Mechanical Forces

 

 

 

 

Application of mechanical forces during massage.  A, Compression. B, Tension. C, Bending. D, Shear. E, Torsion. F, Combined loading: compression + tension. G, Combined loading: tension + bend + torsion. H, Combined loading: compression + bend + torsion.

From Fritz: Clinical Massage in the Healthcare

 

In this second post in the series  about Advanced Massage we will explore what massage methods do to the body tissues.  At the foundational base massage introduces mechanical forces into the tissues and then the body needs to figure out how to respond to the force .  All massage methods regardless of name can be described by the mechanical forces introduced and how the application is modified by when it is applied, how long, what speed, what direction, the depth of pressure, etc.  I suggest you get some modeling clay and observe what occurs when you apply the mechanical forces.  Does the clay get warmer,  colder, stretchy, longer, shorter, etc.

Actions that involve pushing, pulling, friction, or sudden loading (e.g., a direct blow) are examples of mechanical force. Mechanical forces can act on the body in a variety of ways. The different types of mechanical force and the ways they are applied therapeutically are important aspects of massage.

The five kinds of force that can affect body tissues are compression, tension, bending, shear, and torsion. Not all tissue is affected the same way by each type of force. We will look at each of the five types of force, the different ways they can cause tissue injuries, and the ways they produce important therapeutic benefits when applied by a skilled massage practitioner.

 

Compression

Compressive forces occur when two structures are pressed together. Compressive force is a component of massage application and is described as depth of pressure. This kind of force may be sudden and strong, as with a direct blow (percussion), or it may be slow and gradual, as with gliding strokes. The magnitude and duration of the force are important in determining the outcome of the application of compression .

Some tissues are quite resilient to compressive forces, and others are more susceptible. Nerve tissue is an interesting example. Nerve tissue can withstand a moderately strong compressive force if the force does not last long (e.g., a sudden blow to the back of your elbow that hits your “funny bone”). However, even slight force applied for a long time, as occurs with carpal tunnel syndrome, can cause severe nerve damage. The practitioner must take this into account when determining the duration of a massage application that involves compression over nerves. Compressive force should not be maintained on a specific area for extended periods during massage. Generally, a compressive force need not be sustained for longer than 15 seconds to achieve results.

 

Ligaments and tendons are quite sturdy and resistant to strong compressive loads. Muscle tissue, on the other hand, with its extensive vascular structure, is not as resistant to compressive forces. Excess compressive force can rupture or tear muscle tissue, causing bruising and connective tissue damage. This is a concern when pressure is applied to deeper layers of tissue. To prevent tissue damage, the practitioner must distribute the compressive force of massage over a broad contact area on the body; the more compressive force used, the broader the base of contact with the tissue.

Compressive force is used therapeutically to affect circulation, sensory and autonomic nerve stimulation, nerve chemicals, and connective tissue pliability.

 

 Tension

Tension forces (also called tensile forces) occur when two ends of a structure are pulled in opposite directions. This is different from muscle tension. Muscle tension is created by excess muscular contraction, which results from an increase in motor tone or an increase in tissue density caused by fluid accumulation and connective tissue changes (muscle tone). Muscles that are long as a result of being pulled apart are affected by tensile force. Certain tissues, such as bone, are highly resistant to tensile forces. An extreme amount of force is required to break or damage a bone by pulling its two ends apart. Soft tissues, on the other hand, are very susceptible to tension injuries. In fact, tensile stress injuries are the most common soft tissue injuries. Such injuries include muscle strains, ligament sprains, tendinitis, fascial pulling or tearing, and nerve traction injuries (i.e., sudden stretching of nerves, such as occurs in whiplash).

Tension force is used during massage with applications that drag, glide, lengthen, and stretch tissue to elongate connective tissues and lengthen short muscles .

 

Bending

Bending forces are a combination of compression and tension. One side of a structure is exposed to compressive forces as the other side is exposed to tensile forces. Bending occurs during many massage applications. Force is applied across the fiber or across the direction of the muscles, tendons or ligaments, and fascial sheaths. Bending forces rarely damage soft tissues; however, they are a common cause of bone fractures. Bending force is very effective in increasing connective tissue pliability and affecting proprioceptors in the tendons and belly of muscles.

 Shear

Shear is a sliding force, and significant friction often is created between the structures that slide against each other. The massage method of friction uses shear forces to generate physiologic change by increasing connective tissue pliability and creating therapeutic inflammation. However, excess friction (shearing force) may produce an inflammatory irritation that causes many soft tissue problems .

