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.
Deep Tissue 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.