
One of the advantages of having a PMS is the time that can
be saved compared to maintaining paper records. You work
hard, so whether that time saved means you can treat more
clients, devote more energy to building your practice or have
more time for yourself, it is a benefit that you should realize.
Your chosen profession is massage therapy not information
technology. Is the PMS you are considering intuitive, user-
friendly and easy to learn? Are there training options if you
don’t want to learn by reading a manual? Does your software
provider offer you support when you need it? How easy is it
to access that support and what are the costs involved? These
It will take some time to investigate practice management software
options, but the benefits, to you and your clients, of having a system
that is right for your practice will be worth it.
are all important considerations in choosing a PMS, if you
want to spend your time working with your clients rather
than your computer.
ESSENTIAL FEATURES
General Elements – Practice management software should
be able to record and manage all your client demographic
information. Once your client has completed intake informa-
tion, your software should allow you to access and update
that information quickly and easily. The software should be
able to use this demographic information to create a mail-
ing list of your clients or a list of your new clients. Also, it
should give you referral information so that you can adjust
your marketing plan based on what is working well or not

16 MASSAGE THERAPY CANADA • SPRING 2013

working so well. Client privacy is always important and the
software you use should have security features that keep your
client records secure.
Your time is valuable and so is your clients’. The software
solution you choose should effectively manage appointment
schedules – yours and your client’s. It must allow you to
provide excellent customer service to your clients with an
appointment book that is flexible and easy to use so you can
book appointments quickly. It should be simple when you
need to add new, and change existing, appointments. You
must have quick access when you want to view your schedule
or confirm a client’s next appointment. There must be tools
available to help you manage your client’s treatment plan by
keeping them on schedule.
Accident Claims – Some of the clients you will see in your
practice will have injuries sustained in motor vehicle acci-
dents or workplace accidents. In many provinces there are
extensive paperwork requirements when you treat accident
victims. Electronic form submission and billing require-
ments exist in some places and your software should be
able to help you meet these requirements. Many of your
clients will need to submit expenses to extended health-care
providers. Does the software you are considering have func-
tionality in place to help your clients get what they need for
reimbursement?
Reporting Options – A software solution is only a solution
if you are able to use it effectively to produce the results
you want and the reports you need. When investigating and
comparing PMS, check the available reporting options. There
should be a range of reports to give you valuable practice
information. When you need to create accurate financial
reports for your bookkeeper or accountant, it should be
straightforward. Consider the ease of tracking revenue and
cash flow. Consider the management of your accounts receiv-
able. A PMS should make producing client receipts and
statements effortless, reduce time required for billing and be
able to give you numbers that make sense.
As Your Practice Grows – As your practice grows, does your
software grow with it? Will it expand to accommodate mul-
tiple practitioners? If you are joining an existing practice, is
there software in place that will provide for your needs? If
your expansion plans include introducing different disciplines
will the practice management software support everyone?
It will take some time to investigate practice management
software options that are available to you but it is worth the
effort. You and your clients will benefit from a software solu-
tion that provides features designed for your practice.
After many years working with DCs as a chiropractic
assistant, office manager and bookkeeper, Liz
Pridham joined the Ontario Chiropractic Association
in 2004. As part of the software department she is
involved in testing and offers support and training to
PMP users. Liz’s clinical experience in multidisciplinary
offices along with her background in accounting give her the ability
to offer practical examples and suggestions to apply PMP in your
office for maximum results.
MASSAGE THERAPY CANADA • SPRING 2013 17
 2013 Business Supplement
My Massage Therapy
Practice
What is its value?
BY LLOYD MANNING
A
t some point, every massage therapist thinks that
now is the time to sell out or do something dif-
ferent. No matter the reason, there is always the
question: does my massage therapy practice have
a value? The truth is that many massage therapy practices can
command a high dollar while others are worth very little.
The first step in establishing market value is a clarification
of what is to be for sale. A buyer will weigh the logic of buy-
ing your operation, buying another or establishing a new
practice. A fair value for your massage therapy practice is
what another will pay for it and what you will accept.
GOODWILL DEFINED
Other than furniture, fixtures and equipment (FF&E), for
most massage therapy practices the value is in “goodwill.”
Although there are several definitions, the best comes from a
1910 English law case, where a Lord Eldon stated “Goodwill
is nothing more than the probability that the same patrons
will continue to patronize the same shop.” In addition to
FF&E, this is what you have to sell and this is what a valua-
tion puts the dollar sign in front of.
We will place goodwill into three distinct categories:
Personal or Professional – This is goodwill that’s been built
up by the work of the therapist. When (s)he leaves, any
goodwill created by his/her abilities, techniques and personal-