 

Torsion

 

Torsion forces are best understood as twisting forces. Massage methods that use kneading introduce torsion forces and target connective tissue changes and fluid movement.

Application of torsion force to a single soft tissue structure is not very common and is rarely the cause of significant tissue injury. Torsion force applied to a group of structures (e.g., a joint) is much more likely to be the cause of significant injury. For example, when the foot is on the floor and the individual turns the body, the knee as a whole is exposed to significant torsion force .

 

Massage Manipulations and Techniques (Mode of Application)

The methods of massage introduce one or a combination of the five types of mechanical force into the body to achieve a therapeutic benefit .  As mentioned, this process is influenced by the quality of touch, depth of pressure, drag, duration, speed, rhythm, and frequency. Appropriate use of mechanical force is necessary. If insufficient force or the wrong type of mechanical force is used, the application will not be effective; conversely, excessive or inappropriate use of force can damage tissues.

 

The variety of massage and bodywork modalities in the profession  can be clarified by describing what is done during the application, using qualities of touch, mechanical forces, and mode of application. For example, the method called active release is compression applied by the massage therapist and tension force that occurs as the client moves the area.  

A trained massage therapist should be able to modify the massage application from surface to deep, fast to slow, and long to short, as appropriate, based on the client's individual needs. The intention and outcome of the massage application appropriately influence fluid movement, nervous system function, musculoskeletal function, and connective tissue pliability in both acute and chronic conditions. Our attention to the client is based on an intent to serve our clients in a focused and compassionate manner.

Advanced massage is skillful use of the basics.  

 

Simply Advanced

Fundamentals of Therapeutic Massage 5^th ed by Sandy Fritz

I am going to begin a series of blogs about how to simplify the concept of ADVANCED massage application.  There is so much confusion about  methods considered advanced i.e.  orthopedic or deep tissue or myofascial, or neuromuscular or lymphatic  etc, etc. etc.   There are a trillion ( well maybe not that many) names out there being marketed as advanced massage and under the umbrella of continuing education . This is confusing because if a massage method is going to work then it must be tied to anatomy and physiology or location and function.  Naming of methods adds to confusion and I suggest that any naming should describe how the method interacts with the location and function.

My definition of advanced massage application: Skilled, experienced use of the fundamentals  to  achieve desired outcomes.  

A foundational problem occurs when the fundamentals of massage are lacking and unfortunately I believe this is a common problem in education especially at entry level—but that is another topic.  Another major problem is experience.  Most entry level massage programs will provide a clinic of some type and student may due 50 massage sessions and then they graduate and are expected to perform at a professional level that the general public is going to pay for?  I think this is ludicrous.   If  believe a person needs to do 1000 massage sessions before they even grasp the concept of therapeutic massage within and entry level framework..  If I ran the world a person would be required to complete this level of experience before being allowed licensure and certainly before beginning any sort of advance training.

We also have to consider the validity of the  advanced methods.  This begins with the correct anatomy and physiology of the methods target. For example: lymphatic drainage or myofascial release.   There should also be a research search to determine the level of evidence for the support of the benefit of the method or does the method do what it says it does.   There are many types of valid evidence from high level met analysis of research studies to expert opinion.  Right now the amount of high level evidence for just about all massage methods is scant so beware of unrealistic claims made by those teaching “advanced “ massage methods.  Any of us that teach need to be honest about the claims for benefit we make. It is ok to say that there is no research evidence or to indicate that expected benefits are antidotal.  It is not ok to make claims that are inaccurate.

 I typically consolidate benefits that cluster around relaxation and pleasure based benefit,  stress/mood management, pain management,  mobility management.

Relaxation and pleasure benefit is likely the most important benefit of massage. I can get frustrated when this type of massage outcome is seen as insignificant when I think it is the most significant outcome of all and massage application should have this approach as a primary focus.  The massage approach is what Dr. Leon Chaitow calls –constitution- meaning general and non specific.  The massage approach typically is what is thought of as the Classical / Swedish style.  Unfortunately this type of massage is often taught and applied in a routine and in a mindless “paint by number or follow the dots” approach when it should be the foundation for massage therapy.   The massage application is rhythmic, full body, nonspecific,  broad based medium  pressure, non-painful, involves rhythmic but passive joint movement and  provided by a caring, nurturing and empathetic massage professional in a safe environment, .  The primary physiology targeted is the autonomic nervous system.  In my mind the biggest application mistake for this approach is too light or too deep of a pressure.  If we visualize the anatomy as a sandwich- with the bone as one slice of bread and the skin/superficial fascia as the other piece of bread with the muscle based soft tissue as the filling, then the depth of pressure is through the top layer of bread and just into the filling.  

