Ep 68 – Muscular Therapy: Built from Curiosity with Dr. Ben Benjamin

0:00:00.5 Kristin Coverly: This episode of The ABMP podcast is sponsored by Pain in the App. Pain in the App, mobile app by Dr. Ben Benjamin, is a new way to learn about the injury process from head to toe. Quiz yourself on the theory behind why injuries happen and what we can do about it, explore common injuries across the whole body and dig into how specific treatments work and why. Get started with dozens of free questions, then get hundreds more for only $9.99, but be careful. It's addictive. Go to the App Store and search for Pain in the App, coming soon to Android.

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0:00:48.6 Darren Buford: Welcome to The ABMP podcast. My name is Darren Buford, I'm Editor-in-Chief of Massage & Bodywork Magazine and Senior Director of Communications for ABMP.

0:00:55.5 KC: And I'm Kristin Coverly, ABMP's Director of Professional Education and a licensed massage therapist.

0:01:01.6 DB: Our goal is to connect with luminaries and experts in and around the massage bodywork and wellness profession in order to talk about the topics, trends and techniques that affect our listeners' practices. Our guest today is Dr. Ben Benjamin. Dr. Benjamin holds a PhD in Sports Medicine and owned and ran a massage school for over 30 years. He has studied under James Cyriax, M.D, widely known for his pioneering work in orthopedic medicine. Dr. Benjamin has been teaching therapists how to work with injuries for over 35 years, and has been in private practice for over 50 years. He works as an expert witness in cases involving musculoskeletal injury and sexual abuse in a massage therapy setting. He is the author of dozens of articles on working with injuries as well as these widely used books: Listen to Your Pain, Are You Tense? And Exercise Without Injury. For more information, visit BenjaminInstitute.com. Hello, Ben and Kristin.

0:01:56.4 Speaker 3: Hi there.

0:01:58.1 KC: Hi. Ben, we're so excited to have you here and we have so many things that we'd like to talk to you about and that we're anxious to talk to you about, but let's start by sharing your story with listeners. How did you get started in the massage therapy profession?

0:02:09.2 S3: Well, I was 13, I jumped up in the air, came down, and I had a pain in my back. And so I was studying to be a professional dancer, and as a result of that injury, I couldn't walk, I couldn't sit, I couldn't stand without pain, and I was referred to a man named Dr. Kagan. Now, he wasn't a doctor, but that's what everybody called him. He was a massage therapist, and he was the most gifted therapist that I had ever experienced. He had incredible hands, he was just a natural, he was a master. And I always felt like it was a privilege to be treated by him.

0:02:42.9 S3: When he treated me, I was just taking it in. I learn a lot by having people work on my body. I can tell when somebody is a good therapist or not such a good... After two or three minutes of them touching me, I'm very sensitive that way. And then I used to bring all my friends, my girlfriends, and I would watch him work for years and years and years. And he became kind of like my second father, and he was a very inspiring person, I loved him so much. And he trained me in a one-on-one situation. And at 18, I joined a dance company in Canada called Les Grands Ballets Canadiens, Les Grands Ballets Canadiens, and I moved to Montreal. And I quickly began to start treating all the dancers in the company, when I was about 18 or 19 years old, and when I began, I remember I was charging $5. That was 1963, a long time ago.

0:03:38.0 KC: Ben, you've been in practice for 50 years now. How has your career progressed over the years?

0:03:42.2 S3: Well, after Montreal, I came back to New York City where I was living, and I got a small office that they gave me at Lincoln Center, and I began treating the American Ballet Theatre Company dancers in New York City. And then I opened a private practice in New York when I was about 20 years old. Kagan and I, my teacher, would go out to dinner periodically. And one day, well, I think I was about 23, he invited me to come and work for him, and I nearly cried. I mean, I just loved the man so much and I was ecstatic, and then I used to work for him for three days a week, and I worked for myself two days a week. And later that same year, I was invited to teach at a place in California, an avant-garde dance company named the Anna Halprin Dancers' Workshop. That was in Marin County, near San Francisco.