ity leaves too; however, because a successful practice is largely
a trust relationship between the professional and the clien-
tele, that trust may be partly transferable. A fair assumption
in clients’ minds is that the new buyer will have the same
training and professionalism as the seller. This ensures a mea-
sure of continuity. So, the value here relates to the trust of
the clientele in the established system of training and accredi-
tation of massage therapists.
Goodwill of Establishment (a.k.a. Business Goodwill) – The
longer the practice has been established, the more regular and
devoted the clientele and the greater its value. It’s about the
probability that the same clientele will return, no matter who
is in charge. The measure is the retention and potential for
continued patronage from existing clients. Consider the com-
petition: some is good but excessive competition is ruinous.
18 MASSAGE THERAPY CANADA • SPRING 2013
If the market for therapeutic massage is large and expanding,
competitors will soon appear.
Location – A massage therapy practice can be location-
dependent or location-independent. Location-dependent is
where the clients are nearby. The practice cannot be simply
packed up and moved across town without losing many of
them. Location-independent would be where the practice
can be easily relocated, and the clients will seek it out. If
independent, there is no goodwill of location. Everything
depends on the source of the clients. If they are drawn almost
exclusively from the massage therapy operation being part
of a spa or recreation centre for example, this is definitely
location-dependent. Alternatively, if the clientele is scattered
throughout a larger metropolitan area and it would be unim-
portant were the practice located a few blocks or so here or
there, any goodwill value for the practice would only exist for
reasons other than location.
VALUATION METHODS
There are two common valuation methods and each
method has its shortcomings. All that anyone can do is give
it a best estimate. One of the two methods is a “Market
Comparison,” where revenues and selling prices abstracted
from the sale of other massage therapy practices are com-
pared. While data is lacking on the value ranges for massage
therapy practices, they are usually valued between 40 and
60 per cent of annual billings. As there are many factors
involved, the spread is large and this procedure provides
only the broadest of value estimates. Secondly, the “Excess
Earnings Approach” is the summation of the value of the tan-
gible assets, usually limited to the FF&E plus a dollar figure
for goodwill. An explanation follows below.
TANGIBLE ASSETS
A quick method for providing a reasonably reliable estimate
of the in-place value of the tangible assets (principally FF&E)
is first to determine their replacement cost and then to cal-
culate their depreciated value. Estimate the in-place value
as halfway in between. For example, assume that the cost to
replace the FF&E new would be $20,000. Normal useful life
is 15 years. They are now eight years old. The depreciation
would be 8/15ths or 53.3 per cent of $20,000 or $10,660
with a depreciated value of $9,340. The halfway would be an
estimated value of $14,670. The result is not what you could
sell these assets for on the open market, but a value in-place
and in-use that is part of a going concern.
VALUE OF THE GOODWILL
Start with the last five years of average income and expenses
if the income is variable, or at least three years if quite steady.
If there is a noticeable trend, one way or the other, use the
last two years. Remove anything that has nothing to do
with day-to-day operation, such as windfalls, major losses or
purchase/sale of assets. If you own the real estate, add to the
income the amount that you pay for mortgage amortization
but subtract what you would have to pay for rent were the
property owned by another. Always assume the FF&E to be
free of debt, even if this is not true. Determine a fair wage
for yourself. Do not consider it as an expense but adjust it
to what you could earn if working for another, or what you
would have to pay someone to manage your practice. Deduct
all other expenses except interest on debt and depreciation on
capital assets. The remainder is an adjusted cash flow figure,
on which the goodwill value is based.
The goodwill value is calculated by multiplying the adjusted
cash flow by a factor, but the eternal problem is what that fac-
tor should be. In my opinion, if it’s a relatively new practice
or one with little anticipated client retention, a factor of one
would probably be about right. If it’s a well-established or
a group practice, three or perhaps even four times could be
appropriate. For total value, add to the goodwill the value of
all tangible assets, and the real estate if a part of the package.
Bear in mind that only a ballpark figure is produced, one
from which to begin negotiating. Because it is not possible
to reconcile every value contributor or detractor, the best of
appraisal methods has its limits. Check the result with what’s
happening in your marketplace.
Any value estimate is always subject to adjustment by other
determinants. These would include non-competition clauses,
seller financing, or an “earnout,” where you stay with the
practice and accept payments. This last situation is affected
by excessive competition, obsolescence, or where the practice
is largely built on specialized services that are difficult for the
new entrant to continue.
In the end, it still comes down to one’s personal judgment.
What are buyers willing to pay? What will sellers accept? The
going concern value is always based on what is there, the
transferable portions of the practice, and the level of willing-
ness of each party to negotiate and compromise.
Lloyd Manning is a semi-retired business, com-
mercial real estate appraiser and financial analyst.
His newest book, Winning With Commercial Real
Estate – The Ins and Outs of Making Money In
Commercial Properties, is available online from
Indigo-Chapters. He can be reached at lloydmann@shaw.ca.