I strongly believe that this type of massage application is lost in all the “fancy stuff” when true advanced massage application is based on this foundation.  This massage application is the main avenue for palpation and joint assessment.  As the soft tissues are moved in a variety of directions and each joint is also moved, the areas of tissue changes and altered range of motion are identified.   It is also my belief that this is the massage application skill set that must be perfected in entry level massage training.

The next topic in the subject will be assessment since “advanced work” is often considered application to address dysfunction.  You cannot understand dysfunction until you understand function.  I am speaking of a solid, functional understanding of anatomy and physiology normal function.   I think initially in education we focus too much of pathology without cultivating a strong knowledge of normal body function.  Our anatomy and physiology is marvelous and a cornerstone of professional practice in massage. 

More to come.  I welcome your comments.

The time in NOW

MASSAGE PROFESSIONALS -If you agree please click LIKE and SHARE. Comments important. We need to let the LEADERS know that it is time to act.

xxxxxxxx-I want the participants in the massage therapy leadership summit to agree to a position statement about entry level education, including competencies, model curriculum and recommended clock hours and time frame. The massage community must come to agreement about the entry level baseline before anything else can be acted upon.xxxxxxxx

Summit organizations represented are Alliance for Massage Therapy Education (AFMTE); American Massage Therapy Association (AMTA); Associated Bodywork & Massage Professionals (ABMP); Commission on Massage Therapy Accreditation (COMTA); Federation of State Massage Therapy Boards (FSMTB); Massage Therapy Foundation (MTF); and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB).

Actively Involving Students in the Classroom

For some reason teachers think that they must stand up in front of the classroom and deliver information to students. Often this is the least effective method of teaching. Today in the classroom at my school- Health Enrichment Center, Lapeer Mi. the students were given the task of researching a body system. They had to include anatomy, physiology, common pathologies, and research (pubmed) if possible to support the benefits of massage on this system. The students were then given two hours to develop the presentaton which had to include the use of media, examples and demonstration. Following are some pictures of what they did, how technology what used in the classroom and what they learned. Using this process the learning outcomes involve multiple levels including: problem solving, clinical reasoning, reasearch literacy, communication skills, ability to explain and justify massage benefits and of course anatomy, physiology and pathology. I observed, commented when necessary and asked questions during each presentation. And of course took pictures. You will see that the student may not have liked the project but had fun and learned anyway.

TIME TO COME TOGETHER

I encourage all to read Les Sweeney’s Blog found at- abmp.com  He is speaking to the Entry-Level Analysis Project (ELAP), which is collecting data to determine how many clock hours an educational  program for massage should be.  This issue and the apparently selected 500 clock hours determined years ago has been a source of wonderment for many years.  The 500 clock hour requirement has been written into many state licenses for massage.   I am always concerned when something comes out of the blue as it appeared that the ELAP project did. I have investigated and followed multiple discussions on the topic and have formed my own opinions. First, transparency and making sure the project does not have the appearance of bias or self-serving to any one organization or special interest. Because of past action the massage community is suspicious. It is necessary for anything that would influence the entire profession be as transparent as possible.  I am especially concerned that the clock hour requirement for massage education will be influenced by current mandates for eligibility for federal financial aid

 Financial aid eligibility SHOULD NOT BE A CONSIDERATION WHEN DETERMININE NEEDED CLOCK HOURS FOR ENTRY LEVEL MASSAGE EDUCATION.  PERIOD! 

There is/was also concern that similar work would not be taken into consideration, ie the MTBOK, Line by line analysis of the MTBOK by the Alliance for Massage Education, COMTA competencies, NCTMB job task analysis for example. It is important to realize that this is not an either / or situation but validity will only occur when all are considered and all is in the open. There are research methods that can be used to integrate all of the data collect from multiple sources and identify relevance and remove bias. I see the ELAP as another data collection process and in that regard I am supportive.

However, it cannot stand alone and the profession will really only benefit with everything -MTBOK, Line by Line analysis of MTBOK by the Alliance for Massage Therapy Education, Competencies, JTA’s etc, along with data from the ELAP are combined together into an Integrated, profession wide statement on entry level competencies, recommended core curriculum recommended clock hour requirement and then translated into model legislation.

