Tuesday, August 14, 2012

Simply Advanced

Fundamentals of Therapeutic Massage 5th ed by Sandy Fritz

I am going to begin a series of blogs about how to simplify the concept of ADVANCED massage application.  There is so much confusion about  methods considered advanced i.e.  orthopedic or deep tissue or myofascial, or neuromuscular or lymphatic  etc, etc. etc.   There are a trillion ( well maybe not that many) names out there being marketed as advanced massage and under the umbrella of continuing education . This is confusing because if a massage method is going to work then it must be tied to anatomy and physiology or location and function.  Naming of methods adds to confusion and I suggest that any naming should describe how the method interacts with the location and function.

My definition of advanced massage application: Skilled, experienced use of the fundamentals  to  achieve desired outcomes.  

A foundational problem occurs when the fundamentals of massage are lacking and unfortunately I believe this is a common problem in education especially at entry level—but that is another topic.  Another major problem is experience.  Most entry level massage programs will provide a clinic of some type and student may due 50 massage sessions and then they graduate and are expected to perform at a professional level that the general public is going to pay for?  I think this is ludicrous.   If  believe a person needs to do 1000 massage sessions before they even grasp the concept of therapeutic massage within and entry level framework..  If I ran the world a person would be required to complete this level of experience before being allowed licensure and certainly before beginning any sort of advance training.

We also have to consider the validity of the  advanced methods.  This begins with the correct anatomy and physiology of the methods target. For example: lymphatic drainage or myofascial release.   There should also be a research search to determine the level of evidence for the support of the benefit of the method or does the method do what it says it does.   There are many types of valid evidence from high level met analysis of research studies to expert opinion.  Right now the amount of high level evidence for just about all massage methods is scant so beware of unrealistic claims made by those teaching “advanced “ massage methods.  Any of us that teach need to be honest about the claims for benefit we make. It is ok to say that there is no research evidence or to indicate that expected benefits are antidotal.  It is not ok to make claims that are inaccurate.

 I typically consolidate benefits that cluster around relaxation and pleasure based benefit,  stress/mood management, pain management,  mobility management.

Relaxation and pleasure benefit is likely the most important benefit of massage. I can get frustrated when this type of massage outcome is seen as insignificant when I think it is the most significant outcome of all and massage application should have this approach as a primary focus.  The massage approach is what Dr. Leon Chaitow calls –constitution- meaning general and non specific.  The massage approach typically is what is thought of as the Classical / Swedish style.  Unfortunately this type of massage is often taught and applied in a routine and in a mindless “paint by number or follow the dots” approach when it should be the foundation for massage therapy.   The massage application is rhythmic, full body, nonspecific,  broad based medium  pressure, non-painful, involves rhythmic but passive joint movement and  provided by a caring, nurturing and empathetic massage professional in a safe environment, .  The primary physiology targeted is the autonomic nervous system.  In my mind the biggest application mistake for this approach is too light or too deep of a pressure.  If we visualize the anatomy as a sandwich- with the bone as one slice of bread and the skin/superficial fascia as the other piece of bread with the muscle based soft tissue as the filling, then the depth of pressure is through the top layer of bread and just into the filling.  

I strongly believe that this type of massage application is lost in all the “fancy stuff” when true advanced massage application is based on this foundation.  This massage application is the main avenue for palpation and joint assessment.  As the soft tissues are moved in a variety of directions and each joint is also moved, the areas of tissue changes and altered range of motion are identified.   It is also my belief that this is the massage application skill set that must be perfected in entry level massage training.

The next topic in the subject will be assessment since “advanced work” is often considered application to address dysfunction.  You cannot understand dysfunction until you understand function.  I am speaking of a solid, functional understanding of anatomy and physiology normal function.   I think initially in education we focus too much of pathology without cultivating a strong knowledge of normal body function.  Our anatomy and physiology is marvelous and a cornerstone of professional practice in massage. 

More to come.  I welcome your comments.

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