Secrets from Mosby’s
Fundamentals of Therapeutic Massage – 20 + years in the making. Chapter 1
I have a big issue with right answers. There are a few solid facts I guess. A book I
read many years ago influenced me about the question /answer conflict I
have. The book Mister. God This is Anna described an unlikely relationship between
a little girl Anna and a young man Flynn.
One section of the story has
guided me during my textbook writing. It is a discussion about questions and
answers that went something like this. -The answers are not that
important. For example the number 3 is
the answer to hundreds of questions such as 7-4= 3. What is important is the question. When you
can find an answer with only one question that is important. http://en.wikipedia.org/wiki/Mister_God,_This_Is_Anna
From Fundamentals Chapter one-
“Both the questions and the answers evolve for each student
as the individual's information base and experience increase and the journey
through education continues. This text does not provide definitive answers to
any of these questions; however, it does provide information to help you find
your own answers to questions you may face. What will your questions be? How
will your answers influence those you touch? How will your answers touch you?
These are huge issues to consider at the beginning of any course of study. As
you begin to think about them, you might feel interested, excited, overwhelmed,
or maybe even frightened as you come to realize how necessary, beneficial,
complex, and powerful touch can be. Remember that understanding evolves. These
important questions are posed at the beginning of this study and possibly
before you have sufficient information to develop effective answers. Your
awareness of these questions will help you make decisions and find answers as
you progress in your study of therapeutic massage. You will come to understand
the process of developing your answers to the previously mentioned questions
and many others that will arise by embracing the importance of respect, not
only for yourself, but also for all those with whom you interact, both
personally and professionally (Fritz 2).”
I have also grappled with the identity we have as massage
therapists. From the first edition I have been uncomfortable with using the term
therapist when compared to our level of education. The term therapist has a
very layered meaning. The Federation of State Massage Boards Model Practice Act
formalizes the term Massage Therapist. I have been more confident with the term
practitioner. I support vocational
status for massage practice. Vocational
status fits well with health professions. Diploma based education at entry
level allow for relatively quick entry into practice and the education is not burdensome
for those who seek to serve through therapeutic touch. The title of the textbook- Fundamentals of Therapeutic Massage reflects
this belief. I support and have worked really hard for educational pathways
beyond entry level.
“Schools of massage therapy have begun to work with colleges
and universities to develop articulation agreements that allow graduates of
their programs to complete degrees in massage. The first of these articulation
agreements was reached in 1995 between the Health Enrichment Center in Lapeer,
Michigan, and Siena Heights University in Adrian, Michigan, to grant both
associate's and bachelor's degrees in applied science in massage therapy. (Fritz 21)”
Today the associates and bachelor’s degree is available to
those who seek educational advancement based with credit hours articulated into
the university program based on Board Certification through the NCBTMB. Another unsung hero of mine is Norm
Buckwaz a dean at Sienna Height
University. He and I worked together beginning in 1993 to achieve the
articulation agreement and just last year. as he is approaching retirement ,Norm
was a driving force for the agreement between NCBTMB and the university to
award college credit based on Board Certification instead of a loose network of individual articulation
agreements. With degree completion available online ,now any massage therapist
can pursue advanced academic degrees. My dream is that the bachelor’s degree
will support teacher development. I am proud of my contributions to this educational
pathway. However I remain a strong supporter of diploma based education for
entry level massage training because I believe more people can learn massage
and serve others by providing affordable quality therapeutic massage.
“A profession is defined as an occupation that requires
training and specialized study. An occupation can be defined as a productive or
creative activity that serves as one's regular source of livelihood. A
professional is a person who engages in a profession. Professionalism is the
adherence to professional status, methods, standards, and character (Fritz 3)”
I am a supporter of outcome based therapeutic massage based
on assessment and unique adaptation for each client. —
“You will learn to listen to a client give his or her
history and to observe during a physical assessment. However, not until you
touch the client and feel the person will you begin to understand that
individual's body. The client can sense through your touch if you understand
the information the body provides. Touch is a fundamental, multilayered, and
powerful form of communication, the most personalized form of communication we
know. (Fritz 4)”.
Throughout the textbook I use metaphors and stories. I have
become more own best study of anatomy, physiology and human nature. This is not always an easy endeavor. Self-honesty
can be a bit brutal. At the same time I am often my greatest source of
entertainment. It is amazing the amount
of goof I contain and embrace opportunities to laugh at myself. The current situation with my eyes and glaucoma
treatment is an ongoing source of amusement. Currently I have on an eye patch
with holes in it under glasses with the right lens removed with reading glasses
over that also with the right lens removed.
I also have a magnifying glass at hand. My depth perception is a mess and just
watching me go down stairs is a belly laugh. I think story telling is a great
way to teach. We just need to make sure
the story is relevant for the lesson and not just blabbering. When you share your
story you become vulnerable but so are clients as they remove clothing, lay on the massage table and let us touch
them. One of my first stories appears in
chapter one. It was in the first edition
and I have had to keep updating it some but is is true and hopefully an example
for students about the important of self-reflection.