So the problem is not the ELAP, or MTBOK or any of the other data so long as it is valid data. The problem is us–I am so tired of the competition when what we need is unification. There is room for everyone at the table and the Leadership Summits are a start. Now all organization need to come together and present a  unified statement  so the massage profession can move forward. Let’s not forget the importance of the Massage Research Foundation. Without evidence to support massage benefit none of the rest makes much difference.

 The current Job Task Analysis being conducted by the Federation of State Massage Boards has added content intended to collect data for the ELAP.  Everyone need to complete the survey and remember that the focus is Entry Level education.

FSMTB Job Task Analysis Survey 2012

www.surveymonkey.com

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BODY MECHANICS AND GENDER DIFFERENCES

GENDER DIFFERENCES-- or My butt is in a different place than his.

I can do massage the same way a male can.  I can accomplish all the same outcomes but I have to do it different.  This is a concern for me because especially in the continuining education world, many courses are taught by males to to females and body mechanics need to be altered based on research into gender differences

Most massage therapists are female. (AMTA report 2012 Massage Therapy Industry Fact Sheet). Proper body mechanics are affected based on the differences between male and female bodies. Generally, females have more elastic tissues than males. Also, females tend to have a slightly broader range of joint movement. Regardless of gender though, it is necessary to perform massage with the best body mechanics possible

CENTER OF GRAVITY

A female’s center of gravity is lower and further back than a male. Females also carry more weight below the waist, while males are broader in the chest and shoulders and carry their weight above the waist.

You can think of a man as a pear or eggplant standing on its head, and a woman as a pear or eggplant sitting on its bottom. When a man flexes forward the center of gravity is over his toes. When a woman flexes forward, her center of gravity is over her heels. New figure

 PELVIS AND KNEE

The female pelvis is wider than the male pelvis, which means the woman’s femur bone approaches the knee at a wider angle called the "Q" Angle. A greater "Q" Angle can cause a knock-kneed stance which stresses the knee. The structural supports of the knee, the ligaments and tendons, are stretched on the insides and pinched on the outsides. The combination of wider hips and the resulting tendency to knock-knees coupled with a woman’s greater flexibility causes the knee to be more mobile.

 ANKLES

Women do not bend at the ankles and knees as far forward as men. They also have less total ankle strength. Because there is not as much movement at the ankle, a female will need a taller massage table.

SPINE

In women the spine as whole and individual vertebrae in certain regions of the normal spine are more backwardly inclined than in men. These spinal regions are subjected to different biomechanical loading conditions. There is less rotational stability in females than in males. Therefore, females must maintain alignment of the shoulder girdle and pelvic girdle during massage to prevent torsion forces (twisting) on the spine while doing massage. (Janssen et al 2009)

PHYSICAL STRENGTH

Women are generally not as powerful as men. The average female, because of her smaller size, works at a higher proportion of her maximum strength than does the average male. Women only have 55-58 percent of the upper body strength of men, and on average are only 80 percent as strong as a man of identical weight. Women must leverage by leaning their body weight to apply pressure during massage application.

Male massage therapists may be able to use a shorter table without as much strain because when they lean forward, their center of gravity also moves forward and they have more upper body strength. However just because the typical male can “get away with it” does not mean they should do massage in any way that has the potential for harm.

So what does all this mean in relationship to how a female does massage and male does massage? Specifically, females should not attempt to do massage in the exact same way as males.

·         Females generally need a higher massage table to compensate for the lower center of gravity as it shifts to the back when the torso is flexed forward.

·         Females have more joint movement in general, but there is reduced movement at the ankles, again supporting the need for a higher massage table.

·         Females need to reduce the tendency to flex the torso since this moves the center of gravity behind them requiring more muscle force to apply pressure.

·         Females need to make sure that the pelvis does not tilt back during massage causing their bottom to stick out.

·         Females have more difficulty with joint stability, so they need to maintain a tighter body position and not reach or overextend the body when doing massage.

·         Females need to pay specific attention to core strength and stability to stabilize the spine as well as scapular stabilization

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Janssen MM, Drevelle X, Humbert L, Skalli W, Castelein RM: Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays Spine (Phila Pa 1976) 1;34(23):E826-32, Nov 2009.

Kubo K, Kanehisa H, Fukunaga T: Gender differences in the viscoelastic properties of tendon structures. Eur J Appl Physiol 88(6):520-6, Feb 2003.

THIS IS IMPORTANT - Entry-Level Analysis Project

ELAP (Entry-Level Analysis Project) Description.

 I am attempting to understand.  Questions and Comments in CAPS.