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 2013 Business Supplement
The Business Plan
Your road map to successful business development
BY TIMOTHY FEHER
W
hether you’re the sole proprietor of a small
massage therapy practice, a business partner
in a health and wellness clinic, or an owner-
manager of a large spa, retail and multi-
service business, the business plan is your road map, and
your most important management tool, for the sustainability
and growth of your operation. I am frequently called into
businesses and organizations, large and small, to assist with
development issues. I am continually surprised by how many
businesses and organizations are floundering without the
strategic focus of a current or comprehensive business plan. If
a business plan is dug out of the back of a filing cabinet, it’s
often a document that the organization has never used, and
often because the contents are not that useful or strategically
instructive to begin with.
Without the strategic and financial prescriptions of a well-
researched business plan – along with the discipline of follow-
ing its central planning imperatives – managers of the organi-
zation tend to operate independently and sometimes at cross
purposes, employing their own untested assumptions and intu-
itions. This often makes for an unfocused business: one that
gets into trouble, and one that fails to achieve financial sustain-
ability, financial growth or other performance objectives.
I think the analogy of a road map is a good one. Unless
you prefer the risk and adventure of flying blind on the open
road without directions, a road map is a pretty crucial tool.
In fact a road map and a business plan have a lot in com-
mon. Most importantly, they both:
• show the full context of the journey, the forks in the road,
the obstacles, the challenges, the proposed direction;
• propose and assess strategic options and even alterna-
tive routes to reach the destination;
• are scalable so that all elements are measurable, allow-
ing for accurate feasibility assessment and calculated
projections.
FIVE CRITICAL ELEMENTS OF A BUSINESS PLAN
Massage therapists today function in a very competitive
and challenging economic environment. In order to survive
they not only have to provide high quality service, and sus-
tain their customer base, but they must also be creative and
innovative entrepreneurs in order to attract new customers.
A number of my clients have opted to expand their practice,
20 MASSAGE THERAPY CANADA • SPRING 2013
and increase profitability, through a mixture of retail, addi-
tional health and spa services, seminars, workshops, and even
food service. Whatever your approach to sustainability, the
business plan is your planning tool to ensure profitability
and protect your investment. Regardless of the size of your
business, the critical elements of an effective business plan are
pretty much the same. Here is an overview of the five most
important ones. These elements will ensure that your busi-
ness plan will serve as an instructive and accurate strategic
management tool.
1. The Business Idea, or Mission – Your central business
idea is where everything starts. It must be feasible, scalable,
and flexible enough to make it unique among competitors
in the marketplace. Clarifying your business idea is certainly
crucial to your marketing plan or your pitch to investors. But
first and foremost, you want to sell yourself and test the “big
ideas” offered by your business concept.
The business plan is your planning tool
to ensure profitability and protect your
investment.
Take some time to articulate and reiterate the purpose of
your business. What makes it unique in the marketplace?
What specific customer needs will your products and services
satisfy? Can you measure and project the need in the market
that you will serve? How will you meet customer needs dif-
ferently from your competitors? Do you have a different or
new approach? What innovations are offered by your busi-
ness concept? Test your thinking with some focus groups.
Listen to the feedback.
2. The Business Model – Often the weakest part of any busi-
ness plan, the “business model” describes how the business
will make money, how it will be self-sustaining, and how it
will grow. It’s primarily a mathematical exercise that helps
you to design and evaluate the short- and long-term profit-
ability of your business. Unrealistic, inaccurate or poorly
tested calculations in the business model are the cause for
many business failures and bankruptcies.
The Basic Business Model Inputs: A number of basic
inputs should be used and continually updated in your busi-
ness model calculations:
• the potential customer base in your market;
• the cost of reaching and converting potential customers
(marketing);
• projected number of customers daily/weekly (scalable
by increasing marketing or other factors);
• business operating capacity (how many customers can
be served?);
• cost of operating capacity/per customer;
• price point of your products and services;
• projected revenue from customers;
• cost of depreciation and investments in capacity
growth.
The business model is a scalable device that allows you
to evaluate larger or smaller versions of your business.
Profitability can be arrived at by different approaches with
your inputs. A change in any one input will have an impact
on others. Managing a business is a dynamic process of mak-
ing sure your business model is always pointed at profitability.
3. Capacity-Building Investment –Another area of weakness
is the failure to plan for the time and the dollars needed to
continually re-tool or expand the business in order to stay
relevant and competitive in the marketplace. The old capital-
ist imperatives like “grow or die” and “innovate or wither”
are very instructive for surviving in the marketplace. So the
business plan has to anticipate and account for operational
capacity building, from the point of start-up to at least five
years out. Operational capacity building includes:
• replacing outmoded equipment;
• staff training;
• hiring additional staff or those with higher levels of
expertise;
• new program or product design;
• innovation research and development;
• facility capacity and design upgrades;
• enhanced marketing and sales tools.
4. Marketing and Sales – Volumes can be written about
this element of the business plan. This section of the plan
expends much creative thinking, strategy and accurate market
research to answer some crucial questions about acquiring
customers:
• Who is the target market? What is their demographic
5. Financial Planning Scenarios – Your whole business plan,
up to this point, has provided the full strategic background
to allow you to now develop a prudent and practical set of
financial scenarios under which the business can be operated.
Your financial planning will estimate:
• year one to three operating costs and projected revenues;
• start-up capital required;
• annual borrowing costs;
• annual budget and cash flow plan;
• estimated scenario to reach financial sustainability and
profitability.
While I can provide only an outline of what is required to
create an effective business plan within the confines of this
article, my main message is to create a plan and use it regu-
larly just like a road map. It will ensure that your business is
on course and on target towards your objectives.
Tim Feher is a senior partner and creative director
with Blue Bear Media, www.BlueBearMedia.ca
(serving the business development and marketing
needs of small and medium-sized businesses in
Canada); and Mission to Vision Communications,
www.MissionToVision.ca (serving the organizational development
and marketing needs of Canada’s non-profit organizations).
Feher is also a former part-time professor at Algonquin College
where he has lectured on business development and marketing
to third-year massage therapy students.
 Billing
 Scheduling
 Reports
 Email
 Expert support
Treat patients

