Thursday, October 25, 2012




 I have been posting these blogs about my feelings about the concept of ‘ADVANCED MASSAGE” an hope that they have made those reading evaluate how they work with clients as they gain experience from the actual  DOING OF MASSAGE.  I do massage and each massage teaches me.  There are however some factors that advance the teaching from just doing. When you are your own teacher then you are your student as well.  This is interesting.  I was teaching an entry level group of students that just started school and we introduce how to research for information with the main source being MedlinePlus and how to find and use research with the main source being Pubmed.  I don’t see research ability as an advanced skill but a basic skill.  They also had to fool around with a few case studies where the clients were complex yet they then figured out that the massage focused on general nonspecific massage with individual adaptations (previous post).   They did really well showing ability to critically think as well as problem solving skills that I believe are fundamental- not advanced.  I taught them how to look up reliable data and then apply that to each client.  We were discussing medications. There are thousands of them and if I can’t remember all that data how can anyone else.  I taught them to sit with the client – using MedlinePlus and look up there medications. Learn what the medication is for and what are possible side effects.  Then they had to problem solve about what might happen when various massage applications are introduced to the client’s body when the physiological effects of massage and the medication combine.  This is always an exercise in the educated guess.  Then we looked up a condition one of the students actually had experienced- breast cancer and using the information on MedlinePlus learned about the condition and treatments along with side effects.  Then we went to Pubmed to see what research existed to guide massage application.  Finally we came up with a treatment plan using the experiences of the student who had been treated for breast cancer. Some of the ideas we had developed she thought would work well for her and others she did not agree with.  Yup that’s what happens- come up with a great plan and then modify to serve the individual client. 


The students need to learn this process and do it over and over because ultimately then need to be their own teacher.  Maybe –just maybe- massage schools should be teaching students from the very beginning how to do this.  We become more “ADVANCED” or skilled with the increase in experience expecially if we learn about the situation for each client we serve. I am skilled working with athletes because I have worked with hundreds of them.  I am skilled with chronic pain conditions in all the various forms because I have worked with-and therefor learned from many clients with variety of chronic pain issues.  Each time I look stuff up.  Check for new research and continue to learn.  So now I have to research a condition so I am skilled as I work with my next client.

Wednesday, October 10, 2012


Figure this one out!


Popular in the world of advanced massage is the concept of targeted populations. This approach comes in the form of geriatric massage, prenatal massage, infant massage, oncology massage, sports massage, massage for fibromyalgia, massage for anxiety, and the list goes on and on.   I think this approach is more logical than method systems such as  the myriad of connective tissue methods or the huge variety of trigger point methods however in this day of massage confusion both fall short.

Previous posts in this series describe the fundamentals of massage therapy.   Massage is the skilled application of methods that introduce 5 basic mechanical forces into the soft tissue.  The effect of the mechanical forces is modified by direction, drag, location which includes where on the body and what tissue layer or depth and duration. 

Adaptation then involves choices and changes in the type and combination of mechanical forces introduced and the modification i.e. What direction, how much drag, where or where not to apply massage and so forth.  Adaptation also involve positioning of the client, where the client is located (hospital, home, office), alteration of the environment such as barrier free access, massage table, mat or chair etc.

Now we all know that every client is unique therefor a recipe approach to massage will not work.  For example geriatric massage: yes there is a commonality to the physiology of the aging process but each person ages in their own unique way.   There is great variety in those individuals with a cancer diagnosis, however there is commonality in the treatment.   There is commonality in joint replacement procedures however there is huge variety in those receiving a joint replacement.  There is actually a great deal of commonality in all forms of acute care but a huge variation in how to approach chronic conditions.

When an “advanced” massage therapist begins to work with any individual the history and assessment process determines, among other things, the process of adapting the massage to best achieve the determined outcomes in a safe way.

There are in the massage profession excellent educators who are teaching adaptive approaches to various populations- again examples include oncology, infant, sport and so forth.  What you get when you take their courses or read the books is the cumulative adaptive experience which in turn shortens your trial and error learning.  This is a good thing.  You can to some extent increase your individual level of experience by incorporating the cumulative experience of others.  However, even the very best teachers can only offer what they have learned and it will never be enough. 


So how do we do that?  I know a lot about a lot of different adaptive changes during massage.  Most I learned in the trial and error method.  That is what happens when you do many, many massage sessions over many years.  

I learned best when a client challenged me with a problem to solve.   I have learned a huge amount about knee injury for example because I have had many clients with knee injuries.  I have learned a lot about pain in all its many forms because I have had many clients that deal with pain.  And let’s not forget our own personal experiences and how they influence our learning.  A year ago I blew out my left knee-torn ACL, MCL, meniscus, quad. Ugh it was bad.  So I had an idea about what had occurred but still needed the doctors to perform the necessary tests to provide an accurate diagnosis.  I needed a brace and needed to going through the healing process.  I really get knee injury now in my gut as well as in my head.   I also had open heart surgery 6 years ago and that entire process was an invaluable learning experience as you can imagine.

When encountering a client needing adaption during the massage-(AND GUESS WHAT ALL CLIENTS NEED ADAPTATION)- they are your first and most important source of information and your greatest teacher.   Then you need to research. You need to learn about the anatomy, physiology pathology, and treatments including adverse effects of treatment.  You need to determine how the individual is manifesting the condition or responding to the circumstance.  You have to look up all the treatments and learn about them including surgery, medication, herbs, counseling, physical therapy and so forth.  You need to gather information about how massage has been used in the circumstance through research studies such as found on PubMed and those with extensive clinical experience.   YOU HAVE TO DO THIS.  You can take all the classes offered and read all the books and this is a good start but to be “ADVANCED” you have to do the work because your client is unique. 

You also have to adapt based on the limits of your own skills including body mechanics.  There are many different ways to apply a mechanical force to a specific location.   Begin with what you intent to accomplish and then experiment with how you can best perform the method for your most efficiency and clients comfort and benefit.   You can start by doing something the way the teacher does but you will have to modify how you do it somewhat because your body is different.


Massage is actually very basic and fundamental.  The ability to adapt is the mark of excellence.