RMT Jennifer

04/05/2026

Thoracic Outlet Syndrome (TOS): What You Should Know

Thoracic Outlet Syndrome (TOS) is a group of conditions involving compression or irritation of neurovascular structures, most commonly the brachial plexus and/or subclavian vessels, as they pass from the cervical spine into the upper limb.

Types of TOS
• Neurogenic TOS (most common): compression or irritation of the brachial plexus
• Vascular TOS: compression of the subclavian artery or vein
• Disputed / Non-specific TOS: persistent symptoms without clear objective compression (a controversial category in current literature)


Common Clinical Presentation

Neurogenic TOS may include:
• Neck, shoulder, or arm pain
• Paresthesia (numbness, tingling, “buzzing”)
• Hand weakness, reduced grip strength
• Fine motor changes or clumsiness
• In more advanced cases: thenar muscle atrophy

Vascular TOS may include:
• Cold sensitivity in the hand or fingers
• Colour changes (pale, bluish, or mottled)
• Swelling in the arm
• Heaviness or fatigue with use
• Possible diminished pulse (more clinically assessed)

A Practical Way to Understand It
I often describe the thoracic outlet as a “high-traffic corridor” for nerves and blood vessels.

There are three commonly discussed regions where sensitivity or compression may occur:
• Interscalene triangle (between anterior & middle scalene muscles)
• Costoclavicular space (between clavicle and first rib)
• Subcoracoid / retropectoralis minor space

These are normal anatomical spaces, but under certain conditions, they can become mechanically or neurologically sensitive.

Contributing Factors
TOS is typically multifactorial, not caused by a single issue.
Common contributors include:
• Trauma (e.g., whiplash, falls)
• Repetitive or sustained overhead activity
• Occupational demands (prolonged arm elevation, load bearing)
• Anatomical variation (e.g., cervical rib - relatively rare)
• Load intolerance and tissue sensitivity
Posture alone is not considered a primary cause, though it may influence symptom behaviour in some individuals.

Assessment & Diagnosis
Diagnosis is based on:
• Detailed clinical history
• Physical examination
• Symptom behaviour and pattern recognition
Imaging (e.g., ultrasound, MRI, vascular studies) may be used in specific cases, particularly when vascular involvement is suspected.

Treatment Approach
Conservative care is typically first-line.
Treatment may include:
• Symptom modulation (manual therapy, education)
• Gradual exposure to movement and load
• Targeted strengthening and motor control
• Activity modification and pacing strategies
• Sleep and positioning considerations
Surgical intervention is reserved for specific cases, particularly vascular TOS or progressive neurological deficit.

If you’re experiencing persistent arm, neck, or shoulder symptoms that don’t quite fit a typical pattern, this may be worth exploring further.

I wrote a slightly more detailed article about TOS here, if you'd like to read a little more:

What is Thoracic Outlet Syndrome? Thoracic Outlet Syndrome (TOS) refers to a group of conditions involving  compression, irritation, or increased sensitivity of the neurovascular structures  that travel from the neck into the arm, primarily the  brachial plexus, subclavi

04/01/2026

Who is advocating for BC RMTs? Examining Systemic Caps in The Profession.

Introduction
Registered Massage Therapists (RMTs) in British Columbia work within a regulated healthcare profession. However, many of the structures that typically support healthcare workers—such as labour protections, benefits, clear employment standards, and pathways for career advancement—are inconsistent or absent.

At present, there is no union or centralized body actively advocating for:
• fair and legally compliant working relationships
• access to benefits and worker protections
• sustainable compensation models
• modern, evidence-based education
• long-term career development within the profession

Professional associations are intended to represent the interests of registrants. However, there are growing concerns within the profession that key systemic issues affecting RMTs are not being adequately addressed.

This article outlines several of those concerns, based on clinical experience, industry observation, and ongoing discussion within the profession.

1. Labour Classification and Legal Risk
A significant number of BC RMTs work under “independent contractor” agreements that may not align with the criteria set out by the Canada Revenue Agency (CRA).

In many cases, therapists:
• do not control their schedules
• do not set their own fees
• are restricted in where and how they practice
• are subject to clinic policies similar to employees

At the same time, they:
• receive no benefits
• assume full financial and tax responsibility
• are not covered by employment protections

This creates a hybrid situation where therapists carry the burden of self-employment without the autonomy—and the restrictions of employment without the protections.
The implications are serious:
• potential CRA reassessment
• back taxes and penalties (CPP, EI)
• legal exposure for both clinics and therapists

Other professions, such as physiotherapy, have begun addressing this issue by developing guidance aligned with CRA definitions. Similar clarity is notably lacking within the RMT profession in BC.

