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.

MODEL PRACTICE ACT FOR MASSAGE-

I THINK WE NEED A HAND.
 

A model act is a draft of suggested occupational licensing  that is written with the intention of providing an example for legislation. A special interest group, a lawyers' conference, or a government agency may draft a model act. The goal is that the model act will be passed into law by local, state, or federal governments.

For Massage the Federation of State Massage Boards is creating the model practice act. https://www.fsmtb.org/userfiles/PDFs/MPA_Inaugural_Meeting_Press_Release_032811.pdf

There are a couple of organizations that help  create model practice act legislation.

The National Conference of Commissioners on Uniform State Laws (NCCUSL) works to propose model act legislation in the United States. The NCCUSL is a group of attorneys appointed by states who write model legislation for states, focusing on areas of statutory law. The model legislation provided by this organization strives to be non-partisan.

The American Legislative Exchange Council (ALEC) is another organization known for writing model legislation. ALEC is conservative and has both private members and state legislators as members. At its three annual meetings, ALEC’s members vote on proposed model legislation. From there, the model legislation goes to the organization's board of directors. If the board approves it, the draft becomes an official model bill.

I do not know if the Federation of state massage boards  is using such a group but it would seem to be a good idea.

http://www.wisegeek.com/what-is-a-model-act.

Model licensure for massage therapy is is a good concept. The massage community needs to be active in the development.  The most current aspect of the development of a model practice act is the Entry Level Analysis Project.  The Federation of State Massage Boards actually has a task force about ELAP which interests me. https://www.fsmtb.org/content/?id=36. I thought the ELAP idea came from the Leadership group of the massage professional organizations.  I tried to find out more information about the Federation task force but it was not available at least to my searches.  A main goal of the ELAP is to inform the Federation for the development of the Model Practice Act for massage which seems to be the end result of the endeavor. A model practice act will define massage, set educational standards, set forth scope of practice and be the platform of standards of practice.  My educated guess is that many in the massage there community do not understand the process or ramifications of this project.

I searched around and found the procedures and information for the development Emergency Medical Services (EMS). The pathway is very similar to massage therapy so instead of reinventing the wheel I suggest the massage community learn from them.  HERE IS SOME GENERAL INFORMATION.  I ENCOURAGE YOU TO CLICK THE LINKS AND READ THE DOCUMENTS. NOTE: CAPS INDICATE MY THOUGHTS.

The National EMS Scope of Practice Model defines and describes four levels of EMS licensure: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. Each level represents a unique role, set of skills, and knowledge base. National EMS Education Standards will be developed for each level. When used in conjunction with the National EMS Core Content, National EMS Certification, and National EMS Education Program Accreditation, the National EMS Scope of Practice Model and the National EMS Education Standards create a strong and interdependent system that will provide the foundation to assure the competency of out-of-hospital emergency medical personnel throughout the United States.

I AM NOT SUGGESTING A TIERED SYSTEM FOR MASSAGE BUT I AM NOT DISCOURAGING IT EITHER. IT COULD WORK.  Following is a link to the information and I suggest you read it keeping massage therapy in mind.

National EMS Scope of Practice Model http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

Here are some clips from the document. See if this does not sound like massage therapy. Remember the document is for EMS ok.

“identify 39 different licensure levels between the EMT

and Paramedic levels. This patchwork of EMS personnel certifications has created

considerable problems, including but not limited to:

• public confusion;

• reciprocity challenges;

• limited professional mobility; and

• decreased efficiency due to duplication of effort. “

 

“The National EMS Scope of Practice Model supports a system of licensure common in

other allied health professions. Such a system offers the following benefits:

• establishes national standards for the minimum psychomotor skills and

knowledge for EMS personnel;

• improves consistency among States’ scopes of practice;

• facilitates reciprocity;

• improves professional mobility;

• promotes consistency of EMS personnel titles; and

• improves the name recognition and public understanding of EMS personnel.

The licensure of EMS personnel, like that of other health care licensure systems, is part of an integrated and comprehensive system to improve patient care and safety and to protect the public. The challenge facing the EMS community is to develop a system that establishes national standards for personnel licensure and their minimum competencies while remaining flexible enough to meet the unique needs of State and local jurisdictions. This document recognizes the need for “freedom within limits.” ( I LIKE THIS)

 

“In 1993, the National Registry of EMTs (NREMT) released the National Emergency

Medical Services Education and Practice Blueprint. The Blueprint defined an EMS

educational and training system that would provide both the flexibility and structure

needed to guide the development of national standard training curricula and guide the

issuance of licensure and certification by the individual States.”