Okay.
profile? Where are these potential customers and how
many are located in proximity to your services? What

PMP software
do you know about the motivations of your target
market? How will you position your products and ser-

does almost
vices vis-a-vis their likes and dislikes?
• How will you articulate your brand in words, pictures,

everything
partnerships, affiliations, style, values and promise of
performance?
• How will you reach, motivate, educate, communicate
to and convert customer prospects?
• What are the costs, and what is the investment plan
over five years, to acquire the number of customers to 1-800-561-7361
make the business model work?

MASSAGE THERAPY CANADA • SPRING 2013 21

 2013 Business Supplement

Therapist-Clinic
Relationships
They may not be what you think
BY LIOR SAMFIRU, LLB, AND CHUCK TAHIRALI, MIR

W
e all know the “Duck Test” – if it looks like
a duck, swims like a duck, and quacks like
a duck, then it probably is a duck. This test
is of great assistance in determining whether
the relationship between a clinic and a massage therapist
is employer-employee, or whether the therapist is an arm’s
length independent contractor.
Clinic staff could comprise a mix of employees (from
whose wages/salaries the clinic owner makes “source deduc-
tions” such as income tax and Employment Insurance premi-
ums) and independent contractors (contractors are responsi-
ble for their own deductions and usually collect GST-HST).
A therapist’s resumé could include stints as both.
There are various advantages and disadvantages to working
as either, or having employees or contractors at your clinic.
A contractor can be terminated on very short notice (e.g., 15
to 30 days), whereas employees are entitled to much more
It’s in everyone’s best interests to ensure the nature of the therapist-
generous severance entitlements (up to 24 months’ notice or clinic relationship is certain, and that everyone thoroughly
pay in lieu thereof ). Therapist employees have their payroll understands their respective obligations and entitlements.
paperwork and source deductions handled for them by the
clinic, but contractors handle their own. Contractors can mine the actual legal relationship. That is, what’s written in a
deduct business-related expenses at tax time that an employee contract is a factor, but it’s rarely determinative.
cannot. Employment relationships and working conditions How does one go about determining whether the clinic-
are governed by a complex web of legislation, whereas con- therapist relationship is one of employment or contractor? One
tractor relationships are much less regulated, except by pri- applies the appropriate variation of the Duck Test – and if the
vate contract between the parties. therapist walks like an employee and talks like an employee . . .
you guessed it.
SO, IS IT A DUCK? There are several factors involved in this examination. As
Are you certain that you’ve entered into the type of relation- described in Table 1, “employees” are paid a fixed hourly rate
ship you believe you have? One thing to keep in mind in or salary, are covered by benefits, work full time, and report
determining the answer to this question is that what you call to a supervisor who oversees and controls their activities.
yourself or what someone else calls you is largely irrelevant. Employees also have a job title and a clinic business card, use
You may believe your relationship is exactly as specified on the clinic’s equipment and have business expenses paid by the
the piece of paper you and another party have signed. If so, clinic. However, if the individual makes decisions about how
it may come as a surprise that in the face of a dispute or con- services are rendered and charged, is paid on a revenue-shar-
troversy, the inquiring authority – whether it is the Canada ing or other variable basis, is not covered by benefits, decides
Revenue Agency (CRA), the courts or a government tribunal when, or how much, to work, works for other clinics or offers
such as the Ontario Labour Relations Board – will definitely independent services to non-clinic clients, works autonomous-
look beyond what’s stated on that piece of paper to deter- ly (free of supervision), covers his/her own business expenses,

22 MASSAGE THERAPY CANADA • SPRING 2013

TABLE 1: EXAMPLE TEST OF WORKING RELATIONSHIP
Questions Asked Employment Contractor

Is individual expected to work full time and/or to Time and ability to work for others is
Exclusivity is indicative of employment
have an “exclusive” relationship with the clinic? indicative of contractor relationship

Control is indicative of employment Autonomy and freedom to decide how

Does the clinic supervise and control the manner in
– close supervision is indicative of services are delivered is indicative of
which the services are provided?
employment contractor relationship

Ownership of tools and equipment by

Does the clinic own the tools, equipment and Ownership of tools and equipment by
the therapist is indicative of a contractor
materials used to provide the services? the clinic is indicative of employment
relationship

Ability to make profit (or risk loss)

Does the therapist have an expectation of profit (or Fixed hourly rate paid by clinic is
by deciding how to deliver service is
loss) associated with the delivery of the service? indicative of employment
indicative of contractor relationship

If therapist holds him- or herself out as
employee of clinic (has clinic business
How integrated is the therapist into the clinic’s
cards, etc.), has expenses paid by clinic
business?
and is given space to practice at no
charge, this is indicative of employment
To the extent that the therapist is running
his or her own business, responsible for
own expenses and is paying rent for
space, this is indicative of a contractor
relationship

