This blog consists of
highlights from the last four blog posts. The time for comment on the ELAP project is
almost over. I repost my observations as a source of information (biased by how
I feel ) to help you better understand
the critical juncture we are at in the massage therapy community.
One of my main concerns has been the choice of terminology
used in the ELAP document. I think the
MTBOK did a much better job in presenting this content. The entire massage platform in the ELAP is
based on a foundation of Swedish massage. Here are the comments from the original blog:
“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.
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.
http://www.gilhedley.com/index.php.
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. 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?
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.
There is NO
DEFINITION OF MASSAGE in the ELAP!!!!
From previous blogs
“I propose the MTBOK definition with a couple of suggested
edits. Mtbok.org
Section 120 Massage Therapy Definition
Massage therapy is a healthcare and wellness profession
involving manipulation of soft tissue. The practice of massage therapy includes
assessment, treatment planning and treatment through the manipulation of soft
tissue ( I suggest deleting :, circulatory fluids and energy fields ),
affecting and benefiting all of the body systems, for therapeutic purposes
including, but not limited to, enhancing health and wellbeing, providing
emotional and physical relaxation, reducing stress, improving posture (add and
movement ), facilitating circulation of blood, lymph and interstitial fluids (,
balancing energy –suggest alternate
wording : -enlivening physiological
balance ), remediating, relieving pain,
repairing and preventing injury and rehabilitating. Massage therapy treatment
includes a hands-on component, as well as providing information, (
delete-education and non-strenuous activity)s for the purposes of self care and
health maintenance. The hands-on component of massage therapy is accomplished
by use of digits, hands, forearms, elbows, knees and feet with or without the
use of emollients, liniments, heat and cold, hand-held tools or other external
apparatus. It is performed in a variety of employment and practice settings.
There are no overarching
competencies in the ELAP document.
From pervious blogs
“I also propose the use of the COMTA competencies.
http://www.comta.org/
I modified these just a bit for use in my curriculum at my
school.
•PLAN AND ORGANIZE AN EFFECTIVE OUTCOME BASED THERAPETUIC
MASSAGE SESSION •PERFORM MASSAGE FOR THE THERAPEUTIC BENEFIT OF THE CLIENT •DEVELOP
AND IMPLEMENT SOUND BODY MECHANICS DURING MASSAGE APPLICATION •PERFORM MASSAGE
IN AN ERGONOMICALLY SUPPORTIVE ENVIROMENT •INPLEMENT SELF-CARE STRATEGIES TO
SUPPORT CAREER LONGEVITY •DEVELOP SUCCESSFUL AND ETHICAL THERAPEUTIC
RELATIONSHIPS WITH CLIENTS, PEERS AND OTHERS IN THE HEALTH AND WELLNESS
PROFESSIONS •DEVELOP STRATEGIES FOR A SUCCESSFUL PRACTICE IN BOTH A SELF-EMPLOYED
OR EMPLOYEE CAREER PATHWAY •IDENTIFY STRATEGIES FOR LIFE LONG LEARNING AND
ONGOING PROFESSIONAL DEVELOPMENT
Finally ,for this blog the ELAP-Entry Level Analysis Project
needs to be revised based on the comments being collected right now and the
feedback from the many experts in the field who have expressed concern over
both the process and the content in the project. The work group needs to be more transparent
and when the final report is published please provide the original survey, raw
data and the procedure used to analyze the data for the first draft. I would also like to see the revisions made
from the comment process and the raw data from the comments.
And---Why
ELAP anyway? ELAP was meant to inform
development of model legislation
Model legislation will define who we are and what we do
(scope of practice) .
Model legislation will direct educational content and
delivery
Please all of you who are reading this blog, I hope
you use it as a launch pad to becoming informed. We do not have to always agree
but we need to stay informed and work together. I hope you will share this
information and encourage others a to be informed. I also hope that we all
remember that the people involved in doing all this work are good, caring
committed people. Support the people please as you share your comments and
concerns. I hope we will be productive
and offer suggestions, be willing to compromise and not complain and bitch just
for the sake of it. I hope we get this done.
We need to organize our definition of massage, our
competencies, our body of knowledge and our core educational content into a
unified statement.
