Breaks some of our little hearts.

 

This post evolved from a response to Ryan Hoyme   (the MassageNerd)  http://theyoungthumbs.com/why-all-the-hate/.

Ryan is one of the gentlest, most compassionate people I know and I believe the controversy in our community is breaking a piece of his little heart.  Mine too Ryan. And I think there is a solution.  

Having grappled with this issue for many years I have come to a bit of peace about it. There is massage as a system. It is whole in and of itself. It does not need anything added to be complete.  While a definition eludes us, we can recognize massage regardless of what someone is calling it. There is a  logical benefit of seeking to understand the value of a system through research and other forms of evidence.  Massage as a system is getting there but high quality research remains scant. Many of the “claims “ people make about massage are opinion at best and some are outright wrong.  We –the massage therapy community need to stop perpetuating the myths and continue to seek understanding.  But-I say again- I believe we have enough evidence to claim valid benefit for those seeking our services.

 Massage as a unique system has limitations and these also need to be recognized.  Massage as a health approach only targets part of the wellness continuum.  That’s ok.  There is just too much to know and I am just fine being competent in my area. I know that wellness is a multifaceted process.  I don’t have to be a counselor, nutritionist, exercise expert, chiropractor, physical therapist, or spiritual support for example.  There are other professionals that are skilled in these areas. We can all work together even when there may be some overlap in some skills.  A physical therapist for example can so some massage but it is a minor element of the practice.  Massage is my thing-it is what I do. I can suggest some simple exercises but I just don’t have the training to develop a rehab program.  And I don’t want to.  Massage is essential, I have been learning about it for almost 35 years now and I am excellent at it.  I can be a team player. 

There are other systems that can also stand alone in the sense that a client's issue can be addressed with the methods of the system.   I think of hydrotherapy as an example. As a massage therapist I don't have to incorporate hydrotherapy for the application of massage to be complete. However there are elements of hydrotherapy that compliment massage (and vise versa). I can even use elements of hydrotherapy as a massage tool.  Think of an ice cup as an implement for massage. 

Essential oils/aromatherapy is another example.  In the research you will find studies that combined the two independent methods such as massage used to apply the oil.  However, essential oils have an independent body of knowledge and can function without massage. Massage has an independent body of knowledge and can function without essential oils.

 Specific forms of movement and exercise are stand-alone methods. Many are named for the individual that organized the concepts into a system such as Pilates. Some are cultural such as yoga but these systems share fundamental observable elements regardless of the name.

Energy based systems while varied, multicultural and attributed to individuals that formalized the systems fit into this type of explanation. If you observe a variety of styles you will recognize a fundamental sameness.

None of the unique systems provide the whole answer to health and wellness.  Just like massage, there is plenty to know, learn and practice within the system.  Each can be a life time of learning. And just like massage the client benefits with a team assisting them.

Regardless of the system-it is the responsibility of the practitioners of the methods to be seeking evidence for value and practice in an ethical manner.  However, I do not have to prove or disprove any other system.  I just don’t want the practice of what is massage and what is not massage to further confusing  us and other health care professions and clients. Even when multiple systems  become blended in a individuals personal practice each can be described and validated (or not) based on itself-not as the blend.  You can be multiple trained. You can be a massage therapist and a yoga teacher. Just present as such.  If I come in for a massage- I do not want a yoga lesson.

I am going to cap this so it does not get lost ok--ALL THERAPEUTIC INTERACTION, REGARDLESS OF SYSTEM, IS MORE EFFECTIVE WHEN THE CLIENT AND PRACTITIONER SHARE AN EMPATHETIC, COMPASSIONATE, ETHICAL THERAPEUTIC RELATIONSHIP WITH INTENTION, ATTENTION AND WITH PRACTITIONER EXPERIENCE TO DRAW ON-INTUITION.  ------so don’t get your fascia in a twist around some nerve with dermal branches ok.