has his/her own business cards, uses his/her own equipment
and pays rent for the space to practice, then it is very likely
that such a person is a “contractor.”
Exclusivity, degree of control, ownership of tools/equip-
ment, risk of profit/loss and the degree of integration of the
therapist into the clinic’s business are key factors in deter-
mining the type of relationship. No single factor is deter-
minative on its own. An inquiring authority will examine
all factors and make a global assessment. Keep in mind also
that depending on the inquiring authority (a court versus
the CRA), or the purpose of the inquiry (e.g., to determine
whether the individual is owed damages for wrongful dis-
missal versus a determination of whether or not back taxes are
owed), a slight variation of the test will be used. The determi-
nation may also vary slightly from one province to the next.
THE ‘DEPENDENT CONTRACTOR’
To further complicate things, it’s possible to have a contrac-
tor relationship but one in which the contractor is depen-
dent on a single clinic for most or all of his/her income. In
such cases, the clinic’s relationship may be deemed deemed
to be with a “dependent contractor.” Legally, a dependent
contractor is treated very similarly to an employee in terms
of entitlements at the time of terminating the relationship.
As is always the case, this type of relationship is determined
through looking at all the test factors, but the degree of eco-
nomic dependency is crucial. The more economically depen-
dent the therapist is on a single clinic for income, the more
likely he or she will be seen as a dependent contractor.
Whether you are a clinic owner/manager or a therapist
working as what you believe to be a contractor, you should
consider these test questions carefully. Although the popular-
ity of contractor relationships has soared over recent decades,
many such relationships are improperly characterized by the
parties themselves. Unpleasant scenarios can result from not
having the relationship clearly determined by both parties.
For example:
• A contractor, who for several years has positioned him/
herself as such (invoicing you month after month and
perhaps collecting HST), sues you for wrongful dismissal
when you terminate the relationship on short notice,
now claiming to have been an employee all along.
• The CRA decides deductions relating to the work
a particular therapist ought to have been made “at
source” (by you, the clinic) and not only seeks repay-
ment of outstanding taxes and deductions, but also
imposes penalties and interest.
• An “employment standards officer” determines that your
contractors are employees, and therefore owed vacation
pay, overtime pay and public holiday pay.
It’s in everyone’s best interests to ensure the nature of
the relationship is certain, and that everyone thoroughly
understands their respective obligations and entitlements.
Analyzing your relationships now and taking any steps to
clarify them will help you avoid unpleasant surprises or dis-
putes down the road. If you have contractors who “quack”
like an employee, you may wish to take steps to transition
them into an employment relationship using a contract that
captures the parties’ mutual expectations with respect to
issues such as termination. For this, we strongly recommend
that you seek legal assistance.
Lior Samfiru has established a reputation as a lead-
ing employment lawyer in Ontario and heads the
Labour and Employment Law practice at Samfiru
Tumarkin LLP. Samfiru represents and advises both
employees and employers with respect to all work-
place matters, including employment agreements (and other types
of contractual arrangements), employee terminations, disciplinary
issues and human rights.
Chuck Tahirali is a senior human resources consul-
tant and an integral member of the Labour and
Employment Group at Samfiru Tumarkin LLP. He
works in conjunction with the firm’s labour and
employment lawyers to provide specialized human
resources advice and services to employers of every size. Tahirali
possesses over 20 years of experience providing assistance to
human resources management and corporate clientele with
respect to labour and employee relations.

MASSAGE THERAPY CANADA • SPRING 2013 23

Feature BY ANDREA COLLINS, RMT

Relocating
Your Practice
Points to ponder when it’s time for a move

T
he thought of relocating is a terrifying thought for many of us. Being uprooted from friends, family,
work and everything that you are accustomed to is among the top most stressful situations that we
will encounter in our lives. Many therapists are faced with this situation either out of choice for a
change of lifestyle or out of a sense of adventure. Many moves are the result of necessity, such as
massage opportunity elsewhere, employment for partners/spouses, or family obligations.

Relocating out of a sense of adventure or a change in lifestyle
provides the opportunity to do some investigating of your
options ahead of time. Of primary importance, you should
not inform your current workplace or clients of your plans to
move until you have something concrete to tell them. You do
not want to have to deal with a knee-jerk reaction from them
if things don’t pan out and you stay put. In the meantime,
you should be investigating the massage work opportunities
in the potential new community. Look for position postings
and investigate networking with other therapists in the area.
Get a feel for the climate of the massage market (see side-
bar, “Considerations for moving your MT practice to a new
area,” in this article for some things to consider). This is only
a start to your investigation as your answers will create more
questions, and this is a part of the process.
CONGRATS – YOU’VE MADE THE DECISION!
Once the decision to move has been finalized, you now have to
deal with your active business. If you work at a clinic with other
massage therapists, your responsibilities are slightly reduced ver-
sus being a sole practitioner working independently. But, once
you know your timelines you can begin to make plans.
You need to review any contracts or leases to remind your-
self of your contractual obligations in order to establish time-
lines to exit your agreement. Most clauses have specific time-
lines that need to be observed for notice. This is something
you may want to consider when you are deciding upon your
scheduling for the move – if you have a choice.
If you own a clinic or are an independent practitioner who
maintains your own practice, you have many more decisions
in your future. The size of your practice will come into play
– if you have a larger practice, you may have the opportu-
nity to sell your practice – as will business name (if you have
established an identity outside of your given name), client list
and goodwill that you have established in your community.
Determining the value of the practice is where most thera-
pists struggle. A quick list of considerations: fixtures (table,
office equipment, linens, etc.), the size of your active and
inactive client list and the previous history of your business
(you should assemble statistics of your treatment times and
gross income [not including GST/HST or expenses] for one
to two years) will give you some idea of value. For a more
CONSIDERATIONS FOR MOVING YOUR MT
PRACTICE TO A NEW AREA
• Is the area over-serviced or under-serviced? Examine
population size versus number of therapists.
• Is the area urban or rural? This will help you to
understand the client base you will be helping as
well as start to develop your advertising strategy.
• Is there a group of therapists that you could net-
work with?
• What are the going rates for massage?
• Do you need more or less liability insurance than
you are carrying (leaving your jurisdiction)?
• Do you need to apply to another college or associa-
tion or register before you can even work in this
jurisdiction? – This is especially important because
if you go from a non-regulated province to a regu-
lated one, unfortunately, you will not be able to
hang your shingle and start to work right away.
• If you are leaving the country, will you need a visa
to work and would you qualify?
These are only suggestions and a starting point from
where to start your investigation. Your answers will create
more questions and this is part of the process.

