Friday, June 5, 2015

Secrets from Mosby’s Fundamentals of Therapeutic Massage – 20 + years in the making. Chapter 1

Secrets from Mosby’s Fundamentals of Therapeutic Massage – 20 + years in the making. Chapter 1

I have a big issue with right answers.  There are a few solid facts I guess. A book I read many years ago influenced me about the question /answer conflict I have.  The book Mister. God This is Anna described an unlikely relationship between a little girl Anna and a young man Flynn.   One section of the story has guided me during my textbook writing. It is a discussion about questions and answers that went something like this. -The answers are not that important.  For example the number 3 is the answer to hundreds of questions such as 7-4= 3.  What is important is the question. When you can find an answer with only one question that is important.,_This_Is_Anna

From Fundamentals Chapter one-

“Both the questions and the answers evolve for each student as the individual's information base and experience increase and the journey through education continues. This text does not provide definitive answers to any of these questions; however, it does provide information to help you find your own answers to questions you may face. What will your questions be? How will your answers influence those you touch? How will your answers touch you? These are huge issues to consider at the beginning of any course of study. As you begin to think about them, you might feel interested, excited, overwhelmed, or maybe even frightened as you come to realize how necessary, beneficial, complex, and powerful touch can be. Remember that understanding evolves. These important questions are posed at the beginning of this study and possibly before you have sufficient information to develop effective answers. Your awareness of these questions will help you make decisions and find answers as you progress in your study of therapeutic massage. You will come to understand the process of developing your answers to the previously mentioned questions and many others that will arise by embracing the importance of respect, not only for yourself, but also for all those with whom you interact, both personally and professionally  (Fritz 2).”

I have also grappled with the identity we have as massage therapists. From the first edition I have been uncomfortable with using the term therapist when compared to our level of education. The term therapist has a very layered meaning. The Federation of State Massage Boards Model Practice Act formalizes the term Massage Therapist. I have been more confident with the term practitioner.  I support vocational status for massage practice.  Vocational status fits well with health professions. Diploma based education at entry level allow for relatively quick entry into practice and the education is not burdensome for those who seek to serve through therapeutic touch.  The title of the textbook- Fundamentals of Therapeutic Massage reflects this belief. I support and have worked really hard for educational pathways beyond entry level.

“Schools of massage therapy have begun to work with colleges and universities to develop articulation agreements that allow graduates of their programs to complete degrees in massage. The first of these articulation agreements was reached in 1995 between the Health Enrichment Center in Lapeer, Michigan, and Siena Heights University in Adrian, Michigan, to grant both associate's and bachelor's degrees in applied science in massage therapy.  (Fritz 21)”

Today the associates and bachelor’s degree is available to those who seek educational advancement based with credit hours articulated into the university program based on Board Certification through the NCBTMB.   Another unsung hero of mine is Norm Buckwaz  a dean at Sienna Height University. He and I worked together beginning in 1993 to achieve the articulation agreement and just last year. as he is approaching retirement ,Norm was a driving force for the agreement between NCBTMB and the university to award college credit based on Board Certification instead of  a loose network of individual articulation agreements. With degree completion available online ,now any massage therapist can pursue advanced academic degrees. My dream is that the bachelor’s degree will support teacher development. I am proud of my contributions to this educational pathway. However I remain a strong supporter of diploma based education for entry level massage training because I believe more people can learn massage and serve others by providing affordable quality therapeutic massage.

“A profession is defined as an occupation that requires training and specialized study. An occupation can be defined as a productive or creative activity that serves as one's regular source of livelihood. A professional is a person who engages in a profession. Professionalism is the adherence to professional status, methods, standards, and character (Fritz 3)”

I am a supporter of outcome based therapeutic massage based on assessment and unique adaptation for each client. —

“You will learn to listen to a client give his or her history and to observe during a physical assessment. However, not until you touch the client and feel the person will you begin to understand that individual's body. The client can sense through your touch if you understand the information the body provides. Touch is a fundamental, multilayered, and powerful form of communication, the most personalized form of communication we know. (Fritz 4)”.

Throughout the textbook I use metaphors and stories. I have become more own best study of anatomy, physiology and human nature.  This is not always an easy endeavor. Self-honesty can be a bit brutal. At the same time I am often my greatest source of entertainment.  It is amazing the amount of goof I contain and embrace opportunities to laugh at myself.  The current situation with my eyes and glaucoma treatment is an ongoing source of amusement. Currently I have on an eye patch with holes in it under glasses with the right lens removed with reading glasses over that also with the right lens removed.  I also have a magnifying glass at hand.  My depth perception is a mess and just watching me go down stairs is a belly laugh. I think story telling is a great way to teach.  We just need to make sure the story is relevant for the lesson and not just blabbering. When you share your story you become vulnerable but so are clients as they remove clothing,  lay on the massage table and let us touch them.  One of my first stories appears in chapter one.  It was in the first edition and I have had to keep updating it some but is is true and hopefully an example for students about the important of self-reflection.