2. Power Imbalance and Restrictive Contracts
There are increasing reports of restrictive contract terms, including:
• non-compete clauses
• geographic restrictions
• threats of litigation when therapists leave

These conditions are difficult to reconcile with the definition of true self-employment, which includes the ability to work freely and independently.

For early-career therapists in particular, this creates a significant power imbalance:
• limited understanding of legal rights
• financial vulnerability
• fear of retaliation

The result is a work environment where some therapists feel unable to leave unsafe or unsustainable conditions.
Regardless of intent, these dynamics can contribute to:
• coercive workplace environments
• reduced professional autonomy
• barriers to career mobility

3. Compensation, Benefits, and Sustainability
Unlike many other healthcare professionals, most RMTs in BC do not have access to:
• extended health benefits
• paid sick leave
• maternity or parental leave
• statutory holiday pay or wage differentials

Compensation models often rely on percentage splits or minimum rent structures, which can:
• incentivize high treatment volumes
• discourage breaks
• contribute to physical and mental burnout

In some cases, inconsistent billing and payout structures may also create financial instability for therapists.
These conditions raise an important question:
Is the current compensation model sustainable for a long-term healthcare career?

4. Gaps in Advocacy and Representation
Professional associations are uniquely positioned to advocate for registrants. However, concerns have been raised about:
• potential conflicts of interest
• lack of action on known labour issues
• limited engagement with evolving workplace realities

When systemic issues persist without clear guidance or intervention, it can create uncertainty across the profession.

This is not about assigning blame to a single organization. Rather, it highlights a broader gap in coordinated advocacy for:
• labour standards
• workplace safety
• professional sustainability

5. Education and Evidence-Based Practice
Concerns have also been raised about the consistency of evidence-based education within the profession.

These include:
• continued promotion of outdated or unsupported treatment models
• limited integration of modern pain science and pathophysiology
• lack of coordinated updates to competency frameworks

For a profession that operates within a healthcare system, maintaining alignment with current evidence is essential for:
• public trust
• clinical effectiveness
• professional credibility

6. Limited Career Pathways and Advancement
RMTs in BC have limited opportunities for:
• specialization recognition
• career progression within the profession
• integration into broader healthcare systems
• advancement through education that impacts compensation

Experienced clinicians often have the same earning potential as new graduates, regardless of:
• years of practice
• additional training
• clinical expertise

This lack of progression can contribute to:
• reduced job satisfaction
• burnout
• attrition from the profession

7. Workplace Safety, Harassment, and Training Gaps
RMTs work in environments that can carry unique risks, including:
• sexual harassment from patients
• workplace discrimination
• exposure to trauma-related clinical scenarios

Despite this, there appears to be limited formal education or ongoing training in:
• recognizing and managing harassment
• understanding workplace rights
• trauma-informed care
• inclusive and accessible practice environments

Without these supports, therapists may be left to navigate complex situations without adequate guidance.

Conclusion: A Profession at a Crossroads
The issues outlined here are not isolated—they are interconnected.

Labour classification, compensation models, education, and workplace safety all contribute to the overall sustainability of the profession.

BC RMTs are highly trained healthcare providers. They deserve:
• clear and lawful working structures
• safe and respectful workplaces
• access to benefits and protections
• opportunities for growth and advancement
Addressing these challenges will require:
• collaboration between stakeholders
• increased transparency
• willingness to evolve alongside current evidence and labour standards

This is not a critique of individuals. It is a call to examine whether the current systems are adequately supporting the profession—and if not, what needs to change.

This article is intended to encourage informed discussion within the profession and to support ongoing efforts toward meaningful improvement.

In British Columbia, Registered Massage Therapists work within a highly regulated healthcare profession—but without many of the labour protections, advocacy structures, or career pathways seen in comparable fields.

03/31/2026

Do you offer Manual Lymphatic Drainage (MLD)?
I get asked this a lot.

I am trained in lymphatic techniques and and will incorporate them into treatment when appropriate.

In practice, MLD on its own doesn’t tend to produce lasting changes — compression and active strategies are much more effective for managing swelling.

My approach is to integrate the most effective pieces of care rather than rely on one technique.

MLD can provide short-term relief for swelling — but on its own, the effects are temporary (4-6 hours).

The current gold standard for managing lymphedema is compression therapy (garments or bandaging).

If you’re specifically looking for traditional MLD sessions, I don’t offer it as a standalone service — but rather an integration of a more comprehensive treatment plan that includes movement and compression garments. I can absolutely help with swelling management and guide you on the most effective options, including compression if needed.

I focus on care that creates more lasting results, and I’m always happy to help guide patients toward the most effective options for their situation.

03/30/2026

Something that almost nobody talks about:
The 1980s Physiotherapy-Massage Therapy Conflict in BC over MSP funding.

In the 1980s conflict physiotherapists allegedly tried to discredit massage therapy training. Which may explain a lot about the professional dynamics we still see today.