24 MASSAGE THERAPY CANADA • SPRING 2013

comprehensive description of how this works, please see
Lloyd Manning’s article titled “My Massage Therapy Practice
– What Is Its Value?” in the business guide included in this
issue of Massage Therapy Canada.
You also must consider existing liabilities against the name:
leases for space, outstanding gift certificates and receivables,
existing contracts that are tied to the business name (advertis-
ing, including ads, websites, etc.) to name a few. This brief
list is only an overview of your options and there is a good
chapter in Don Dillon’s book Massage Therapist Practice to
help with your determination. The bottom line is, your busi-
ness is only worth what someone is willing to pay for it.
TRANSITIONING YOUR CLIENTS
When I recently relocated, I had to deal with all of the above
– but the hardest part for me was telling my clients. Whether
you are a therapist within another therapist’s clinic or a sole
practitioner, you will be affected when informing your cli-
ents. If you have been in practice for a number of years, you
develop relationships with clients that you see on a regular
basis. Many of my clients had seen me for several years, some
for over a decade. I knew that leaving my clients was going to
be hard, but I was not prepared for the emotions that came
after everyone’s final treatment. One of my clients put it best:
“It feels like you are breaking up with me.” Imagine having to
do this with 50 people. There were many tears shed during our
farewells. One way I used to help deal with this loss was to do
my best to find another therapist that I could refer them to in
order to make the transition for my clients easier and to create
as little disruption to their treatments as possible.
OTHER BUSINESS CONTACTS
Some final details you would need to deal with are the address
notifications. We all remember our driver’s licence, health card,
utilities and credit cards, but don’t forget your business contacts.
These may include your regulatory body or new jurisdiction
regulatory body (don’t forget many provinces have mandatory
change of address notification periods); provincial or national
associations; professional or lobby magazine subscriptions; school
or additional training course mailing lists for education notifica-
tions or updates; investment or insurance companies; business
related memberships, like Staples or massage supply outlets. Once
you’ve established the list of contacts, you may consider keeping a
file for future reference or in the event of future moves.
Change in our lives can be scary but also exhilarating and an
adventure. If you are prepared and organized, your move can
be less stressful, if not stress-free, and your new life can begin.
Andrea Collins, RMT, has been a massage therapist
since 1999. She has worked in a variety of settings,
and owned her own clinic. Collins has taught business
at a private massage school and has expanded to CEU
seminars in business (four-part series) and a techniques
course (Massage Smarter, Not Harder). She is currently working on a
business book for Canadian massage therapists that is due out in the
near future. For more information, please visit www.rmthelp.ca.
MASSAGE THERAPY CANADA • SPRING 2013 25
Feature BY DR. MICHAEL HURLEY

Assessment
Made Easy
Harnessing the efficiency of the Exstore system

W
hether we are students learning in a classroom setting, or health-care practitioners building a
patient base, we need clarity when initially assessing new patients. In school, we are taught
a variety of orthopedic tests that are supposed to form the foundation of our assessments.
Having been through the classes, we finally start to treat patients – but we soon discover,
and studies tell us, that frustration sets in when traditional orthopedic tests don’t give us consistent results.
(Contant, 2003)

For instance, picture this brief scenario: A patient complains
of low back pain. You have them perform range of motion
tests, a straight leg raise and Kemp’s test. All tests point to
everything being normal. Ten minutes of testing goes by, and
you are still no closer to finding the cause of your patient’s
discomfort. I am sure most practitioners have been in this
situation at one point or another.
It was this type of frustration that made me seek out a system
that would be time efficient and allow me to accurately diag-
nosis dysfunction in my patients. This is when I came across
Exstore, a comprehensive assessment system developed by Dr.
Anthony Lombardi, a chiropractor from Hamilton, Ontario.
HOW IT WORKS
The biggest mistake made by practitioners in manual medi-
cine is spending too much time focusing on the area of pain,
which may not be specifically localized to the area of pathol-
ogy. Assessing the patient using the Exstore system allows
the practitioner to find the cause of the problem rather than
focus on where it hurts.
The assessment system employs two steps that thoroughly
and accurately diagnose the cause of dysfunction in a net-
work that is based on three major foundations of the skeletal
system: the vertebral column, the scapular girdle and the pel-
vic girdle. Hamill (2006) describes the girdles as foundations
of human movement. These girdles serve as attachment sites
for muscles and are constantly adapting to movements of the
upper and lower extremities.
The first step is palpation. It is key to understand and
recognize how tissues feel. Devor (1999) states that fibrous
tissues form palpable, taut muscle bands and trigger points;
such muscle dysfunction and spasm lead to compression of
blood vessels, and decreased blood flow, leading to increased
pain stimulation and decreasing joint mobility.
The second step, which is the key to the entire system, is
assessing motor inhibition of the tissues around the scapular
and pelvic girdles. Le Pera (2001) describes muscle motor
inhibition as the inability of the peripheral nerve to contract
the muscle due to chemical or physical trauma. This motor
muscle inhibition can be cause by three different factors:
nociception, pain and arthrogenous changes.
WHY INHIBITION MATTERS
Portenoy (1994) described nociception as the neural processes
of encoding and processing noxious stimuli. It is the afferent
activity produced in the peripheral and central nervous sys-
tem by stimuli that have the potential to damage tissue. Nijs
(2012) concluded that chronic nociceptive stimuli result in
cortical relay of the motor output in humans, and a reduced
activity of the painful muscle. Nociception-induced motor
inhibition might prevent effective motor retraining. In addi-
tion, the sympathetic nervous system responds to chronic noci-
ception with enhanced sympathetic activation. Not only motor
and sympathetic output pathways are affected by nociceptive
input – afferent pathways (proprioception and somatosensory
processing) are influenced by tonic muscle nociception as well.
Svensson (1996) studied people suffering from jaw pain
and concluded that sensory-motor interactions can be
explained by a facilitatory effect of activity in nociceptive
muscle afferents on inhibitory brain-stem interneurons dur-
ing agonist action.Thus, generated movements have smaller
amplitudes and they are slower which most likely represents a
functional adaptation to experimental jaw muscle pain.
Finally, studies have shown the presence of arthrogenous
muscle inhibition. Sedory (2007) found arthrogenic inhibi-
tion of the hamstrings muscles bilaterally and facilitation of

26 MASSAGE THERAPY CANADA • SPRING 2013

 Research
verifies the
principles that have
been taught the past
40 years by
John F. Barnes, PT.