Now I do get frustrated when a method is presented as different than massage when actually massage application has been adapted to target a tissue, function or outcome.  The whole concept of "fascia, myofascial " methods is an example. Another set of  currently popular approaches right now involves specific skin massage under the term dermal --------.  Another example is when a method that is essentially massage gets separated out of the massage system because of some sort of claim that it interfaces uniquely with a particular anatomical or physiological function. You can recognize these approaches because  neuro ----- or some body fluid shows up in the name.  I also think of methods such as nerve stretching or flossing and lymphatic drain as examples. All of these types of methods fundamentally use physical contact to create a mechanical force into the body tissues. –massage.  To me they are massage adaptation and not unique systems. Yes there can be expanded learning in these areas (and should be) but fundamentally massage is being use as the approach. Those teaching should be ethical about explaining this.

This next paragraph is bolded because I think it explains a lot of the problem.

So now here is where I think it all got confused.  The massage community in the past , in an attempt to legitimize itself, somehow decided that massage in and of itself was not enough. Massage was incomplete.  Therefore many systems of health practice got all jumbled in. And we ended up with the whole massage and bodywork  debacle.   

 Even more confusion occurred as multiple names for massage evolved--manual therapy, myotherapy, massotherapy,  medical massage, western massage, eastern massage, and all  you have to do is look at a list of forms and styles. 

Education for massage then began to include bits and pieces of all the individual systems diluting massage and doing a disservice to other systems that require unique knowledge and skills.  What a mess.

My recommendation  is-------------------------TA DA

The massage community needs to reclaim massage therapy as a whole approach.

If an individual practitioner wants to blend systems in their professional practice then they should commit to comprehensive study of that system and then openly present to clients and the larger community that they combine multiple approaches. The client has the right to be informed.

WE DO NOT NEED TO FIGHT. WE DO NEED TO CLARIFY. 

 

Figuring it out--Part 2

 

 

In the previous two blogs (and others in the past) I described a generic concept of massage as application of mechanical forces that the affect the tissues of the body.  In this blog I am going to attempt to describe HOW massage/bodywork methods apply the mechanical forces.  Get ready now because it is just so simple. 

WE PUSH OR PULL ON TISSUE.

It can’t be that simple can it? Well kind of.  We can complicated it by calling the pushes and pulls lots of different names I guess.  For example:

Compression/pressing/squeezing (or whatever trillion names people use)  is a push

 

 Glide/effleurage/stroke/ (or whatever trillion names people use)  is a push if the tissue moves away from us and a pull if it moves toward us.

 

Kneading,  petrissage , twisting, wringing, rolling, squeezing, lifting and squeezing/rolling/ twisting (or whatever trillion names people use) combines pushing and pulling.

 

Let's take a leap----------------

How about “ Myofascial release”.  What ya think? How do you do it?   Push or pull? Maybe both? 

Look at the following-- push? pull? both?

 

And without a doubt this is a push and pull-----

 

 

And as a side note-- if mechanical force application requires pushing and pulling then--- just maybe-- we can figure out how to do it in an ergonomically and biomechanically efficient way.

Force application or how to do it  http://www.darcor.com/public/File/pdf/Darcor_Casters_WhitePaper.pdf

ON A FINAL NOTE--- BEFORE ANYONE GETS THEIR FASCIA IN A TWIST---REMEMBER MY WORKING DEFINITIONS

Massage/bodywork as a method uses physical applications  to the body to create mechanical forces that act on the body tissues which then affect the body through multiple pathways including but not limited to the nervous system, endocrine system, connective system and fluid systems of the body .

Massage therapy or therapeutic massage is the intelligent, compassionate and respectful process of using massage to support another along the continuum of health and wellness  . Therefore massage therapy is a multidimensional  therapeutic relationship consisting of  observable and measurable mechanical aspects and an interpersonal more subjective experience both of which have therapeutic value for the client through multiple interacting specific and nonspecific pathways/

http://www.rnpedia.com/home/notes/fundamentals-of-nursing-notes/health-and-wellness 

Check out the link for excellent explanation of the wellness continuum

Thanks to the MassageNerd for some of the photos. http://ryanhoyme.com/preview-free-photos/

LET'S BEGIN TO FIGURE IT OUT.

Teaching can be lots of fun.

 

 

 

 

BASED ON MANY COMMMENTS I AM GOING TO EDIT THIS BLOG POST FOR SOME CLARIFICATION.  I AM OFFERING A WORKING DEFINITION OF MASSAGE THAT I WILL ADD BELOW.

 

Big picture:  Massage/bodywork as a method uses physical applications to the body to create mechanical forces that act on the body tissues which then affect the body through multiple pathways including but not limited to the nervous system, endocrine system, connective system and fluid systems of the body .