Entry-Level Analysis Project*

Submitted by the Entry-Level Analysis Project (ELAP) work group: Pat Archer, Clint Chandler,

Rick Garbowski, Tom Lochhaas, Jim O’Hara, Cynthia Ribeiro, Elan Schacter, and Anne Williams

I AM STILL NOT SURE HOW THESE INDIVIDUALS WERE PICKED FOR THIS PROJECT BUT I AM CONFIDENT THAT THEIR INTENTIONS ARE GOOD.  I CAUTION ALL OF YOU IN THE WORK GROUP TO BE AS UNBIASED AS POSSIBLE AND PLEASE NO PERSONAL AGENDAS OK.  I KNOW HOW HARD THAT IS TO DO BUT DO NOT GIVE ANYONE AN EXCUSE TO QUESTION YOUR INTEGRITY. 

Introduction

What is entry-level massage therapy education? What should core content encompass? How many hours of education are necessary for learners to obtain the basic knowledge, skills, and abilities (KSAs) needed to enter the massage profession and build a viable practice or work successfully as an employee?  GOOD QUESTIONS MANY OF US WHO HAVE BEEN AROUND A WHILE HAVE BEEN ASKING THEM AWHILE

Many regulatory agencies have settled on a 500-hour benchmark, but how they and the massage profession arrived at this number is unclear. Additionally, a variety of topics are taught within or excluded from a 500-hour curriculum based on the philosophy undergirding each particular training program. THIS IS ACCURATE HOWEVER MOST MASSAGE EDUCATIONAL PROGRAMS USE COLLEGIATE PUBLISHED TEXTBOOKS AND ARE IN COMPLIANCE WITH EDUCATIONAL REQUIREMENTS STATED IN LICENSING AND CERTIFICATION EXAM?

 As well, the influence of federal student aid and/or a belief that 500 hours is insufficient to accomplish desired instructional goals has caused many institutions to set their program length at 650–900 clock hours. I REALLY TAKE ISSUE WITH THIS STATEMENT.  IT IS REALLY OUT OF CONTEXT.  FEDERAL STUDENT AID DOES NOT CARE ABOUT MASSAGE CURRICULIUM—AND THE CLOCK HOUR REQUIREMENT SPANS ALL OCCUPATIONAL EDUCATION.  WHAT IS CONSIDERED AS APPROPRIATE MASSAGE EDUCATION SHOULD NOT BE INFLUENCED AT ALL IN RELATIONSHIP TO ELIGIBILITY TO FINANCIAL AID. IF AN EDUCATIONAL PROGRAM WANTS TO PARTICIPATE IN FEDERAL FUNDING PROGRAMS THEN THEY WILL NEED TO BE IN COMPLIANCE WITH THE CLOCK HOUR REQUIREMENT AND JUSTIFY THAT TO POTENTIAL STUDENTS IF ENTRY LEVEL COMPETENCY TRAINING CAN BE DELIVERED IN FEWER HOURS

As a result of these diverse decisions and influences, massage education in the United States can be characterized as inconsistent. CURRICULUM IS NOT THAT INCONSISTENT.  TEACHING SKILLS IN THE CLASSROOM ARE.

 While inconsistency in itself is not necessarily harmful in massage education, it has spawned problematic consequences – notably too many massage school graduates who experience short, unsuccessful careers and many geographically mobile therapists whose career development is stymied by barriers to credential portability.  PORTABILITY IS A STATE ISSUE AND WILL REMAIN AN ISSUE AMONG VARIOUS STATES.  SIMILAR LICENSING STANDARDS WILL HELP STATES COOPERATE BUT IT IS THE LICENSING PROCESSES NOT THE EDUCATIONAL PROCESS AT FAULT.

The Massage Therapy Body of Knowledge (MTBOK) document details the depth and breadth of topics taught in massage programs of 500–1,000+ hours across the country — programs that prepare learners to sit for credentialing exams and work in a variety of service-oriented and/or health care-oriented settings. YES THAT’S RIGHT.  It provides an important piece of the massage education puzzle by capturing a complete set of concepts, terms, and activities taught in massage training programs. OK I CAN AGREE WITH THAT.

Now, we need to do more work to identify the essential elements of massage practice that are necessary in an entry-level curriculum; in other words, we need to identify the key KSAs required to pass a national licensing exam and provide competent, safe massage in an early massage career.  REALLY OR IS THAT DONE ALREADY BY THE MTBOK?  THERE NEVER WILL BE A NATIONAL LICENSING EXAM—THEY DO NOT EXIST- THIS IS A STATE BY STATE PROCESS. 