The root issue: MSP money
In the 1970s–80s, BC had something unusual:
Massage Therapy was covered under the provincial Medical Services Plan (MSP).

Patients could use their limited allotment of treatments for either physiotherapy or massage therapy. That meant the two professions were literally competing for the same government healthcare funds.

At the time:
• Many RMTs depended heavily on MSP billing.
• The number of RMTs was growing quickly.
• Physiotherapists began seeing them as competition.

By 1986 there were about 400 RMTs in BC, and physiotherapists increasingly viewed them as a threat to the shared pool of MSP funds. That’s when things started getting political.

In 1987, Irene Ruel, a Physiotherapis and APMP Council member, wrote to the BC Trial Lawyers Association accusing RMTs of misrepresenting qualifications, creating negative publicity for the profession.

Massage Therapists responded with:
• public relations campaigns
• political advocacy
• formation of stronger professional organizations

The most concrete documented incident is the letter written by Physiotherapist Irne Ruel to the BC Trial Lawyers Association.

Legal counsel characterized the letter as “a deliberate trivialization of the qualifications of massage practitioners.”

The letter had substantial readership in the legal world of BC, circulating among trial lawyers who frequently referred patients to RMTs. It could have had significant reputational consequences for the profession.

Legal counsel for Massage Therapists suggested the motivation was competitive pressure related to MSP payments.

2003 marked the end of the widespread, traditional coverage of RMT services under MSP for BC RMTs.

Since then, MSP only covers a limited amount for "supplementary benefits" for individuals on premium assistance.

Today, most RMT visits are paid out-of-pocket or through private extended health benefit plans.

03/29/2026

Why frozen shoulder is more common in perimenopause (and what helps)

Frozen shoulder (Adhesive Capsulitis) was previously thought of as a local shoulder issue — but that’s not the full picture. It may be part of a bigger physiological shift, not an isolated injury.

Emerging research suggests hormonal changes may influence how connective tissue behaves, including increased stiffness, decreased joint and tissue elactisity, increased inflammation, and slower recovery.

It most commonly affects women between 40–60, and is increasingly linked to hormonal changes like declining estrogen.

Frozen shoulder is not purely a local shoulder problem
It may be a systemic condition involving:
• low-grade inflammation
• metabolic dysfunction
• neuroimmune changes
• endocrine (hormonal) factors

What people often notice:
• Shoulder pain that starts without a clear injury
• Progressive stiffness and pain - especially at night
• Difficulty with everyday movements (reaching, dressing, sleeping)

This isn’t just “tight muscles” — and it’s not something to push through.

Supportive care can include:
• Pain management strategies
• Gradual mobility work
• Education around pacing and recovery

Massage therapy can be one part of that support — helping reduce discomfort and maintain as much movement as possible through the process.

If this sounds familiar, you’re not alone — and there are ways to manage it.

I see this pattern often in practice, especially in women navigating hormonal changes.

03/24/2026

03/23/2026

5 Super Weird Migraine Symptoms (in my opinion).

Alice in Wonderland Syndrome - 17% of migraine sufferers experience distored visual and body perceptions, including objects appearing larger or smaller, closer or farther away.

Phantosmias (Olfactory Hallucinations) - Brief episodes of unpleasant, chemical, or burning smell that precede or accompany headache pain. Occurs in less than 5% of people living with migraine.

Kinesiophobia - When movement makes pain and other symptoms worse it can lead to an understandable fear and avoidance of movement known as kinesiophobia.

Gastroparesis - Delayed Stomach Emptying frequently co-occurs with migraine, causing severe nausea, vomiting, or abdominal pain while significantly reducing the effectiveness of oral migraine medication

Audiovestibular Symptoms - Ear pressure, tinnitus, dizziness, sound sensitivity or temporary hearing loss are common, often overlooked symptoms of migraine. A form of sensory aura or referred pain from the trigeminal nerve.

Have you experienced any of these unusual migraine symptoms?

Photo by Aarón Blanco Tejedor

03/19/2026

What Is Migraine Aura, Really?
Spoiler: it’s not just “sparkly lights.”

Migraine aura is a set of temporary neurological symptoms that occur before - or sometimes during - the painful headache phase of a migraine.

Aura reflects changes in brain activity and is often an early warning that a migraine is beginning. These symptoms are fully reversible and typically resolve on their own within 5-60 minutes.

What’s Happening in the Brain?

Aura is linked to a process called “cortical spreading depression” - a slow moving wave of electrical activity across the brain, followed by a brief period of reduced activity.

As the wave moves through different regions of the brain, it temporarily disrupts their functoin. This is what causes the wide range of neurological symptoms which can include:
• Visual disturbances
• Numbness or tingling
• Speech or language difficulty
• Dizziness or balance issues
• Weakness
• Smell or sound disturbances
Symptoms vary depending on which part of the brain is affected.

