Friday, March 8, 2013



As I wander around in the massage related social media and webpages for the various organizations I am seeing content related to how to teach massage.  This is good because without excellent teaching we cannot lay the foundation for excellent massage practice.  However, just like the hundreds of massage types (very confusing and really basically the same), there are many theories about how people learn and how to develop curriculum and then implement that curriculum into to actually abilities through teaching.  

There are some real obstacles for massage therapy education such as:


We do have an excellent start however in the competencies developed by the Commission on Massage Training and Accreditation and the Massage Therapy Body of Knowledge.  The ELAP (Entry Level Analysis Project) is also supposed to address this issue.  In the meantime educators in the massage community continue to make individual best guesses about what people need to know and be able to do to be considered massage therapists.  Obviously this is a frustrating issue for many and it is no secret that I personally am frustrated with the lack of progress from my peers about laying this foundation, however this is not the topic of this blog.  Ha.

My last blog was about the evolution of the textbook into multidimensional learning systems.   I have had questions and comments about the blog.  This combined with the many discussion found on the web has prompted me to expand on this topic. 

Being a massage school owner and education almost 30 years now has made me continue to learn.  Writing textbooks has also made me explore learning theory. I doubt that many who use my textbooks realize just how much research has gone into how the information is presented. 

First is the audience- Adult learners regardless if they are baby boomers, generation X or Y or whatever -Adult learners want relevance or:

• Why am I learning this?

• Don’t waste my time?

• What’s in it for me?

In other words, adults will be motivated to learn when they experience value in the process. They want quality because they are paying for it.   There is a reason/outcome for the learning as opposed to having to be in school like k-12.  Adults choose to learn. 

When I am considering content for a textbook one of the first questions I ask myself is “What does this information have to do with actually giving a massage that a client will feel is worth paying for?” This means that the information in some way is going to help the massage application be beneficial and not harmful.  We all have had school experiences where the content seemed stupid and have little or no relevance.  Certainly this statement needs to be qualified based on usage.  I recall having to learn math in K-12 even if I did not actually experience the relevance until I had to balance a checkbook (do we even have check books anymore?)  or sort out statistical meaning in massage related research.  When I am teaching I will say to students, “Yes you need to know this even though the relevance is not obvious just yet.”   Medical terminology can sometimes fall into this realm.  I give examples and provide activities that show them the relevance.  In my science text- Mosby’s Essential Sciences for Therapeutic  Massage-I have practical application boxes strategically place so the learning knows they will actually use the information they are learning about. 

Another process I use in the textbooks is spiral learning theory and novel repetition. In it’s most basic explanation, spiral learning is just introducing a topic, touching on it for a short time and then moving on knowing the content will appear again and again. The premise is that a subject isn’t learned the first time around and the student can pick up more information the second third and fourth time. With each learning session, the student will expand on their skill level and build new understanding.   The key is that each time the content is presented it needs to be presented in a novel way (different but similar) and with relevance based on the skill set of the student at the time.  For example: The beginning student will need to know the basics of scientific language and then progress to using that information to break down work meanings as they read, progressing to using terms to complete charting and so forth.

 Spiral learning is not a new model of learning and it is especially effective in skill building or developing competencies.   This type of learning can be messy but that is a good thing.  It is harder to develop curriculum and courses within the curriculum because each part must related to the other courses.  It is much more like playing with Legos than coloring a picture in a coloring book

 I am personally not a fan of linear or mastery learning methods (coloring book). The linear/mastery learning model suggest that students learn in a sequential way – they must master a topic before moving on to the next. The topic will not be “revisited” as in the spiral learning method.

Often there is a combination.  Draping during massage is an example.  It is helpful in the beginning for the student to learn a way to drape.  I will drill in a method until they can do it without being nervous about doing it right. At the same time I know that draping adaptation is going to show up over and over through the program. This allows the students to be refreshed in the key concepts and at the same time expand skills.

I did not create the spiral learning concept. Jerome Bruner put those pieces together. Jerome S. Bruner (1915- ) is one of the best known and influential psychologists of the twentieth century. Bruner's model of the spiral curriculum is an element of educational philosophy suggesting that students should continually return to basic ideas as new subjects and concepts are added over the course of a curriculum. The idea behind the method is for students really to learn, rather than simply memorizing to pass a test.  In simpler terms, one learns best through the repeated experience of a concept. Over the course of development, behaviors and pieces of knowledge are reinforced by outcomes. The important part of this is that the information needs to be repeated in novel forms that evolve as the student evolves.

