When it comes to helping clients with complicated medical histories, massage therapy may only be able to scratch the surface. You cannot do it alone, nor should you try, thanks to your education’s scope of practice. Referring out to capable professionals is the wisest path to success—for both you and your client.

Today, massage therapy is often viewed as health care—at the very least a huge component of wellness; this means you are a health-care/wellness provider. As such, you now belong to a network of professionals, so you need to start thinking like part of a team.  

Your goals with a complicated client are to create a plan to address the complaints that massage therapy can affect, outline her overall concerns that cannot be addressed solely with massage therapy, refer her to appropriate professionals who can address her specific needs, maintain an ongoing massage therapy relationship with your client, and maintain an ongoing professional relationship with those specialists to whom you refer.

It’s easier to do than it sounds. 

Chiropractor

Licensed to practice medicine. Manipulates the spine and other joints. Cannot perform surgery. Some use only mild fingertip manipulation or small instruments to realign the spine. 

Reasons to Refer 

Alice’s car accident and back pain most likely indicate cervical and lumbar spine misalignment. Any client who has experienced a car accident, a fall, or any twisting or sports injury could use the aid of a chiropractor. In addition, you will often assess a spinal misalignment when you work your thumbs down the lamina groove. Trust yourself—if the spinal column feels out of place or rotated to you, suggest a chiropractor.

Naturopath

Various levels of certification and accreditation. Specializing in wellness, the naturopathic doctor takes postgraduate training sometimes as rigorous as that of a medical doctor. Takes a more holistic approach to a patient while considering diet, exercise, medical history, and the use of natural substances for healing. Less invasive than most forms of allopathic (Western) medicine. 

Reasons to Refer 

Alice has been to a boatload of doctors and is not enamored with the Western medical model right now, but her history makes it necessary that she sees a medical professional. A naturopath is a real doctor, yet does not approach patients with either a surgical or pharmaceutical bias.

Orthopedic
Surgeon 

Licensed to practice medicine, and also known as an orthopedist. Practices a specialized branch of surgery that treats the musculoskeletal system. Uses both surgical and nonsurgical measures. Specialties within this field include congenital disorders, degeneration, sports injuries, and trauma. Many specialists focus on one part of the body.

Reasons to Refer 

If Alice’s cervical spine or lumbar spine pain is not alleviated by chiropractic manipulation, an orthopedist could be her next stop. She may require injections or surgery.

Personal Trainer 

Varying levels of certification and accreditation, with programs lasting a few weeks to six months to several years. Some will get an undergraduate degree in exercise physiology and then add a personal training certification. Often works in gyms, spas, or private practice. Specializes in helping to create an individualized exercise/fitness program. 

Reasons to Refer 

Alice wants a new body and has long-term plans for looking good. A personal trainer can help her become fit, increase her strength and energy, help her lose weight, and aid in a new self-image.

Physical Therapist

Has a postgraduate degree. Specializes in care and rehabilitation for amputation, chronic debilitating medical conditions, degeneration, physical dysfunction, stroke, and trauma. Depending on the education and the degree, some physical therapists can diagnose and treat; others must treat only with a physician’s order. Some work in a hospital setting, but there are increasing numbers of free-standing clinics that can treat with or without a doctor referral.

Reasons to Refer 

If Alice is limping and perhaps has leg-length discrepancy, she will need exercises to strengthen and balance her gait and address her weight-bearing abnormalities.

Talk Therapist, Psychotherapist, Psychiatrist

Mental-health therapists specialize in one-on-one, couple, or group therapy. Specialties vary widely: aging, coping skills, drug abuse, learning disabilities, marriage counseling, posttraumatic stress disorder, and sexual abuse. Therapists’ education requirements range from four years of college for some, to mandatory medical school for psychiatrists, who are physicians that specialize in psychotropic medications. 

Reasons to Refer 

Alice clearly needs to talk about her marriage and perhaps convince her husband to attend couple’s counseling. In addition, many clients have had life experiences with which they continue to grapple. These events can negatively alter physical function and self-esteem. Diplomacy is key when suggesting this referral. 

The preceeding list is only the beginning. Your referral network can include acupuncturists, homeopaths, neurologists, podiatrists, reflexologists, and more. The more you learn about optional medical and holistic specialists, the more valuable you become as a referring agent for your clients’ challenges.

Setting Up Your Network

OK, so you’ve assessed that your client needs a chiropractor, or a physical therapist, or a personal trainer—but do you know who to send her to? You’ve got two options: use your present client base to get word-of-mouth knowledge about the specialists you are looking for, or go out and find them yourself.

Clients will often mention that they’ve seen a wonderful doctor. Pick up on this. Ask “What made her so great?” “How did she treat you that was so special?” Then ask your client to bring you a wad of business cards the next time she visits that doctor. 

Your second option takes a little more work but gets you out of the practice room, plus it’s a lot of fun. Say you need a reference for a good neurologist. Hit the web, find one in your area who looks good, then call the office and say, “Hello, I’m looking for a great neurologist to refer my clients to, and I’d like 10 minutes of Dr. Smith’s time to learn more so I can refer my clients to someone appropriate.” I have never had a doctor turn me down with this approach.

On the day you are to meet with the good doctor, look your professional best, have your list of questions prepared, take up only as much time as you said you needed, and express genuine gratitude for the time and effort. During the last two minutes of the appointment, tell the doctor exactly what massage therapy is and leave a stack of business cards with the receptionist for any patients who might be looking for an experienced massage therapist. Everybody wins!

If the physician refers a patient to you, write an immediate note expressing gratitude and include a couple of your business cards in the envelope. Likewise, if you refer to a specific doctor, write a note saying, “Thank you so much for taking care of my client, Alice Jones.” At least every six months you should drop by the office, perhaps bringing flowers, and refresh your pile of business cards. A great marketing tool is to offer a free massage to front-desk and nursing staff—they’ll see your session room, experience your massage, and be able to rave about you the next time anyone is looking for a good massage therapist.

Finally, for the doctors I refer to, and from whom I receive regular referrals, I offer one Christmas gift certificate for an employee of their choosing.

When a mind-boggling and complicated client walks through your door, remember you are a member of a wellness team, and you can utilize the team at your disposal. It shows you care, that you’re thinking beyond the table, and sends a message that, although massage therapy is widely beneficial, we can share this responsibility with other compassionate and capable professionals. 

Timing is Everything

Don’t offer referrals on the first appointment. Get to know your client’s needs. Take your time, listen, and think about how best to approach her before you start the referral process.

You may not want to start referring the day of the client’s needs assessment. That day may be overwhelming for her, so perhaps you’ll choose one small, noninvasive referral and run it by your client to see how she responds.

You must be credible, compassionate, and professional in order for your client to take you seriously. If you aren’t working out, how can you refer your client to a personal trainer? If you aren’t taking care of yourself holistically, how can you convince a client to think about her long-term health? 

Don’t ever suggest referrals when the client is on the table. Her near-naked state makes her entirely too vulnerable. Any referral conversation should be done when the balance of power has been reestablished (i.e., after the session with the client clothed).

Be careful when suggesting mental-health professionals. To hear that recommendation from a stranger, or someone not trustworthy, is too difficult and will be met with outright resistance. Watch your timing on this referral, but be brave and compassionate when you realize it is the right time.