Wednesday, June 26, 2013


As I continue wading though the ELAP document I find myself longing for a definition of massage but I can't find one. Instead what I find is  a tab that says Massage Forms and Styles.  Under this tab is :
Foundation Principles and Skills
Swedish Massage
Myofascial Approaches
Deep Tissue Approaches
Proprioceptive Approaches
Neuromuscular Approaches
Hydrotherapy for Massage
Seated Massage

I guess that this is the definition for massage. I have issues for sure.

Foundation Principles and Skills- This section was well done and reflective of entry level.

Swedish Massage - In my previous post I explain the problem with using the term Swedish massage as the platform for massage language. I suggest a term such as general massage or massage therapy or massage.

These next sections get really odd for me.
Myofascial Approaches
Deep Tissue Approaches
Proprioceptive Approaches
Neuromuscular Approaches

I do not understand why they are seen as specific methods rather than adaptation of general massage application. The fascia appears to respond to  tension forces, however why is not understood. Tension force is created with gliding methods that drag the tissues.  Lubricant is reduced or eliminated during application to create drag. In addition, the myofascial and deep tissue content areas were overlapping and the separation between the two is artificial. Fascia and other forms of connective tissue are structures of the body (anatomy) with interconnected function with other body systems (physiology). Deep tissues are under surface tissues or am I missing something here.  Don't you adapt depth of pressure to address the various layers of the body from surface to deep.  I recall Gil Hedley's dissection videos where he sequentially reveals various tissue layers.
This is anatomy-not method.  Pin and stretch was considered deep tissue (I think because once you complete an area you can't get back in). However, pin and stretch is considered a direct method (into the resistance) and by nature of the application isn't this myofascial????--or is it???.  You can see the problem I hope.

Proprioceptive approaches was confusing.  It appears to me that what is meant is the use of muscle energy techniques and pressure on muscular attachments.  Muscle energy techniques consist of a variety of controlled muscle contractions that are used primarily to support stretching. Since stretching and joint movement is part of the general massage (Swedish in the document) why is this a separate method?  In addition compression as a method described for both this category and neuromuscular as well as seated massage was not included in the methods of Swedish massage. 

Neuromuscular approaches are reflected as trigger point focus. The concept of trigger points as a condition (not a method) is under scrutiny.  It is likely that some sort of tender spot phenomenon exists but this would be a pathological condition or an adaptive response which would be addressed if appropriate with an adaptation of general massage. Besides the trigger point concepts in only a small aspect of neuromuscular methods as a system.  I have been fortunate enough to have Dr. Chaitow as a teacher and mentor for years and his analysis of trigger points and how to address when appropriate has evolved. His uncle Bois formalized neuromuscular applications. I just cannot support the way proprioceptive and neuromuscular methods were presented.

Hydrotherapy for Massage- Hydrotherapy is not massage. The complete system of treatment can compliment massage and therefor falls under my understanding of adjunct (something added to another thing but not essential to it.) I did not have issues with the content specifically but how does this fit under the category of- Massage Forms and Styles.  While there are some simple hydo/thermotherapy methods that an entry level massage therapist could add to the massage session I would really see this as a specific specialty beyond entry level.

Seated Massage- Why is seated massage a whole different concept than general massage adapted to the seated position and why was there a specific business and marketing strategy involve?

Also as a side note, I had my entry level students complete the section on the skeletal system and they thought is was good and that they should know the content. I agree with them.  I did take issue with being told how to teach the content however.  I actually choose to use the ELAP to teach today and that was not a possibility listed in the curriculum map.

I realize that this blog is coming a crossed sarcastic but I am choosing to leave it this way because I believe my frustration is valid.  I also know what it is like to be on the other side of a review like this. The individuals who worked hard on this, I believe were doing the best they identified at the time of creating this draft.  I also know how important it is to pay careful attention to reviewers.  Reviewers see things differently and can point out flaws, inaccuracies and biases when as an author or in this instance part of a work group cannot see because of being too close and attached to the project.. Please workgroup--pay attention.

Monday, June 24, 2013

ELAP-Some of my observations for you to consider.



First, before I write anything else it is important to state that I am supportive of the ELAP project.   I want it to succeed.

Now here are some of my observations and concerns:

The initial survey attached to the Federation of State Massage Boards job task analysis survey was flawed.  The only option for general massage was the term Swedish Massage and for a therapeutic intervention was deep tissue massage.  The problem is:

Swedish Massage as an approach is too limiting and has current and historical confusion about what it means.  I searched state licenses and seldom is the term Swedish Massage used. Massage Therapy and Therapeutic massage are much more common.  In the state licensing descriptions of massage application terms such as gliding, kneading, pressing, shaking and so forth are use almost exclusively instead of effleurage, petrissage and so forth. If effleurage means “gliding” then use gliding and if petrissage means “ to knead” then  use the term knead.   I strongly believe that is time to use terminology that explains what is done and qualified by how it is done if for no other reason than to help researchers be able to standardize protocols.  The project is attempting to describe entry level practice so the simpler the better

Alteration of the ELAP is simply a term replacing process while leaving the intent of the document in place. Easy to do and clinging to the historical terminology is not worth the potential  problems that can arise and how this language could undermine the whole project.  Please –the language should be as generic as possible.

As problematic is the inclusion of deep tissue massage.   There is little agreement about what deep tissue massage is and that is a huge issue for entry level education.  I strongly feel that this section should be eliminated and the general massage platform include the ability to adapt pressure to address the various tissue layers of the body.

The method of compression was totally left out and yet it is the approach that is used in many situations especially over clothing and when lubricant is limited or not used.  This is a flaw in supporting methods like seated massage or in situation where static pressure is used. 

I propose that entry level should be based more on safe practice of general nonspecific massage with outcomes of wellness, relaxation, stress management, and able to address minor manifestations of pain and mobility in the generally health client.

Content related to professional communication is important and I believed covered well in the document.   There are aspects of specific methods for communication skill based on organized systems integrated into the document and I think this should be more generic.  For example- I am skilled in the used the Myers Briggs system but would never suggest that this approach be incorporated into the ELAP document.

I also am concerned over content in the ELAP document that relates to psycho/emotional issues.   Topics such as breath work, emotional release, psycho/social l behavior and energy balance are too controversial and if and when valid are way outside the realm of entry level. These topics should be eliminated.  

I have some concern over the use of the taxonomy created by the work group.   I think it would have been better to use a method to create the document that is grounded in current education and implementation into standard academia may be an issue. This being said, I believe what the work group did develop is workable.  I do think that the curriculum map based on the taxonomy is too tight and could be perceived as dictatorial.  I personally understand the domains and how a bit of content is addressed in each domain, but as I reviewed the document it felt like the curriculum map was telling me HOW to teach instead to indicating WHAT to teach.  WHAT AND HOW ARE VERY DIFFERENT.  For example many times it is stated to use mock forms to analysis something or write a sample massage plan or role pay and critique peer. These are all fine educational methods but they are HOW to teach something instead of WHAT to teach.  I suggest that the curriculum map stick with WHAT to cover and if appropriate list methods that are used to teach this type of content separately. Personally I think the HOW should be more directly related to teacher training.

Also removing the HOW TO TEACH SOMETHING and concentrating on WHAT TO TEACH would significantly simplify the document which is overwhelming.   I think the work group attempted to do too much and suggest that the document be simplified.
This is enough for now. More to come.   What do you think? 

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