Goals

• To implement an Entry-Level Analysis Project (ELAP) to delineate key learning outcomes schools can be encouraged to address in their core instructional programs to ensure attainment of KSAs for competent and safe application of massage in an early massage career. THE ALLIANCE FOR MASSAGE THERAPY EDUCATORS LINE BY LINE ANALYSIS OF THE MTBOK COVERED MUCH OF THE BACKGROUND FOR THE DEVELOPMENT OF LEARNING OUTCOMES.  BE AWARE ALL,  THE DEVELOPMENT OF EDUCATIONALLY SOUND LEARNING OUTCOMES NEEDS TO BE DONE BY PROFESSIONALS TRAINED SPECIFICALLY IN THIS PROCESS.  THAT IS WHY THE COMMITTEE THAT DID THE LINE BY LINE ANALYSIS OF THE MTBOK DID NOT MOVE INTO THAT PROCESS.

• To assess how many program hours are needed to attain this KSA goal, assuming capable instruction. I AM SO TIRED OF THIS CONVERSATION.  SPELL OUT THE COMPETENCIES IN AN EDUCATIONALLY SOUND MANNER AND LET THE SCHOOLS AND LICENSING FIGURE THIS OUT.

Methodology

Methodology

A work group has been formed of eight individuals rich in experience in massage curriculum development, teaching, and assessment of established research. Working with skilled psychometricians, this group will develop questions for a companion survey to the FSMTB 2012 Job Task Analysis (JTA) that will allow segmentation of findings to provide insight into KSAs actually utilized and perceived to be important for safe and competent massage practice by individual massage therapists. Work group members will also assess the results of a newly administered employer survey, and the work products of previous profession projects addressing curricula, competencies, and standards for relevance to the ELAP goals. Knowledge garnered through these diverse activities will be funneled into the development of learning outcomes maps in each topic area related to practitioner- and profession-identified important KSAs. Work group members will then analyze the learning outcomes maps, based on their own experience in curriculum design and teaching, to quantify estimated training hours necessary for students to become competent in these KSAs.

A work group has been formed of eight individuals rich in experience in massage curriculum development, teaching, and assessment of established research. Working with skilled psychometricians, this group will develop questions for a companion survey to the FSMTB 2012 Job Task Analysis (JTA) that will allow segmentation of findings to provide insight into KSAs actually utilized and perceived to be important for safe and competent massage practice by individual massage therapists. Work group members will also assess the results of a newly administered employer survey, and the work products of previous profession projects addressing curricula, competencies, and standards for relevance to the ELAP goals. Knowledge garnered through these diverse activities will be funneled into the development of learning outcomes maps in each.  CAUTION—MAKE SURE THAT THE FSMTB 2012 Job Task Analysis IS NOT DIRECTLY LINKED TO THIS PROCESS.  IT WILL APPEAR BIASED AND SELF SERVING EVEN IF THIS IS NOT THE INTENT.

 LEARNING OUTCOME MAPS NEED TO BE ACADEMICALLY SOUND AND PROFESSIONALLY CREATED. I BELIEVE THE DATA SHOULD BE GIVEN TO AN INDEPENDENT GROUP TO COMPLETE THIS DESIGN.

Benefits

The new understanding gained through this project is expected to benefit the profession in a number of ways. The profession’s leadership could make an informed statement regarding what constitutes evidence based, minimum educational requirements a student should meet to qualify for a license to practice massage. MAYBE

 Massage schools will have a blueprint of essential topics, key learning outcomes, and appropriate clock hours on which to base their foundation curriculum. MAYBE

Organizations accrediting massage programs potentially will gain a consensus view from the massage profession of core education components to factor into their accreditation expectations for program approval. MAYBE

 Project outputs could be used to inform regulatory bodies about essential curriculum components, which, if broadly adopted, would help ensure greater consistency in massage education. I DOUBT IT.

 The Federation of State Massage Therapy Boards (FSMTB) will have a more informed basis for the education component in its development of a Model Practice Act.  THIS COULD HAPPEN AND I WONDER IF THIS IS NOT A MAJOR DRIVING FORCE. 

Adoption of consistent core education requirements by multiple states could increase regulators’ confidence and encourage the portability of credentials long sought by the massage profession. WELL I ALREADY ADDRESSED THIS BUT MAYBE

 A broadly accepted foundational education core would allow for a more accurate differentiation of additional expected knowledge and competencies to qualify for certification and advanced credentialing.  MAYBE

 Improving the consistency of massage education is important for the continued health and evolution of the massage profession; all the major U.S. stakeholder organizations have undertaken projects at various times that support this vision.  TRUE

With a clearly defined baseline, the massage profession will be in a better position to determine appropriate next steps, develop resources that help schools and professional therapists fill education gaps, and provide meaningful and informed leadership to both students and practicing massage therapists. SEE, I THINK WE HAVE THIS IN THE MTBOK AND THE LINE BY LINE ANALYSIS BUT IN RESEARCH DATA COLLECTION DUPLICATION IS OK SO LONG AS IT IS COMPARED.