0:04:31.8 S3: And that's when I created my first set of massage techniques to teach that summer, and it was a six-week course, I taught three days a week. And my work was so different from what everybody else had ever seen in California, that within actually a week of teaching, I had actually a full-time private practice. After the classes in the day, I would go to my office home where I was staying, and I would treat people from like 5:30 at night till 10 o'clock at night, almost everyday.

0:05:00.8 S3: And that fall, I returned home to the east coast, and I began commuting to San Francisco, which lasted for almost a year. And I still had a practice in New York and I had a practice in San Francisco. And then several years later, I began to train people in massage, and sort of the way I was trained, one-on-one. And I trained them on my own body in a private lesson sessions once or twice a week sometimes. And many years later, I opened a school, The Muscular Therapy Institute, and central to the actual training in that school, were private lessons. Students had three or four private lessons a month, and I didn't realize it at the time, but that kind of training as the primary teaching method, one-on-one, was pretty unique. I know people do it occasionally, but I did it, people had dozens and dozens of lessons, and I ran my school for about a little over 30 years.

0:05:54.0 KC: Ben, let's talk a little bit more about the Muscular Therapy Institute in Massachusetts. How would you characterize what was important about your school?

0:06:02.7 S3: Well, the school was really different than many places. The school was really about how to become a better human being, but you couldn't call it a human being school. So massage was the vehicle and each class actually stayed together for their entire training, which was about three years long. It was on weekends, and it was like every third weekend or every second weekend, and we did that for many years. And then after about 12 or 13 years of that, I became a regular daytime school and got a building and we changed it to a two-year program. And the core of the program was communication skills, boundaries, how to run a business, ethics, understanding yourself and your own sexuality and what was appropriate sort of and what wasn't. And the other part was the hands-on techniques I had developed from my work with Kagan, my mentor, and I called the work I did Muscular Therapy. And because at that time, massage didn't have the greatest reputation, and so I made that a different... I called it something different.

0:07:05.8 DB: And Ben, when did you start teaching communication skills?

0:07:08.6 S3: Well, they say you study the things that you have to learn, or that becomes important to you, and I didn't start out as a really good communicator. I had to learn it. I started out teaching communication in the late 1970s in my school, and I realized I had a talent for mediating conflict, just a natural ability. And our school did week-long retreats at beautiful places at the beach or in the mountains a couple of times a year. I remember we were at Rehoboth Beach and students lived together in these beautiful houses, each class would live in a house by the ocean. And we had classes in the morning, in the evening, so the students could enjoy the beach during the day. And when they were living together with each other, what emerged when you're living with someone, you have interpersonal trouble. And then I would step in and I would do my conflict coaching, and this sort of emerged sort of naturally. And then in 1980, I tried to actually retire and I moved to Oregon, where there are a lot of people that I loved, and I found a teacher there in Oregon and I really studied communication formally. Before that I would just sort of improvise.

0:08:13.7 S3: And two years later, I moved back to the east coast and had a private practice in New York and Boston, and from then on, I taught communication skills at my school, and also three or four nights a week, I taught communication for years to the general public in both New York and Boston. And almost two decades later, in the late '90s, I found a system called the system for analyzing verbal interaction or SAVI for short. And when I began to learn this SAVI system, I realized how much I didn't know and I wanted to know more. So I actually became the first person officially trained in this SAVI method. It was only held by a very few people, and I kind of learned to be a communication detective. The SAVI system gives you a method and techniques to figure out what goes wrong in a conversation when things turn bad, and it trains you in techniques to change how you communicate, and it was a very exciting period in my life. I remember then in 2012, I co-authored and published the first book ever written on SAVI, called Conversation Transformation.

0:09:23.7 KC: Ben, let's transition a little bit to talk about hands-on techniques. You're very well known in our profession for orthopedic manual therapy. And actually, we're very lucky to have several of your online courses in our ABMP education center available to learners. How did you first become interested in working with injuries specifically?