Proficiency Exercise 1-2 My Touch History


On a piece of paper, write a brief touch history of yourself. Then explain the ways your history may influence your delivery of professional touch. The following example is provided as a model.

Culture: I grew up in the United States in Michigan. I lived in a small town that was primarily Caucasian.

Subculture: My family was a blue collar, working class family.

Genetic predisposition: I am most comfortable with a large personal space and plenty of time alone.

Gender: Female

Age: Mid 60s

Life events:

I experienced touch trauma from a grandfather and uncles, who would tickle me until I could not stand it.

I gave birth to three children and am a single parent.

I had a special friend who was blind.

I had unexpected open heart surgery.

My oldest son was killed in a tragic accident at age 33.

Spiritual path

I initially had an unstructured Protestant focus. I developed a specific fundamentalist path in early adulthood. I embraced many paths as truth in later years as I evolved from the practice of religion to the development of personal spirituality.

Ways my touch history may influence my delivery of professional touch

I had to learn a lot about different cultures, because my exposure to a diverse population was limited while I was growing up. I have to be careful to understand a person's culture before I approach to touch him or her. I am most comfortable with blue collar, working class people. I am more relaxed and find myself willing to spend more time when I touch someone from this population. I feel overwhelmed if I am touched too much and tend to limit initiated touch from the client. I am a woman, and I learned during my gender role development to fulfill others’ needs before my own. I often overextend myself for a client instead of setting time limits. I am hypersensitive to light touch and tend to avoid giving light touch when I give a massage. I am understanding of the numerous demands on a single parent and tend to touch one in similar circumstances with sympathy instead of empathy. I have to be careful of boundaries when I touch stressed, overwhelmed single parents. I am casual when touching someone with a disability. I have experienced life-threatening illness, tragedy, and loss. This has changed my life perspective, and if I am not careful, I can discount what may seem to me to be the more minor struggles of others. I seek to understand various spiritual paths and deeply wish to respect issues of touch within each discipline. I tend to assume that one must actually make physical contact during spiritual healing and must remind myself that this is not everyone's truth. (Fritz 5)”

The history of massage is fascinating.  Another important person in the development of the textbooks is Richard van Why.  He searched for and provided volumes of historical documents and I purchased all of it. I have files of the material Richard found.  Sadly I have lost track of Richard but he remains an interagal part of the textbook development

“Richard van Why has said, “It was in the field of pain research and pain management that the greatest gains for massage were made.” Ronald Melzack, a professor of psychology in the anesthesiology department of McGill University Medical School and one of the initial proponents of the gate control theory of pain, published the results of several controlled clinical trials on the value of ice massage and manual massage for the relief of dental pain and low back pain. Melzack not only found these techniques effective in preventing or reducing pain, he also proposed a theory for the neural mechanisms by which they operated. Other researchers picked up on this theme and began to examine the role of massage in the liberation of endorphins, pain-killing chemicals more potent than morphine that are produced by the brain in response to certain stimuli, including massage.

In the late 1980s, in the prestigious journal Clinics in Anesthesiology, Melzack proposed a theory to explain endorphin release. His theory of hyperstimulation analgesia was the first in recent decades inspired by findings concerning massage. The theory argues that certain intense sensory stimuli, such as puncture with a needle or exposure to extreme cold or pressure when applied near the site of an injury, sends a signal to the brain by a faster channel than that used by the pain signal it was attempting to treat, thereby disrupting the pain (van Why, 1992). (Fritz 19)” van Why, RP: History of massage and its relevance to today's practitioner, the Bodywork Knowledgebase. 1992, self-published, New York. (Fritz 23-24)

All the rage on Facebook for the last couple of years has been information and discussion of the “NeuroMatrix” Richard was describing it way back when.

J Dent Educ. 2001 Dec;65(12):1378-82.

Pain and the neuromatrix in the brain.

Melzack R1.


The neuromatrix theory of pain proposes that pain is a multidimensional experience produced by characteristic "neurosignature" patterns of nerve impulses generated by a widely distributed neural network-the "body-self neuromatrix"-in the brain. These neurosignature patterns may be triggered by sensory inputs, but they may also be generated independently of them. Acute pains evoked by brief noxious inputs have been meticulously investigated by neuroscientists, and their sensory transmission mechanisms are generally well understood. In contrast, chronic pain syndromes, which are often characterized by severe pain associated with little or no discernible injury or pathology, remain a mystery. Furthermore, chronic psychological or physical stress is often associated with chronic pain, but the relationship is poorly understood. The neuromatrix theory of pain provides a new conceptual framework to examine these problems. It proposes that the output patterns of the body-self neuromatrix activate perceptual, homeostatic, and behavioral programs after injury, pathology, or chronic stress. Pain, then, is produced by the output of a widely distributed neural network in the brain rather than directly by sensory input evoked by injury, inflammation, or other pathology. The neuromatrix, which is genetically determined and modified by sensory experience, is the primary mechanism that generates the neural pattern that produces pain. Its output pattern is determined by multiple influences, of which the somatic sensory input is only a part, that converge on the neuromatrix.