 Massage therapy or therapeutic massage is the intelligent, compassionate and respectful process of using massage to support another along the continuum of health and wellness - . Therefore massage therapy is a multidimensional  therapeutic relationship consisting of  observable and measurable mechanical aspects and an interpersonal more subjective experience both of which have therapeutic value for the client through multiple interacting specific and nonspecific pathways/

http://www.rnpedia.com/home/notes/fundamentals-of-nursing-notes/health-and-wellness 

Check out the link for excellent explanation of the wellness continuum

Following is the original blog which suggests a way of finding common ground on the mechanical aspect of massage /bodywork . I intend to follow with another blog about what we do to create the mechanical forces in the tissues such as gliding (and the multiple names for it) kneading (and multiple names involved) and movement and you guessed it( the multiple names used). This series of blogs is looking only at the potential of common ground related to physical aspect of massage application.

ORIGINAL BLOG.
It appears at least at some level that we are beginning to agree on the term massage even if it is confused with bodywork.  The Federation of State Massage Boards, The National Certification Board for  Therapeutic Massage and Bodywork, The Association of Bodywork and Massage Therapy  have the concept of massage and bodywork lumped together and reluctantly I am going to have to live with this confusion for a while I think.  

The age old problem of differentiating between massage and bodywork may indirectly be defined however.   Based on the ELAP work group‘s presentation at the Federation of State Massage Boards  and the AMTA convention the concept of forms and styles is going to  be built on the platform of mechanical forces that act on the soft tissue .  There will be a learning curve and the need to think just a bit differently and learn a slightly different language. But it will not be that complex. I applaud the work group’s diligence and efforts in this huge undertaking. 

 So first, if the the approach is going to be considered massage/bodywork it needs to fit this criteria-  creates mechanical forces that act on soft tissue ----!

If this is the case, then the approach has to at the very least change the physical shape of the tissue.  I submit to you that a very light touch will create a very tiny deformation of soft tissue. With observation then we can determine if an approach is on the massage and bodywork continuum.  If actual physical contact is not made and the tissue does not at least change shape a little bit (deformation) then it is not massage and bodywork.  Just this differentiation would clear up a lot of confusion.  

The fundamentals presented in this blog can be used to explain ANY style or form of massage and bodywork regardless of the history /culture of the approach, underlying philosophy and claims or evidence for or against the approach.  Remember now, the only thing that matters at this particular stage of analysis in this blog post is observation of what mechanical forces are generated by the method.  YES THERE ARE MORE FACTORS----ONE STEP AT A TIME HERE.

NOTE;  The ethics  and potential harm of making unreasonable claims  about a particular system of massage and bodywork  is a very important issue and I will eventually blog on these topics again. HOWEVER-ONLY WATCHING WHAT SOMEONE DOES AND BUILDING  THE DESCRIPTION FROM WHAT IS OBSERVED CAN BE A TREMENDOUS HELP IN IDENTIFYING CORE COMPETENCIES  FOR MASSAGE EDUCATION AND CRITICAL THINKING ABOUT THE CONFUSING, FRUSTRATING TENDENCY TO LABEL THE SAME FUNDAMENTAL APPLICATIONS AS SOMETHING NEW OR UNIQUE.

OK, let’s get started.

There are five mechanical forces. I have blogged on this before so check out past posts.  Mechanical forces are pretty universally understood and agreed upon so that really helps.  If you ask an engineer what a shear force is for example she or he will understand what you are talking about..

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.  Eventually we will need to look at each of the five types of forces, the ways they produce important therapeutic benefits when applied by a skilled massage/bodywork practitioner and the different ways they can cause tissue harm.

Compression

Compressive forces occur when two structures are pressed together

Tension

Tension forces (also called tensile forces) occur when two ends of a structure are pulled in opposite directions. 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

Shear

Shear is a sliding force, and significant friction often is created between the structures that slide against each other.

Torsion

Torsion forces are best understood as twisting forces.

 

Now for the justification for professional training and core competencies. 