0:09:41.0 S3: Well, I had all the injuries. By the time when I was 20, Kagan had treated me sort of intuitively for all those injuries, and I thought I knew a lot about injuries in my 20s. But later I realized I didn't really know much of any substance, because in 1979, I was in a PhD program in education, but I changed my major to sports medicine, because a doctor on my committee told me about this guy, James Cyriax. And then I went to a five-day conference in orthopedic medicine, and it blew my mind. Cyriax could figure out exactly what was wrong with just about anybody, and he did these demonstration clinics as part of the course. What he would do, I thought was impossible. He would look at somebody, he would do all these tests and he would figure out exactly what they had, and then he would inject them with some Xylocaine to check it and then treat them.

0:10:33.2 S3: And it was amazing that he could do all these assessments right in front of our eyes, and I was determined at that moment that I was gonna learn everything I could about orthopedic medicine. And after the course with Cyriax, I opened a free clinic in New York City with a doctor friend of mine who happened to be at the course, too. And for eight months, three days a week, we saw people for free, and over that year, I went to that Cyriax course three separate times. The first time I was totally lost. In five days, we learned all the anatomy, assessment testing, history, treatments for the neck, the back, the shoulders, the neck, the wrist, the hand, the hip, the knee, the foot, everything, and you left with a scrambled egg brain. I mean, you didn't know anything.

0:11:15.4 S3: So the second time I really began to really understand, and the third time I really got it, and no one actually... He used to ask a bunch of questions in the course, and no one ever answered his questions, 'cause what he was talking about was very complicated. And he was pissed because I actually started answering his questions correctly, because people... I mean who can learn all that stuff in five days? It was just too difficult. And then I heard about a doctor named Angli, from this doctor that I was working with, and then I just called him up one day, 'cause I came across a client that I didn't understand. And he didn't know me, but he spent an hour on the phone talking with me. Now, what doctor does that? And he changed my life forever. And I was in Oregon, part of this time in a summer and I invited him to treat about 80 patients. There were five doctors I knew in that small town in Ashland, Oregon, and 80 patients came. And he got almost all of them better, and they had been in pain for years and years and years and years, and been to clinics and all kinds of things.

0:12:25.0 S3: So what I soon realized was this doctor was the world's most gifted doctor, and he left Cyriax actually in the dust, and I used to talk about him as if he was from the 23rd century. Because if we know what he knew at that time, it would be amazing. And over the next 30 years, he taught me what I thought was unknowable, and it led me to write my book, Listen to your Pain.

0:12:49.3 DB: Ben, where do you teach your orthopedic manual therapy?

0:12:52.6 S3: Well, I teach little parts of it in the webinars that I do for myself on my website and for you, but the real courses I teach are... Apart from what I did in my school are 10, two and a half day or three-day trainings that it takes about a year or two years to complete. And I start one of those every couple of years, and I've done them in Boston, in Seattle, in Michigan, but mostly I do them in Boston now. And that's been going on for about 35 years, 'cause they used to be taught at my school as well. We train people in everything I know.

0:13:25.4 KC: And you also, in addition to your in-person or on-ground courses, we sometimes say now, because online is becoming such a big thing, you have an incredible online school at the benjamininstitute.com, which offers learners, advanced courses and resources. How did you make that transition from the in-person workshops to the online education?

0:13:44.2 S3: Well, 10 years ago, I did a webinar with a place called ABMP, and I learned that that was a great way to reach people, so I started doing webinars on my work with injuries. And each webinar series had five to seven hour long webinars, they were all in series. Plus, I would do short little videos on how to find the structure, how to assess it, how to treat it. And I did about 70 webinars on the low back, the neck, the knee, the shoulder, the ankle, headaches, ethics, and so forth. And then I produced about another 70 webinars from all kinds of other people. The cancer stuff that I did with Tracy Walton, she did stuff hospital, Ruth Warner, Carole Osborne, Cherie, myself. So I had this whole library of over 140 webinars and hundreds of shorter video clips and stuff. And I wanted to make things much more accessible to people, 'cause if you do a webinar, usually that was it. So I collected them all together. And each webinar would cost $20 or $25, and a series might cost 100, 150 and you'd have access for 90 days. But about five years ago, I got the idea that I would have a subscription service where people would pay just $29 a month, and they would have access to everything, and it actually took five years to create that platform. But it's done and it's out there, and hundreds of people are using it every day, every night.