PMID: 11780656 [PubMed - indexed for MEDLINE] Free full text

During writing of the 5th edition I was thrilled to have the MTBOK as a guide.

“The foundation of the Massage Therapy Body of Knowledge (MTBOK), the document produced by the MTBOK stewards, consists of (1) definition of massage therapy (scope of practice, terminology, and descriptions of the therapeutic massage field) and (2) definition of the competencies of an entry-level massage therapist in terms of knowledge, skills, and abilities (KSA). The initial work was completed by mid-2010, and MTBOK projects continue. The work of the MTBOK stewards was pivotal in transforming the massage profession from a fragmented, loosely formed group into a cohesive partnership invested in the advancement of the massage therapy profession. (Fritz 21)”

Unfortunately the value of the document went largely unrecognized and as I work on the 6th edition I am using the ELAP-entry level analysis project.  The Alliance for Massage Therapy Education did extensive committee work on the MTBOK and you can find that work on the website as a resource. We worked hard to take the document to the next level for use in the education of massage. It is very well done and helpful to educators, but alas also largely ignored.  

“In 2010 the Alliance for Massage Therapy Education was established. This organization brings together directors and administrators from massage therapy schools, along with massage school teachers and those who provide continuing education seminars and advanced training in the field. All are committed to the advancement of quality education. The alliance and the Massage Therapy Foundation, working together, will ensure that massage therapy follows the path of excellence into the future. (Fritz 21)”

I am proud to be a founding member of this organization.  A group of us contributed $1000.00 each to get the organization up and running. I venture to say that most of us had to struggle to find the money in our budgets but we did. One of my dreams for the massage profession is coming real this July

Join us for the 1st 2015 Educational Congress

hosted by The Alliance for Massage Therapy Education and the Commission on Massage Therapy Accreditation

The 2015 Educational Congress meetings will take place over 8 days July 21-28 with the main portion of the conference with exhibition hall will only be July 23, 24, and 25. The event will be held at The Commons Hotel in Minneapolis, MN located on the University of Minnesota Campus.

I will be there. Eye patches and blurry vision will not stop me!  I am presenting as well.

The end of chapter 1 asks some important questions.

“The future will determine the way the profession responds to the needs created by this success. Some questions we must answer to continue moving forward are:

             Will we be willing to accept research findings and let go of myths and misinformation about massage?

             Will we learn to use critical thinking skills to develop outcome-based massage sessions to achieve client goals?

             Will we learn to work together with other professionals in multidisciplinary teams?

             Will we agree on terminology about massage so that we can communicate with each other?

             Will we let go of the differences that divide us and reach for the similarities that bring us together?

             Will we commit to expertise through educational excellence, professional practice, and ethical behavior?

             Will we demand that educators and professional organizations be current, proficient, and committed to training the future generations of massage therapists?

             Will we respect our history, understand our traditions, and strive to bring those values into the future? (Fritz 21)

“A shift has occurred from the confusing proliferation of massage and bodywork styles to understanding massage application provided to achieve outcomes such as stress and pain management, increased mobility, and enhanced performance. Hopefully, the abundant massage and bodywork methods will continue to combine into a consolidated system of therapeutic massage without losing the rich diversity of professional expression. Terminology and education are standardizing, yet we have maintained the integrity of the individual applications of massage and bodywork. For those of you now entering the profession of massage therapy, success depends not on how many different styles of massage you know, but on your commitment to critical thinking, understanding the nature of human connection, and practice to perfect skilled application of the fundamental aspects of massage. The pressure to learn many different ways to do massage will evolve into skilled massage application based on evidence-based professional practice. The move from opinion and experience-based practice to the more objective evidence-based practice of massage is an ongoing theme in this text. Two tracks of massage service probably will continue to standardize: wellness massage outside the health care system and medical massage within the health care system. Although very similar, these trends allow a vast diversity in the types of services available. Critical thinking skills, research literacy, experience, and empathy are the markers of career success. The future is bright and promising, especially if we pay attention to our past and remember the words and wisdom of an old Russian physician: “massage is massage.” We ourselves constitute one of the biggest threats to the future of massage. Currently the profession is fragmented, and educational standards are inconsistent. All bodywork professions must come together to work for the common good. As the massage profession moves forward and reclaims its heritage as an important health service, it is important to look back so that we can see the strengths and weaknesses of the professional journey (Figure 1-6). (Fritz 22)

Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby, 2013.

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