Mechanical forces are generic.  When I push down on a key on my computer keyboard I am generating a compressive force with my finger that will then cause something to occur.  The key moves down and a letter shows up on the screen. To be honest with you, I am not quite sure what happens as the key responds to the applied force.   I am also sure that there are a multitude of events that occur so that the letter ends up on the screen.  Now about the only thing that can be observed in this whole process is that compressive force is the mechanical force required to move the letter key down.  Then a whole bunch of unseen things happen and then the next observable thing is the appearance of the letter.  Yea! 

How effectively I apply the compressive force is huge consideration.  Right now I am using my finger. It fits the key.    I could use my elbow, my toes, my forehead or an implement or tool like a pencil and as long as I can get the correct letter to appear on the screen the outcome is appropriate.  The anatomy of my laptop makes it cumbersome to use my elbow or other body part but I have seen people that are able to use other parts of their body or a tool to create the compressive force to move the key.  So it is not so much how the compressive force is applied as long as the key moves down. 

I also have to apply compressive force to the correct key and in the right intensity.  If the application is too surface or light then the key does not move. Too much intensity and effort is wasted, I could hurt my finger or even break the computer.   I also need to make decision about what key I want to compress so the outcome is understood.  Some pretty odd messages can occur or unexpected results if the wrong letter is used or if auto correct takes over.

OK enough metaphor.   Hopefully you are starting to appreciate why massage /bodywork education needs to include an understanding of the anatomy, physiology and pathology, how tissue and related physiology responds to the mechanical forces and how each application needs to be modified to achieve an expected outcome without causing harm.

The hundreds of methods of massage /bodywork introduce one or a combination of the five types of mechanical force into the body to achieve a therapeutic benefit. The application is modified for safety and benefit by altering the   depth of pressure, drag, duration, speed, rhythm, direction, location and frequency.  The intended outcome should make sense by, at the very least, mimicking normal physiological function. For example, if you think the result is going to increase a joint’s range of motion than the application should at least have a chance of achieving that outcome.

The variety of massage and bodywork forms and styles in the profession can be clarified by describing intended outcome, what is done during the application, how it is adapted, mechanical forces, and mode of application.

I challenge you to describe a. particular method this way. For example: myofascial release, shiatsu, lymphatic drainage, Swedish, cupping, foam rolling and so forth.  Grief, there are hundreds to choose from.  Forget right now the names, creators and teachers, theory and physiology.  Just observe what is being done and what the end result was.  What mechanical forces are being created? How are the forces generated? How is the application modified and adapted?  Where and for how long are the methods applied?

Following are some helps so you can break down any massage bodywork system into it’s fundamental elements.

·         Depth of pressure (compressive force) can be light, moderate, deep, or variable.

 

·         Drag is the amount of pull (stretch) on the tissue (tensile force). In this context the term drag refers to the effort required to overcome resistance. Lots of drag-little slipping no slack. Lots of lubricant little drag.

·         Direction means that the massage may proceed from the center of the body outward (centrifugal) or from the extremities inward to the center of the body (centripetal). It can proceed from proximal to distal attachments of the muscle (or vice versa) following the muscle fibers, transverse to the tissue fibers, or in circular motions.

·         Speed of techniques can be fast, slow, or variable.

·         Rhythm refers to the regularity of application of the technique. A method that is applied at regular intervals is considered even, or rhythmic. A method that is disjointed, or irregular, is considered uneven, or nonrhythmic.

·         Frequency is the rate at which the method repeats itself within a given time frame .

·         Duration is the length of time the method is applied or that the technique remains in one location.

·         Location. When the application is being applied. Leg, abdomen, head etc. What structures are in the area.

·         Intended outcome.  What is supposed to happen and what happened.

Here are figures of the mechanical forces.

 

 

 

 

 

HOW TO DESCRIBE WHAT WE DO.

Mechanical Forces That Act on the Body

Mechanical forces occur from actions that involve pushing, pulling, friction, or sudden loading, such as a direct blow. Five different kinds of force act on the body tissues. (DESCRIBED IN A BIT SO KEEP READING) Tissue types respond differently to different forces. Bending forces seldom harm the soft tissues but will break bone. Tensile forces seldom injure bone but often damage soft tissues. Massage therapists can use these same mechanical forces therapeutically during massage application.

During massage we 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 should 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.