To learn more check out these reference links:

The spiral approach is a technique often used in teaching or textbooks where first the basic facts of a subject are learned, without worrying about details. For example; instead of learning the individual names of all the muscles that flex the elbow-learn first that the groups are called elbow flexors.  Then as learning progresses, more and more details are introduced, while at the same time they are related to the basics which are reemphasized many times to help enter them into long-term memory.  The spiral learning concept support current discussion on Facebook about the “flipped classroom” where the emphasis is less on what the teacher has to say especially in lecture and more about what the students can discover.

I use the spiral model as I create textbooks.  Sometimes reviews I get about the books question the repetition however the spiraled repetition is the point.  While the textbooks I write can be used for individual classes successfully, the imbedded spiral learning is less successful than when the books are the platform for the curriculum and each chapter is a “course book”.  I think educators make a big mistake by giving entry level students too many textbooks. It is confusing. Following is the table of contents from the 5th edition of Mosby’s Fundamentals of Therapeutic Massage with notation about the imbedded spiral for learning.


Chapter 1            Therapeutic Massage as a Profession

This is the big picture which briefly presents the need for knowledge and the relevance for practice


Chapter 2            Ethics, Professionalism, and Legal Issues

This chapter loops back (spiral) to pick up on the concept of a service profession and the structure of professional behavior. Critical thinking and Clinical reasoning is introduced


Chapter 3            Business Considerations for a Career in Therapeutic Massage

Now the information from chapters 1 and 2 is looped again but with a very practical practice building outcome—relevance and the critical thinking process is used for decision about practice building and management.


Chapter 4            Massage and Medical Terminology for Professional Record Keeping

This chapter introduces the idea of scientific basis of massage and immediately relates nuts and bolts content to relevance for documentation.  Critical thinking spirals into how documentation is completed.


Chapter 5            Research Literacy and Evidence-Based Practice

Chapter five spirals back into content from chapter 1-2-3 and challenge the student to use the content from chapter 4 to read and analysis the research.  The research is presented in terms of outcomes for massage which loops back to the marketing of massage or what does the client want and what will they pay for.  Critical thinking and Clinical reasoning spirals into the scientific model and the analysis of research.


Chapter 6            Indications and Contraindications for Therapeutic Massage

This chapter spirals through all the information of previous chapters in the novel repetition format that expand on the foundation set for   outcome based massage application and treatment plan development .


Chapter 7            Hygiene, Sanitation, and Safety

The nuts and bolts of this chapter are absorbed because the student understands the relevance based on previous chapters.


Chapter 8            Body Mechanics

This chapter involves the doing of massage, spiraling into the concepts of career longevity, adaptation, safe practice and method application. It also presents ergonomic and biomechanical research to support methods being taught reviewing previous content.


Chapter 9            Preparation for Massage: Equipment, Professional Environment, Positioning, and Draping

This nuts and bolts chapter also reviews (spirals) back through the first 3 chapters based on respect and care of the client establishing relevance and practical application.


Chapter 10          Massage Manipulations and Techniques

A nuts and bolts chapter that loops back into all of the research, indications and contraindications as well as critical thinking and clinical reasoning of the previous content.


Chapter 11          Assessment Procedures for Developing a Care/Treatment Plan

Again this chapter, by teaching assessment, reinforces critical thinking, clinical reasoning, and the importance of research, client expectations and experience.  The end result is the foundation for individualized massage application based on client outcomes that can be justified and documented within a multi -disciplinary heath profession.


Chapter 12          Complementary Bodywork Systems

Building on all previous content this chapter presents bodywork methods that are typically part of the massage approach but called different names and presented as unique systems.  Additionally ,true adjunct methods such as hydrotherapy review the importance of relevance, research, safety and documentation

Chapter 13          Massage Career Tracks and Practice Settings

This chapter loops all previous content in the platform of where the learner wants to practice massage and how massage is framed in the various practice settings.

Chapter 14          Adaptive Massage

Again Adaptive massage is the same material from previous chapters in the novel presentation of clusters of populations and the individual adaption of professional integration, assessment, treatment planning, justification and massage application.

Chapter 15          Wellness Education

Building on massage as part of the larger system of health and wellness this chapter loops back through the textbook content by indicating that massage is supportive of and supported by a broader scope of experience.

Chapter 16          Case Studies

This chapter presents 20 stories and pulls it all together in a final spiraling process toward competence.


Hopefully those reading this blog can identify the broader based of a well-designed textbook as more of a learning experiences than an efficient collection of facts.   This is hard to do and take time and a team of developers.  Not just me.

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