0:15:05.5 DB: Ben, there's so much online education, especially in these extraordinary times that we're in, tell us about what's unique about your online trainings?

0:15:12.8 S3: Well they can just type in like a shoulder and they get 30 different things come up. Hour long courses, about 10 of them and short video clips that are two to four minutes that shows you, well, how do you find a supraspinatus, how do you find a medial collateral ligament? How do you do friction therapy? How do you do myofascial therapy on an injury? And I also do right now, I do two live webinars a month, that the subscribers attend for free and other people can pay a very small amount and they can come as well. And I'm updating all the older courses and improving it all the time, and do supervision stuff. So I think it's very unique, 'cause people can just go to it and type in what they're interested in and find it and watch all kinds of stuff for days and weeks, on just one topic.

0:15:58.5 KC: So I just heard you mention the word supervision in conjunction with online education. Can you tell us a little bit more about that?

0:16:04.9 S3: Yeah. Sure. Supervision coaching is an underutilized and much needed resource in the massage therapy field. There are two types of supervision. There's technical supervision and relationship supervision. Technical supervision and massage and body work involves working with an experienced therapist who's an expert in the kind of hands-on work that you do. Now, this kind of supervisor can help you know how to approach a problem, develop new skills and techniques with working with a particular injury, whether it's myofascial therapy, massage therapy, orthopedic manual therapy, cranial work, and so forth.

0:16:37.0 S3: For example, students and graduates in my orthopedic manual programs periodically call me for a supervision consultation, I'm working with a client who has a particular kind of pain that they've not seen before, or they're not responding to the treatment that they would expect them to respond to. And then relationship supervision, often referred to as clinical supervision. The supervisor works with the therapist on how to deal with ethical and communication issues. For example, a practitioner may have a client who talks incessantly during a session or asks a lot of personal questions or ask you out on a date or to coffee. Or maybe the therapist is attracted to the client and doesn't really know what to do with all those feelings. Now, all of these issues should be discussed, not brushed aside, as if they were inconsequential, and that's what supervision is for.

0:17:26.9 S3: At first, a supervisor responds, helping this therapist discover their own answer if possible, and advising if it's more appropriate for them to tell you something, but hopefully they get it out of you. And after an ongoing group develops, the participants also respond and help each other. The role of supervision in training massage therapists has been greatly neglected. Supervision can help practitioners deal with the feelings that often come up in a therapeutic relationship that develop with their clients. For example, there are times when the therapist has an uncomfortable or disturbing experience when giving a client a massage, and the client may have made an off-color joke or they may have been inappropriate in some subtle way.

0:18:10.5 S3: Practitioners need a shame-free, trustworthy relationship with peers and a supervisor to review and evaluate these kind of difficult, challenging experiences. I offer live supervision as part of my subscription service to my people for free, and often it allows people to open up and find something that they really didn't think about before, some way they could deal with it or a way to discharge or have people really listen, who can understand. And it's really, it would be a great thing if the spas employed supervisors, who knew this kind of thing. They'd have much less problems in retention and with sexual assault and things like that, so hopefully that will happen.

0:18:51.2 DB: Ben, you also have a DVD collection. And when did you start making DVDS?

0:18:55.4 S3: A long time ago, about 30 years ago. And actually when my kids look at those trainings 30 years ago, they laugh because they don't... That's before they were born, that's what it looked like. So I started making DVDS of my work, and they were really based... Most of these DVDs are based day four-day trainings we used to do on each part of the body. Most of the DVD programs have about five discs each, and we cover the anatomy in great detail with cadaver footage and what I call anatomy palpation and drawing. Students draw each structure. For example, there in the lower back, there's like 18 ligaments that you wanna know how to find, and two muscles that cause lower back pain, and we draw them, we palpate them.