Massage manipulations, which are modes of application, are used to apply mechanical force during massage in an appropriate way to achieve the determined outcome for the massage.  In the massage and bodywork community we use many different names to describe the mode of application.   We glide /effleurage/ stroke and knead/petrissage/ twist and the list goes on in a very confusing way.  Regardless of what we call what we do, the application can be effectively determined by describing what is able to be observed during the application, the modifications to the application such as how deep, speed, direction, location, duration repetitions, pull and drag on the tissue and so forth.  Then by determining the mechanical forces acting on the body tissues the likely outcome of the application can be described.   An example is provided at the end.  The following paragraphs describe the types of mechanical forces and the potential injury and therapeutic application pertinent to therapeutic massage.

Compression

Compression forces occur when two structures are pressed together . Compression is a common way that tissues become injured. Ligaments and tendons resist compressive injury. Muscle tissue, because of its extensive vascular structure, is not as resistant to compressive forces. Excessive compression force ruptures or tears the integrity of the muscle tissue, causing bruising and connective tissue damage.

Compression is a major mechanical force used in the application of massage to support circulation, stimulate nerve function, and restore connective tissue pliability. The massage therapist applies compression in such a way as to achieve benefits without damaging tissue, usually with the broad-based application of compressive force

(From Fritz S: Mosby's fundamentals of therapeutic massage, ed 5, St Louis, 2013, Mosby.)

Tension

Tension forces, also called tensile forces, occur when two ends of a structure are pulled away from each other .Bone resists tensile forces. However, tensile stress injuries are the most common way soft tissues are damaged. Examples of tensile stress injuries include avulsion (complete tearing of attachment), muscle strains, ligament sprains, tendinitis, fascial pulling or tearing, and nerve traction injuries (sudden nerve stretching such as that which occurs in stingers). Tensile stress injuries are described as first degree (mild), second degree (moderate), and third degree (severe).

Tensile force is applied during massage, particularly during gliding and traction. Therapeutically, tensile force supports proper alignment of fiber structures and can increase pliability in connective tissue.

 

(From Fritz S: Mosby's fundamentals of therapeutic massage, ed 5, St Louis, 2013, Mosby.)

Bending

Bending forces are a combination of compression and tension . One side of a structure is exposed to compressive forces, whereas the other side is exposed to tensile forces. Bending forces are a common cause of bone fractures and ligament injuries but seldom harm other soft tissues.

Bending is used during massage when kneading methods are applied. The proprioceptors in muscles and tendons respond to these forces. Bending forces also affect connective tissues, especially the viscosity of the ground substance.

 

 

Shear

Shear is a sliding mechanical force with friction created between structures that are sliding against each other. Excessive shearing force at a ligament or tendon creates an inflammatory irritation that leads to adhesion and fibrosis.

Shear and friction, called cross-fiber friction, is a massage method that uses specific force to create therapeutic inflammation to reverse fibrotic connective tissue changes.

Torsion

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

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

 

 

 

 

 

 Example of combined loading: torsion loading (A) + tension loading (B) + compression loading (C).

HERE IS AN EXAMPLE OF HOW “MYOFASCIAL RELEASE” CAN BE EXPLAINED.

Ease occurs when tissue is slack.  Bind occurs when tissue is taut.

Connective Tissue Protocol

1              Place crossed hands over tissue and meld hands to the skin.

2              Separate hands moving tissue to and just into bind/taut.. Do not slip.

3              Forearms can be used. Place on the tissue and meld to it.

4              Separate arms moving tissue to and just into bind/taut.

5              Small areas of tissue can be stretched by placing the short tissue between the fingers of both hands, and then without slipping separate tissues into the bind/taut and just into the tautness to stretch. .

6              Stabilize tissue at one end of the target area and hold fast. Then slowly glide, with drag maintaining tension on the tissues at all times.

7              Use shear forces to move tissue in and out of bind.(slack/taut)

8              Use bending force to move tissue into bind (skin rolling).

9              Grasp, lift, and pull to create combined loading to move tissue into and out of bind.

10           Use torsion force to twist tissue into and out of bind.

11           Stretching methods take tissue into bind. Hold at the ends of the area to be stretched and move away to create tension force.

12           Traction applies tension force to the tissues surrounding a joint. Grasp firmly above and below the joint and move hands apart to create tension force into bind.