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MASSAGE THERAPY CANADA • SPRING 2013 27

 the quadriceps muscle ipsilateral to the involved limb were
noted in subjects with unilateral chronic ankle instability.
The Exstore assessment system allows the practitioner to
determine the inhibition of the patient’s dysfunction in a
systematic and efficient manner. The system is simple to SAGE THERAPIST PRAC
MAS SUCCEED
apply in practice and is ideal for chiropractors and manual S TA RT • S U S TA I N •

“
therapists who use acupuncture and myofascial release as part
I rememb
offers practical insight and
Massage Therapist Practice I decided
working with other practitioners,
experience for the practitioner to
sources of income or preparing to contin
wishing to generate secondary is painted
A comprehensive picture
retire and sell her/his practice. future I had str
past, present challenges and

of their treatments.
of the massage profession’s for the
chapter is included particularly
opportunities, and an entire year in a
entry-level practitioner.
a practic
of government policy, insurance
• Analyze the implications a busine
gatekeeper disciplines,
compensation,economic health, and
exploiters and profiteers,
public and media perception, provided
on the viability of massage
the intrinsic politico-culture
therapy practice. I needed
should look for
• Where massage practitioners practice

INJURY PREVENTION
opportunities in the new economy.
convictions that doom busy. I l
• Common (often disastrous!)
massage business relationships. busines
in operating a massage business.
• Financial facts and fictions I believ
- the primary (and unidentified)
• The elephant in the room
financial terms. running
source of tension in negotiating

Unlike most assessment systems, Exstore is also very effective

unprofitable business
• Strategies for turning around didn’t.
agreements.
the employer/empl oyee model over rent I h
• Benefits of
contractor model. was fo
owners can reduce turnover
• Learn how massage business

in helping patients and athletes prevent injury. This system

busine
and grow profit margins.
money as a contractor practi
• Why you don’t earn enough
you can.
massage practitioner, and how not ha
agreements are problematic.
• Why straight-percentage
in
longevity and productivity

has been used on many professional athletes as a means of pre-

• Managers: Cultivate loyalty,
your associates.
value, leverage and income
• Practitioners: Increase your
in negotiating business agreements.
for practitioners working
• Practical and profitable models

screening and treating before any serious injuries can occur.

together.
clauses
• Legal implications of contract
industry-related
• 12 profitable, low- or no-hands-on,
secondary sources of income.
when buying or selling a massage
• Points to consider

Exstore is useful not only in helping elite athletes but also can therapy business.
• Valuating your business.
• 12 practice development
practitioners.
essays for entry-level

help practitioners be more specific and time efficient while

Final_Cover.indd 1

helping patients from all age groups and levels of activity.

NOT JUST FOR CHIROPRACTORS D

Since this system was created, it has been taught to chiro-
practors, physiotherapists, occupational therapists, massage
therapists, athletic therapists and medical doctors for use on
all of their patients.
The Hamilton Family Health Team in Hamilton, Ontario,
which houses primary care physicians and nurses and serves
approximately 280,000 patients, has asked Dr. Lombardi to
teach Exstore to its MDs, nurse-practitioners and nurses.
Dr. Ravinder Ohson, an MD from Hamilton, utilizes the
assessment system in his own practice.
“I have used the Exstore system and found it to be an effi-
cient way to localize the cause of the dysfunction,” says Dr.
Ohson. “This has saved me time as well as reduced my reli-
ance on radiology to give me the diagnosis. I would suggest
this system to any primary care provider in the assessment of
a musculoskeletal disorder.”
Exstore has changed the way I approach patients daily. It
has given me the confidence to accurately diagnose and treat
any musculoskeletal complaint and I feel it would be a wel-
come system in any clinical practice.

To view the sources used for this article, please visit Current Issue
at www.massagetherapycanada.com.

Dr. Michael Hurley is a 2011 graduate of New

York Chiropractic College. He is the owner of
Middlesex Spine and Sport Clinic in Mount
Brydges, Ontario. The clinic is a multidisciplinary
office, which offers chiropractic, physiotherapy,
massage therapy and naturopathic medicine. www.middlesex-
spineandsportclinic.com, info@middlesexspineandsportclinic.com

ERRATUM – WINTER 2013 ISSUE

On page 9 of the Winter 2013 issue of Massage Therapy
Canada, Don Dillon’s article titled “Research Made Relevant”
carried a sub-title of “Making the most of the patient intake
process.” In fact, the subtitle should read, “Why Research
Matters to the Business of Massage Therapy.” Massage
Therapy Canada apologizes for this discrepancy.