0:19:35.9 S3: So the therapist can find the structure with their hands, which most therapists can't do. And then slowly, we teach the history questions and what they mean, and various assessment tests. For example, in the low back, there are 26 assessment tests, in the neck there are 40 tests. If you don't know how to do that, you can't really figure out what's wrong with somebody, you're just guessing. And then we put it all together with the test, the history, the anatomy and what it all tells you. And then finally we teach the friction therapy, the myofascial therapy, the exercise programs for each injury.

0:20:07.3 KC: Ben, hearing your story is so inspiring, number one, but also just remind us that you're clearly a life-long learner, like so many other massage therapists and educators. What are you excited about now? What's new for you?

0:20:19.0 S3: Well, actually, I've just finished creating an app called Pain in the App. I wanted to make something that taught people, both therapists and lay people, everything about the injury process really inexpensively, and all the principles, the foundational concepts, assessments and treatment options that I know are available. And I wanted to do it to sell that everybody could have access to it. So the app has over 500 questions and answers and explanations. There are 650 original images that I had done of things that have never been drawn before. I have a cartoons for people to have a good laugh and hundreds of photographs, and there are separate sections to each part of the body. The back, the neck, the shoulder, the elbow, the hand, the thigh, etcetera, etcetera.

0:21:02.5 S3: And it was incredibly fun to do, and when people do it, they can't stop. It's very hard for a therapist to stop because it's really exciting, 'cause each question builds on the next question, and then you can push a button and make them all random. And if they're random, then you have to really know it. And the whole thing, you can see on your phone or your tablet for 10 bucks for the rest of your life. And for people who are hesitant, we have 50 free questions that they can try for free before they actually purchase it.

0:21:31.1 DB: Ben, another work of yours that's used all over the country, is your book; Ethics of touch, and I've been around the block so long now, I could totally remember when ABMP purchased it for its members in practice for more than 10 years. What was your motivation in writing it?

0:21:45.7 S3: Because of the articles I wrote on sexual abuse boundaries, dual relationships and so forth, in massage therapy publications, I was invited to participate in an ethics panel in Boston on sexual abuse prevention in health care in 1993. The department heads of medical schools at Harvard, Boston University, Amherst University and the head of nursing at the Boston College were all on the panel. And then there was me, from the muscular Therapy Institute, and hundreds and hundreds of people there. In the panel, the chairs of the departments reported that the average amount of time they spent in medical school and Nursing School on ethics, sexuality, sexual abuse prevention and communication skills, was between five and 14 hours over a four or five year period. Now, when I spoke about how we at the muscular therapy institute did it, we spent 150 hours of our curriculum on ethics, sexuality, sexual abuse prevention, communication, and it just blew everybody away. And I suddenly realized that my school was light years ahead of the medical profession and nursing schools.

0:22:52.9 S3: Now, one thing I remember, it took them an average of two to three years to get rid of a teacher who was inappropriate, and I gave him an example of, it took us two days to get rid of a teacher. And I gave them an example of a person who did something inappropriate and that teacher had to go to every single class, and we had 11 different classes. They had to go to every single class and apologize to the entire school, one class at a time. And for the next two days, people were coming up to me all the time after the panel who had heard about the presentation, who weren't even there, and they heard about what we had in our curriculum policies, and they were congratulating me. And that was the moment I actually decided that I should write the book, the Ethics of touch. And that led to my expert witness testimony work, and lawyers just started calling me and I began testifying in cases of sexual abuse in massage therapy. And just to say also that at the end of the book, it was hard to finish and I met Cherie Sohnen-Moe, and she worked with me and we collaborated and made it an even better book, and she actually published it.

0:23:57.7 KC: After so many years in the field, I'm curious, what do you see as the greatest change in our profession?