Proficiency Exercise 1-2 My Touch History
On a piece of paper, write a brief touch history of yourself.
Then explain the ways your history may influence your delivery of professional
touch. The following example is provided as a model.
Culture: I grew up in the United States in Michigan. I lived
in a small town that was primarily Caucasian.
Subculture: My family was a blue collar, working class
family.
Genetic predisposition: I am most comfortable with a large
personal space and plenty of time alone.
Gender: Female
Age: Mid 60s
Life events:
I experienced touch trauma from a grandfather and uncles, who
would tickle me until I could not stand it.
I gave birth to three children and am a single parent.
I had a special friend who was blind.
I had unexpected open heart surgery.
My oldest son was killed in a tragic accident at age 33.
Spiritual path
I initially had an unstructured Protestant focus. I developed
a specific fundamentalist path in early adulthood. I embraced many paths as
truth in later years as I evolved from the practice of religion to the
development of personal spirituality.
Ways my touch history may influence my delivery of
professional touch
I had to learn a lot about different cultures, because my
exposure to a diverse population was limited while I was growing up. I have to
be careful to understand a person's culture before I approach to touch him or
her. I am most comfortable with blue collar, working class people. I am more
relaxed and find myself willing to spend more time when I touch someone from
this population. I feel overwhelmed if I am touched too much and tend to limit
initiated touch from the client. I am a woman, and I learned during my gender
role development to fulfill others’ needs before my own. I often overextend
myself for a client instead of setting time limits. I am hypersensitive to
light touch and tend to avoid giving light touch when I give a massage. I am
understanding of the numerous demands on a single parent and tend to touch one
in similar circumstances with sympathy instead of empathy. I have to be careful
of boundaries when I touch stressed, overwhelmed single parents. I am casual
when touching someone with a disability. I have experienced life-threatening
illness, tragedy, and loss. This has changed my life perspective, and if I am
not careful, I can discount what may seem to me to be the more minor struggles
of others. I seek to understand various spiritual paths and deeply wish to
respect issues of touch within each discipline. I tend to assume that one must
actually make physical contact during spiritual healing and must remind myself
that this is not everyone's truth. (Fritz 5)”
The history of massage is fascinating. Another important person in the development
of the textbooks is Richard van Why. He
searched for and provided volumes of historical documents and I purchased all
of it. I have files of the material Richard found. Sadly I have lost track of Richard but he
remains an interagal part of the textbook development
“Richard van Why has said, “It was in the field of pain
research and pain management that the greatest gains for massage were made.”
Ronald Melzack, a professor of psychology in the anesthesiology department of
McGill University Medical School and one of the initial proponents of the gate
control theory of pain, published the results of several controlled clinical
trials on the value of ice massage and manual massage for the relief of dental
pain and low back pain. Melzack not only found these techniques effective in
preventing or reducing pain, he also proposed a theory for the neural
mechanisms by which they operated. Other researchers picked up on this theme
and began to examine the role of massage in the liberation of endorphins,
pain-killing chemicals more potent than morphine that are produced by the brain
in response to certain stimuli, including massage.
In the late 1980s, in the prestigious journal Clinics in
Anesthesiology, Melzack proposed a theory to explain endorphin release. His
theory of hyperstimulation analgesia was the first in recent decades inspired
by findings concerning massage. The theory argues that certain intense sensory
stimuli, such as puncture with a needle or exposure to extreme cold or pressure
when applied near the site of an injury, sends a signal to the brain by a
faster channel than that used by the pain signal it was attempting to treat,
thereby disrupting the pain (van Why, 1992). (Fritz 19)” van Why, RP: History
of massage and its relevance to today's practitioner, the Bodywork
Knowledgebase. 1992, self-published, New York. (Fritz 23-24)
All the rage on Facebook for the last couple of years has
been information and discussion of the “NeuroMatrix” Richard was describing it
way back when.
J Dent Educ. 2001 Dec;65(12):1378-82.
Pain and the neuromatrix in the brain.
Melzack R1.
Abstract
The neuromatrix theory of pain proposes that pain is a
multidimensional experience produced by characteristic
"neurosignature" patterns of nerve impulses generated by a widely
distributed neural network-the "body-self neuromatrix"-in the brain.
These neurosignature patterns may be triggered by sensory inputs, but they may
also be generated independently of them. Acute pains evoked by brief noxious
inputs have been meticulously investigated by neuroscientists, and their
sensory transmission mechanisms are generally well understood. In contrast,
chronic pain syndromes, which are often characterized by severe pain associated
with little or no discernible injury or pathology, remain a mystery.