Project Activities

• In March 2012, participating national organizations nominated candidates to participate in an interview process to populate a work group of six experienced massage educators (minimum requirements: massage curriculum development experience and at least five years of experience teaching massage-related topics in a massage therapy program preparing students to become licensed) and two education professionals holding a master’s degree or doctorate in instructional design or a closely related subject. In fact, the selected massage educators each have experience substantially exceeding the minimum criteria. I AM NOT QUESTIONING THE QUALIFICATIONS AND INTEGRITY OF THE WORK GROUP. 

• With collaborative input from psychometricians  WHO? with prior experience working with the massage profession, the work group has begun writing early-career education-specific survey questions to identify KSAs required for safe, entry-level practice. The questions will help identify what therapists need to know and to be able to do in order to meet the needs of most clients in a beginning private practice or in early career employment. BE VERY VERY CAREFUL TO NOT BIAS OUTCOMES THROUGH HOW THE QUESTIONS ARE WORDED AND CONTENT IS PROVIDED.

• Survey questions will be asked within a companion survey to the FSMTB’s 2012 JTA. CAREFUL IT LOOKS BIASED AND SELF SERVING. JUSTIFY WHY THIS IS THE PROCESS--

Demographic and practice-descriptive information will be collected that permit segmentation and analysis of findings according to experience and practice success dimensions. I DO NOT TOTALLY UNDERSTAND WHAT IS GOING ON HERE.

 One important group will be respondents who are in the early stages of their careers but who have been “market tested”—that is, who have been practicing massage from 12 to 48 months and have delivered at least 500 hours of massage during that time. As shown by their persistence for this time, this group has demonstrated perseverance and the skills to develop a functional practice or work productively as an employee. Another important group will be respondents displaying diverse indicia of long-term practice success. These and other methods of analysis will allow the work group to eliminate the experience bias present in most surveys about massage practice (veteran practitioners consistently have higher survey participation rates) and to examine the education foundations of massage therapists trained in different eras. GOOD IDEA HOPE IT WORKS

• Using the results of the education survey, survey data analysis by psychometricians, and a comparison of findings with other important massage profession resources, the work group will produce a learning outcomes map detailing learning outcomes, competencies, and learning objectives in the cognitive, psychomotor, and affective domains related to each early-career job task.  I AM NOT SURE THE WORK GROUP HAS THE SKILLS TO DO THIS WITHOUT BIAS AND STRONGLY SUGGEST THAT AN INDEPENDENT AGENCY BE USED TO COMPLETE THIS ASPECT OF THE PROJECT.

Competencies are defined here in the classic sense as learning objectives written from a behavioral perspective. They are precise statements that answer the question, “What behavior can the learner demonstrate to indicate that he or she has mastered the skills specified in the instruction?” THAT IS GOOD

Competencies are important starting points, but to truly understand the needed breadth of entry-level knowledge and skills, the feelings, values, and attitudes of the learner (not typically addressed by competencies) also need to be captured. TRUE

• The profession resources that will be consulted for comparison of findings include an employer survey about perceived strengths and deficiencies of newly-hired massage employees, results of the current FSMTB JTA, results of the current NCBTMB JTA, COMTA curriculum competencies, the MTBOK project and its subsequent analysis by AFMTE, relevant AMTA and ABMP data on liability claims filed against massage therapists, and the attitudes and experiences of clients as compiled by consumer reports produced by ABMP, AMTA, and other organizations.  SHOW YOUR WORK IN THE REPORT SO WE KNOW HOW IT WAS DONE.

• The best and most useable learning outcomes maps are highly detailed and specific.  YES AND THAT IS WHY INDEPENDENT SPECIALISTS TO DO THIS PART.

The learning outcomes map that will be created in this project will enable the work group to accurately determine the amount of time needed to teach each identified content component and to recommend core entry-level education clock hours. OK, I ALSO SUGGEST YOU CONTACT ALL OF THE TEXTBOOK PUBLISHERS AND COLLECT THE CONTENT THEY HAVE DEVELOPED

 To ensure a manageable process, the key outputs will focus on learning within a brick-and-mortar environment rather than on online or distance education, which is taught differently and is currently a small proportion of massage therapy foundational education.  BIG BIG BIG BIG MISTAKE.  DO NOT DO THIS. INCLUDE ONLINE LEARNING NOW—YOU WILL BE SORRY IF YOU DON’T.