0:24:03.5 S3: About in the year 2000, I'd say, massage therapy was reported to be one of the fastest growing professions in the country. And I began to see more and more large spa chains open, the profession went from primarily self-employment to spa jobs. And starting around 2002, large corporations began to take over the profession by buying up massage schools, especially the best ones, and slowly they destroyed most of the best schools in the country. They were interested in money and not in quality education, and now they're about actually half the number of graduates each year from massage schools than there was about 10 or 15 years ago.

0:24:46.0 S3: Corporate owners fired the experienced teachers, because they were too expensive, and they hired people for less money who were right out of school to replace them. They eliminated teacher training, which the best schools had begun to implement years before, and now those corporate schools are closing, and I hope there will be a resurgence of the small quality schools. There are still some quality schools around the country, but there aren't many, and it's hard to compete when a corporate school spends hundreds of thousands of dollars on advertising, but they don't actually deliver quality education. So that was a sad thing.

0:25:21.6 DB: One of the things that we're hearing from new therapists is that they're feeling pressure to work according to standards and values that don't match their own, for example, feelings of safety or boundaries. How would you advise or respond to therapists in that position?

0:25:34.7 S3: Well, if you work in a place that doesn't match your values, it's not good for your emotional or physical health. I'd suggest speak up and voice your concerns. Now, if the workplace doesn't listen to you and they don't make changes, it's not the right place to work. For example, my wife is a hospice nurse, and she let the company she worked for know her boundaries when she first got the job several years ago. And when they violated that boundary, she talked to them and they didn't listen, and she took one day to think about it. She quit, and within two more days she had another job, and she quickly found another place, that would respect her boundaries. That's really, really important to do. And I'm gonna come out very soon in my new edition of my book, and I think in ABMP as well, with a set of guidelines, 15 different guidelines that you wanna check out if you're working in a place, to see if they have those things in place to protect you and protect the clients as well as protecting their business, to do an ethical good job.

0:26:37.3 KC: Yeah. That's really important and I think a lot of therapists need to feel empowered in that way, and they need the information to feel empowered. So I think that's great that you're gonna start sharing that. That'll be really helpful to a lot of people. Ben, we've heard you say that you live life on your own terms. What does this mean to you?

0:26:53.2 S3: I don't engage in things that I don't like. I don't hang out with people whose values I don't agree with. My friends are all people of integrity. When I was a young boy, I was a professional dancer. That was not the usual thing. I created my own massage technique called muscular therapy, because when I started massage was associated with massage parlors, and the people in the profession were not really very skilled. The psychotherapy that helped me turn my life around was a therapy out of the mainstream, that was based on a theory of emotions that were trapped in the body and made us emotionally unhealthy. It was called Orgone therapy, developed by Dr. Wilhelm Reich, so really out of the mainstream. Dr. Reich was one of the only people to be prosecuted by the United States government and had his books burned in the US, because he was so ahead of psychiatry in his work that they felt threatened. Then I began eating organic food when I was 19 years old, not a normal thing. I opened an organic food store. You get the idea. I always live life on my own terms. Almost everything I do is not traditional or conventional.

0:27:58.8 KC: Thank you for being with us, and I think hopefully a lot of our listeners will hear your story of how you were open to new educational opportunities all throughout your life and career. And that led you in different directions, which then helped you create this fantastic and wonderful, not only career for yourself, but you've shared your education with so many people. So my hope is that listeners will be inspired by your story to make change in their own lives and practices. Thank you so much for being here.

0:28:26.6 S3: Thank you for having me.

0:28:28.1 DB: Where can listeners find out more information about you and your courses?

0:28:32.0 S3: They just go to benjamininstitute.com, and it explains the whole thing there. There's a free course that you can do if you wanna try it out. Everybody gets a free course, then you can join for $29 a month or pay by the year. You'd save a couple of months of the fee and you have 24/7 ability to keep learning, and if you ever have a question, you just call me up or you write me an email and I answer you. And the app, go to the app. It's on the iPhone now, and it's gonna be on the other one on the Android soon. We're just finishing that up and you just look for Pain in the App. Try it out, it's great.

0:29:08.1 DB: Thank you so much for joining us, Ben.

0:29:10.3 S3: Thank you for having me.