Furthermore, chronic psychological or physical stress is often associated with
chronic pain, but the relationship is poorly understood. The neuromatrix theory
of pain provides a new conceptual framework to examine these problems. It
proposes that the output patterns of the body-self neuromatrix activate
perceptual, homeostatic, and behavioral programs after injury, pathology, or
chronic stress. Pain, then, is produced by the output of a widely distributed
neural network in the brain rather than directly by sensory input evoked by
injury, inflammation, or other pathology. The neuromatrix, which is genetically
determined and modified by sensory experience, is the primary mechanism that
generates the neural pattern that produces pain. Its output pattern is
determined by multiple influences, of which the somatic sensory input is only a
part, that converge on the neuromatrix.
PMID: 11780656 [PubMed - indexed for MEDLINE] Free full text
During writing of the 5th edition I was thrilled
to have the MTBOK as a guide.
“The foundation of the Massage Therapy Body of Knowledge
(MTBOK), the document produced by the MTBOK stewards, consists of (1)
definition of massage therapy (scope of practice, terminology, and descriptions
of the therapeutic massage field) and (2) definition of the competencies of an
entry-level massage therapist in terms of knowledge, skills, and abilities
(KSA). The initial work was completed by mid-2010, and MTBOK projects continue.
The work of the MTBOK stewards was pivotal in transforming the massage
profession from a fragmented, loosely formed group into a cohesive partnership
invested in the advancement of the massage therapy profession. (Fritz 21)”
Unfortunately the value of the document went largely unrecognized
and as I work on the 6th edition I am using the ELAP-entry level
analysis project. Elapmassage.org. The
Alliance for Massage Therapy Education www.afmte.org did extensive committee work on
the MTBOK and you can find that work on the website as a resource. We worked
hard to take the document to the next level for use in the education of
massage. It is very well done and helpful to educators, but alas also largely
ignored.
“In 2010 the Alliance for Massage Therapy Education was
established. This organization brings together directors and administrators
from massage therapy schools, along with massage school teachers and those who
provide continuing education seminars and advanced training in the field. All
are committed to the advancement of quality education. The alliance and the
Massage Therapy Foundation, working together, will ensure that massage therapy
follows the path of excellence into the future. (Fritz 21)”
I am proud to be a founding member of this
organization. A group of us contributed
$1000.00 each to get the organization up and running. I venture to say that
most of us had to struggle to find the money in our budgets but we did. One of
my dreams for the massage profession is coming real this July
Join us for the 1st 2015 Educational Congress
hosted by The Alliance for Massage Therapy Education and the Commission on Massage Therapy Accreditation
I will be there. Eye patches and blurry vision will not stop
me! I am presenting as well.
The end of chapter 1 asks some important questions.
“The future will determine the way the profession responds
to the needs created by this success. Some questions we must answer to continue
moving forward are:
• Will we be
willing to accept research findings and let go of myths and misinformation
about massage?
• Will we
learn to use critical thinking skills to develop outcome-based massage sessions
to achieve client goals?
• Will we
learn to work together with other professionals in multidisciplinary teams?
• Will we
agree on terminology about massage so that we can communicate with each other?
• Will we
let go of the differences that divide us and reach for the similarities that
bring us together?
• Will we
commit to expertise through educational excellence, professional practice, and
ethical behavior?
• Will we
demand that educators and professional organizations be current, proficient,
and committed to training the future generations of massage therapists?
• Will we
respect our history, understand our traditions, and strive to bring those
values into the future? (Fritz 21)
“A shift has occurred from the confusing proliferation of
massage and bodywork styles to understanding massage application provided to
achieve outcomes such as stress and pain management, increased mobility, and
enhanced performance. Hopefully, the abundant massage and bodywork methods will
continue to combine into a consolidated system of therapeutic massage without losing
the rich diversity of professional expression. Terminology and education are
standardizing, yet we have maintained the integrity of the individual
applications of massage and bodywork. For those of you now entering the
profession of massage therapy, success depends not on how many different styles
of massage you know, but on your commitment to critical thinking, understanding
the nature of human connection, and practice to perfect skilled application of
the fundamental aspects of massage. The pressure to learn many different ways
to do massage will evolve into skilled massage application based on
evidence-based professional practice. The move from opinion and
experience-based practice to the more objective evidence-based practice of
massage is an ongoing theme in this text. Two tracks of massage service
probably will continue to standardize: wellness massage outside the health care
system and medical massage within the health care system. Although very
similar, these trends allow a vast diversity in the types of services
available. Critical thinking skills, research literacy, experience, and empathy
are the markers of career success. The future is bright and promising,
especially if we pay attention to our past and remember the words and wisdom of
an old Russian physician: “massage is massage.” We ourselves constitute one of
the biggest threats to the future of massage. Currently the profession is
fragmented, and educational standards are inconsistent. All bodywork
professions must come together to work for the common good. As the massage
profession moves forward and reclaims its heritage as an important health
service, it is important to look back so that we can see the strengths and
weaknesses of the professional journey (Figure 1-6). (Fritz 22)
Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th
Edition. Mosby, 2013.
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