13           Pin and stretch variation. Move target tissue from ease position toward bind and hold in place.

14           As the target tissue is held fixed, move the joint area to create the tension force into the bind.

15           Active release variation. Compress target tissue while in ease and then move from ease to bind position.

16           Client moves the jointed area away while the tissue is fixed to create the tension force to move tissues into bind.

Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby, 2013. <vbk:978-0-323-07740-8#outline(12.10.5.4.5)>.

Describing what we do in this way provides the beginnings of a common language that we so desperately need to move forward in our professional development.  Explaining massage and other forms of bodywork in this manner preserves the integrity of the individual forms and style while identifying the commonalities.   Swedish massage as a style can still use the classical terms of effleurage and petrissage and neuromuscular methods can still use terms such as friction, trigger point release and myofascial manipulation .  Regardless of the method ,when describe by observation of what is done, the mechanical force created that acts on the tissue and the modulators of the application such as pounds of compressive force and degree of pull (tension force ) on the tissue, also location, duration and so forth  as well as intended outcome or what happened to the tissue, a common understanding  can be achieved.

I want to applaud the ELAP work group for advancing the profession by using this method to describe massage and bodywork.

The following links provide interesting information about how important mechanical forces are to the human body.

Mechanical Forces Play Major Role in Regulating Cells http://www.sciencedaily.com/releases/2013/03/130319201941.htm

Small Mechanical Forces Have Big Impact On Embryonic Stem Cells

http://www.sciencedaily.com/releases/2009/10/091018141601.htm

WAITING

It is frustrating for me and many others I suspect when I just have to wait on results.  That is what I am doing now-waiting.  I keep thinking that there is something I should be doing but there is no value right now for me to do anything but what to see what others end up doing.  I will be at the  AMTA convention next week in Texas.  Ed Mohr, one of the graduates from my school will be presenting at the convention and I am excited about that.

Reducing Injury and Increasing Output With Proper Body Mechanics (Hands-on)

Instructor: Edward G. Mohr
Edward Mohr developed and managed the ergonomics program at General Motors, dealing with the elimination of work related stressors. Upon retirement, he became a massage therapist and utilized his prior knowledge of the capabilities and limitations of the body to analyze the work related stressors of massage therapists.


I am waiting for my fall entry level massage training program to begin first of October.  It really surprises me how sometimes you can do everything right and it still does not always work out the way you want.  I believe that I have developed an excellent curriculum for massage education.  I have written the major textbooks for crying out loud.  My school - Health Enrichment Center - has been in business for since 1984.  The graduates typically have jobs before they graduate. The school reputation is excellent and yet I continue to struggle to get a sustainable  enrollment.  Class size is limited to 12 and I teach a large portion of the program.  Tuition is reasonable-$7000 including books for a 600 hour program.  Scheduling is flexible and program is completed in 12 months part time.  I do not participate in financial aid but offer in house reasonable payment plans.  The downside.  I live in Michigan a state that is still reeling from the economic down turn. This seems to be the major issue and there is little I can do about that but wait it out.

I am waiting to find out what revisions have been made to the  ELAP  Entry Level Analysis Project.  I have been as influential as I know how to be.  My intentions are based on the best future for the massage profession and all I can do is hope that enough people commented on the surveys and that the committee pays attention.  I want to see all the raw data which is expected for a valid research project and I am waiting to find out how I will have to adapt based on the results.

Right now I am waiting on a client. I work with professional football players primarily and provide 10 -12 sessions per week. (sometimes more).  Not bad for being in practice for 34 years and 60 years old.

I am waiting to find out what the AMTA is going to actively do about supporting massage inclusion in the Affordable Care Act. AMTA is the "for real" professional association representing Massage Therapy.  The ABMP is a private business entity and while Les Sweeney and his staff provide excellent services  to the massage community it is not their responsibility to take an active role.  I would be nice if they contributed money and other resources  but not their job.

So it is a waiting time. Waiting patiently and attentively is an important contribution .  I am paying attention and being productive.  I have really enjoyed taking Coursera https://www.coursera.org/about college courses during this waiting time.Instructional Methods in Health Professions Education is the one I am finishing soon and will start  Going Out on a Limb: The Anatomy of the Upper Limb next week.  Woot Woot. they are FREE!

So I no longer need to wait on my client.  He is here.

TIME IS RUNNING OUT

 

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.

 elapmassage.org

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.