• The work group will produce a preliminary project report (targeted for November 2012) detailing the research findings integrated with other profession resources. The report will review the work group’s approach, summarize the survey results, summarize the analysis of additional massage profession resources relevant to the ELAP, defend the learning objectives taxonomy and learning outcomes mapping references, explain the selection of key KSAs identified from this research, and describe problems, solutions, research and synthesis of the research, summary of findings, suggested uses and application of the work group outputs, and conclusions.  SUMMARY OK BUT YOU MUST INCLUDE THE WORK UPON WHICH THE SUMMARY IS BASED.

• The preliminary project report will be presented to the leadership group for feedback in December 2012. I THINK YOU ALSO NEED AN INDEPENDENT ADVISORY GROUP TO LOOK AT THIS- I WILL BE PART OF THIS PROCESS AND SURE OTHERS WILL AS WELL.

The work group will then complete its task in time to allow a public release of the draft report for comment in the first quarter of 2013. LEARN FROM THE MTBOK PROJECT. LOTS OF CRITICISM OF HOW THEY DID THIS AND I THOUGHT THEY DID A GOOD JOB.

Public comments will be reviewed by the work group and incorporated into the final report to be available within 60 days after the public comment period closes. CONDUCT THIS WHOLE PROJECT LIKE A RESEARCH STUDY AND USE RESEARCH DESIGN EXPERTS DURING YOUR PROCESS PLEASE.

Scheduled Key Milestones

• April 13, 2012: Project work group members selected.

• May 2, 2012: Work group representatives vet the preliminary project description with the massage

leadership group.

• May 3–4, 2012: Initial project work group meeting to develop survey questions to be administered in June–July 2012 as a companion survey to the FSMTB Job Task Analysis survey.

• June 14, 2012: Work group webinar to review existing profession resources and assign responsibility for analyzing specific documents for relevance to ELAP, to report back to the work group at the August 23–25th meeting.  INVITE THE PUBLIC PLEASE.

• August 23–25, 2012: Work group meeting: Review and analyze survey results. Report on existing profession resources and their relevance to ELAP. Participate in activities to ensure appropriate understanding of the latest thinking and use of learning objectives, learning outcomes mapping, and instructional design for effective learning. Select appropriate learning taxonomies in the three domains and the most effective learning outcomes mapping model for this project. Make substantial progress to create a detailed learning outcomes map of all key KSAs necessary for success in an early massage career. IF THIS MEANS VISUAL, AUDITORY AND KINESTIC DOUBLE CHECK YOU DATA—THIS MAY NOT BE VALID.  I WOULD LIKE TO KNOW YOUR DEFINITIONS OF TAXONOMIES AND DOMAINS

• November 16, 2012: Completion of the preliminary project report, including the full learning outcomes

map, to be sent to leadership group members.  AN ADVISORY GROUP WOULD BE GOOD HERE.

• December 5, 2012: Live presentation by work group to leadership group for feedback.

• December 6–7, 2012: Work group meeting: Revise report based on leadership group feedback. Complete second draft of report suitable for public release and comment solicitation.

• 1st Quarter 2013: Draft report to be released for 60-day public comment period.

• 2nd Quarter 2013: Within 60 days of close of public comment period, work group completes final report and products based on feedback.

Perspective

We view this project as an important, early foundational step. We have no illusion that successful completion of this project will by itself transform massage education and the quality of massage being provided to clients. Other important work, most notably strengthening the teaching abilities of all instructional personnel, commands parallel attention if this ELAP is to have an opportunity to have meaningful impact. We work group members also understand that our group has no permanent standing. Our job is to produce a thorough, defensible final report that is sufficiently compelling to motivate diverse national and local massage therapy organizations to rise to the challenge to ensure the massage profession embraces and implements the report’s recommendations.

Accepting these caveats, and acknowledging both the opportunity and need for improvement throughout the massage profession, we believe this project comprises one important foundational step upon which additional curriculum, teacher preparation, and regulatory standards can build.

The animating spirit of this project is not to criticize, but rather to contribute to the construction of a more solid and consistent educational foundation that will help those entering the profession to thrive in their massage therapy careers while ensuring the practice of massage is safe and beneficial for all clients.  I BELIEVE YOU