How Common is Aura?
About 25-30% of people with migraine are diagnosed with aura. However, many experts believe it is under-recognized, especially when symptoms are not visual.

Types of Migraine Aura

Visual Aura (Most Common)
Occurs when the visual cortex (back of the brain) is affected.
Visual Aura Symptoms:
• Crescent that shimmers or is colourful
• Zigzag or jagged lines “fortification spectrum”
• Flickering or shimmering lights
• A Blind spot, dark patch, or multiple spots floating in your vision
• Objects that appear blury, wavy, distorted, or fragmented

Sensory Aura
Sensory Aura is characterized by physical sensations that spread gradually across the body, usually in the face, hands, or arms.
Sensory Aura Symptoms:
• Tingling or pins and needles that spread slowly from the fingers up toward the face
• Numbness in one side of the face, lips, or tongue
• A feeling of heaviness or unusual warmth in the affected area

Speech & Language Aura (Aphasic Aura)
Affects communication and can feel alarming
Aphasic Aura Symptoms:
• Struggling to find words mid-sentence
• Words come out jumbled
• Unable to respond clearly
• Difficulty reading or writing

Motor Aura (Hemiplegic Migraine - Rare)
Motor aura is rare subtype of migraine characterized by temporary muscle weakness typically on one side of the body.
Hemiplegic Migraine Symptoms:
• Weakness or heaviness on one side of the body
• Difficulty gripping or lifting objects
• Dragging of one leg or arm
• Rarely, temporary paralysis on one side
This type of migraine requires higher level medical evaluation and ongoing management

Brainstem Aura (Previously “Basilar Migraine”)
Originates from the brainstem, affecting coordination and sensory processing.
Brainstem Aura Symptoms:
• Dizziness or vertigo (a spinning sensation)
• Double vision (diplopia)
• Ringing in the ears (tinnitus)
• Unsteadiness or loss of balance
• Difficulty speaking or swallowing
• Changes in hearing

Retinal Aura (Ocular Migraine)
Retinal aura affects only one eye, not both visual fields.
Retinal Aura Symptoms:
• Temporary vision loss or blind spots in one eye only (scotoma)
• Flickering or dimming vision in one eye (scintillating scotoma)
Important: Always assess new single-eye vision loss or changes with your doctor.

Auditory Aura
Auditory aura affects what you hear and manifests as part of the vestibular migraine in 40% of people with vestibular migraines. Auditory aura is easily confused with other conditions like Tinnitus or Meniere’s Disease, proper medical evaluation is important.
Auditory Aura Symptoms:
• Ringing, buzzing, or humming (tinnitus)
• Muffled hearing
• Phantom sounds
• Fullness or pressure in the ear
• Sound sensitivity (phonophobia)

Olfactory Aura (Phantosmia)
Olfactory aura is characterized by unpleasant odours with no source. It’s less common and often under-reported.
Olfactory Aura Symptoms:
• Smelling smoke, burning, or chemicalls
• Metallic or unpleasant odours with no source

Aura Without Headache - Silent (Acephalgic) Migraine
Aura can occure without headache, known as silent (acephalgic) migraine.

This can be confusing and is often misdiagnosed, especially when symptoms are neurological but not painful.

Migraine Without Aura: (Common Migraine)
About 70-75% of patients with migraine do not experience aura.

However, they may still experience premonitory phase hours to days before the headache.
Premonitory Symptoms in Common Migraine:
• Fatique
• Yawning
• Mood changes
• Food cravings
• Neck stiffness.
• Light & sound sensitivity
• Changes in digestion
• Increase urination

What To Do When Aura Starts
Aura can act an early warning window. While short, it’s an opportunity to act.
A Simple Migraine Response Plan:
• Take prescribed medication early.
• Reduce sensory input (dim lights, quiet enironment)
• Hydrate
• Eat if blood sugar may be low
• Pause activities requiring focus (e.g. driving) and get somewhere safe

Important: When To Seek Medical Attention

Because aura symptoms can overlap with serious neurological conditions such as stroke
• If symptoms are new, unusual, or severe
• If they don’t follow your typical pattern
• If you’re unsure what you’re experiencing
Seek urgent medical evaluation immediately.

03/17/2026

Do you ever notice yourself doing this?

• Clenching your teeth while working
• Waking up with jaw tightness
• Clicking or popping when you chew
• Tension headaches around your temples

Most people don’t realize jaw tension is one of the most common triggers of chronic headaches and migraines. They have a bidirectional relationship.

I’ve opened a rare Saturday Shift with only a few appointment spaces for people dealing with persistent headaches, migraine, or jaw pain.

If you'd like to book one of these spots, or if you’re unsure whether massage therapy is appropriate for what you’re dealing with, reach out - I’m always happy to answer questions.