28 MASSAGE THERAPY CANADA • SPRING 2013

 MASSAGE • Big Picture – Past, Present and Prophecy
TH ER AP IST
CTIC E
MASSAGE THERAPIST

PR AC TI CE
• RMT Working Relationships – common
ember clearly the moment ED problems and effective solutions
ded I must succeed if I was START • SUSTAIN • SUCCE
ntinue practicing bodywork.
struggled for more than a
n a new city trying to build
• Improve Your Lot in • Hands-On Work is Tough! Generate other
PRACTICE

Practice
ctice. My initial tenure with
siness-savvy chiropractor
• Past, Present and Prophecy
for the Massage Profession
sources of income
ded the opportunity • RMT Working
Relationships . . .
ded to jumpstart my . . . Make Them Work!
• Planning to Retire? Sell your practice
START • SUSTAIN • SUCCEED

tice and quickly get me of

• Secondary Sources
. I left that chiropractor’s Income - Low Labour,
ness within a year, because High Return

lieved I could do better

ning my own business. I
• Prepare Your Massage
Therapy Business for
Sale • Tangible Advice for Entry-level RMTs
el
• Advice for Entry-Lev
n’t. I soon realized the high Practice
t I had paid the chiropractor
s for the referrals, successful
Guest articles by:
siness model and essential Cherie Sohnen-Moe,
Business Mastery
actice management skills I did Dale Willerton, The Lease
Coach
Touch
t have. Meagan Holub, The Magic
” Jim Smyth, Find and Keep
Great Associates
practitioners
Plus: Interviews with successful
and employers in the field

visionary - a person who

“Don Dillon is a leader and
of our profession (and)
is helping to create the future
a higher standard.”
holding massage therapy to

by Donald Q. Dillon RMT

From the author of
Therapists and

MassageTherapistPractice.com
Charting Skills for Massage
Guide for Massage Therapists
$39.95 CDN Better Business Agreements:
Dillon

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RMT Tech Talk
Choosing an Internet Domain
Name for Your Practice
W
hile on the surface choosing a domain name
to brand your business on the Internet seems
straightforward and obvious, we are finding
that for many practitioners, both the pursuit of a name that
will lend optimal value, and the business process involved in
choosing it, present a challenge.
BENEFITS OF A WELL-CHOSEN DOMAIN NAME
A good domain name increases public name recognition
for your practice, allowing your clients to easily find your
practice on the Internet. Friends and existing clients will be
more likely to pass your website’s name on to others if it is
easy to remember.
A well-chosen domain name imparts a professional and
lasting impression to your clients and website visitors.
It helps brand your practice and allows you to have a
professional email address. The email address janedoe@your-
practice.com appears much more professional, established
and permanent than janedoe@hotmail.com. Why advertise
a public e-mail providers name and business, when you can
advertise your own practice?
A well-chosen domain name can help you get a higher
search engine ranking on Google, Yahoo and others.
Protecting your practice name through domain name regis-
tration will prevent a competing practice from profiting from
your offline marketing efforts. Once registered each year, no
one will be allowed to use the identical domain name you
have chosen.
HOW DO I CHOOSE A DOMAIN NAME FOR
MY WEBSITE?
There are a number of factors to consider when choosing the
name that will properly promote the branding of your busi-
ness on the Internet. The following pointers will help you
choose the right web address for your practice:
Keep it short and to the point – Although you can register
lengthy domain names, keep in mind your clients need to
be able to remember and easily type your website’s address.
Register the shortest name possible that will still allow your
clients to associate it with your practice. For example, if your
practice name is River Walk Massage Therapy and Wellness
Clinic, a domain name such as www.riverwalkmassage.com
rolls off the tongue (and keyboard) more easily than www.
riverwalkmassagetherapyandwellness.com.
30 MASSAGE THERAPY CANADA • SPRING 2013
SUBMITTED BY JESSICA FOSTER,
MINDZPLAY SOLUTIONS INC.
Avoid hyphenated domain names – Hyphens in domain
names are often forgotten by users wanting to get to your
website. You could also inadvertently send your clients to one
of your competitors. For example if your website address is
www.riverwalk-massage.com and your competitor down the
road has www.riverwalkmassage.com, your competitor could
benefit from your marketing efforts. Hyphenated names are
also harder to remember. If a hyphen is used in your business
name already, that doesn’t mean you have to use it in the web
address (domain name).
Choose an appropriate domain extension – There are many
domain extensions to choose from – for example, .com,
.ca, .org – and you may wonder which one is best for your
practice. Most people will agree that .com is by far the pre-
ferred domain extension. By default, the majority of people
will type in “.com” when they remember only your website’s
name “Riverwalkmassage.”
Avoid names that are close to your competitor’s – For example,
if your competitor down the road is using www.riverwalk-
massage.com, it would not a good idea for you to use www.
riverwalkmassage.ca. This could also result in your marketing
efforts driving business to the wrong website owner.
Ask around or ask Internet professionals – When you have
settled on a few available name potentials, ask what your
friends and clients think. A name that may make perfect
sense to you may be confusing or too hard for others to
remember. Some practitioners register a few domain names
and direct them all at their website. This marketing method
can drive significantly more traffic to their practice website.
Professional website developers can also advise you regard-
ing the finer points of domain names as they have a wealth
of knowledge and experience in this area – if you’re having
difficulty with this, you can always check with one of them.
Until next time, be well…
MindZplay Solutions is a provider of massage
therapy websites and practice management
solutions. To learn more about mindZplay visit us
at www.massagemanedger.com or call toll free
888-373-6996.marketing company, ChiroVMail.
He can be contacted at 877-602-8527 or slaverdiere@
atlaschirosys.com. Please visit www.atlaschirosys.com and www.
chiroVMail.com for more information on digital solutions for your
practice.
 The Original
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Unit 1 • September 6-7-8, 2013 v
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