MASSAGE THERAPY STILL DOES NOT HAVE THIS.

 

THIS IS INTERESTING.

As a relatively young discipline, EMS has a limited research base which makes it

difficult to make evidence-based decisions; however, this project was guided by research

whenever possible. The development process used the National EMS Core Content,

State EMS office and medical director surveys, the National EMS Practice Analysis, the

National EMS Information System (NEMSIS) pilot project data, the Longitudinal EMT

Attributes and Demographics Study (LEADS), and peer-reviewed literature where

appropriate.

 

The Scope of Practice Model was also influenced by extensive literature review of other

professions, systematic analysis of policy documents regarding health care licensing and

patient safety, presentations by other allied health credentialing bodies, and crossprofessional

and international comparative analysis.

 

Statistical analysis and research on patient safety, scope of practice, and EMS personnel

competency must become a priority among the leadership of national associations,

Federal agencies, and research institutions. When EMS data collection, subsequent

analysis, and scientific conclusions are published and replicated, later versions of the

National EMS Scope of Practice Model should be driven by those findings.

 

I THINK THE ELAP PROJECT IS KIND OF TRY TO DO THIS BUT I WONDER WHY CURRENT MASSAGE LEGISLATION WAS NOT INCLUDED AS PART OF THE DATA.  ALSO I HOPE THAT  WE ALSO DO - extensive literature review of other professions, systematic analysis of policy documents regarding health care licensing and patient safety, presentations by other allied health credentialing bodies, and cross professional and international comparative analysis.

 

EMS ALSO CREATED EDUCATIONAL STANDARDS.

The National EMS Education Standards are not a stand-alone document. EMS education

programs will incorporate each element of the education system proposed in the Education

Agenda. These elements include:

• National EMS Core Content

• National EMS Scope of Practice

• National EMS Education Standards

• National EMS Certification

• National EMS Program Accreditation

This integrated system is essential to achieving the goals of program efficiency, consistency of

instructional quality, and student competence as outlined in the Education Agenda.

For the purpose of this model, one licensure level is substantially different from other

licensure levels in:

• Skills

• Practice environment

• Knowledge

• Qualifications

• Services provided

• Risk

• Level of supervisory responsibility

• Amount of autonomy

• Judgment/critical thinking/decision

making.

The National EMS Education Standards comprise four components :

1. Competency - This statement represents the minimum competency required for entry-level personnel at each licensure level.

2. Knowledge Required to Achieve Competency - This represents an elaboration of the knowledge within each competency (when appropriate) that entry-level personnel would need to master in order to achieve competency.

3. Clinical Behaviors/Judgments  - This section describes the clinical behaviors and judgments essential for entry-level EMS personnel at each licensure level.

4. Educational Infrastructure  - This section describes the support standards necessary for conducting EMS training programs at each licensure level.

 

Course Length

Course length is based on competency, not hours

Course material can be delivered in multiple formats including but not limited to:

• Independent student preparation

• Synchronous/Asynchronous distributive education

• Face-to-face instruction

• Pre- or co-requisites

 

YOU CHECK IT OUT.  I THINK IT IS A GOOD MODEL: http://www.ems.gov/pdf/811077a.pdf

 

IT MAY INTEREST YOU TO KNOW THAT EMS EDUCATION IS CLOCK HOURS BASED:

At the EMT-Basic level, training includes instruction in assessing patients' conditions, dealing with trauma and cardiac emergencies, clearing obstructed airways, using field equipment, and handling emergencies. Formal courses include about 100 hours of specialized training. Some training may be required in a hospital or ambulance setting. The EMT-Intermediate 1985 or EMT-Intermediate 1999 level, also known as the Advanced EMT level, typically requires 1,000 hours of training based on the scope of practice. At this level, people must complete the training required at the EMT level, as well as more advanced training, such as training in the use of complex airway devices, intravenous fluids, and some medications. Paramedics have the most advanced level of training. They must complete EMT-level and Advanced EMT training, as well as training in advanced medical skills. Community colleges and technical schools may offer this training, in which graduates may receive an associate's degree. Paramedic programs require about 1,300 hours of training and may take up to 2 years. Their broader scope of practice may include stitching wounds or administering IV medications.

http://www.bls.gov/ooh/Healthcare/EMTs-and-paramedics.htm#tab-4

 

So what does this mean for us right now?  Here is my take on it.

 

Model legislation will define who we are and what we do (scope of practice) . 

Model legislation will direct educational content and delivery

ELAP was meant to inform development of model legislation

We need to organize our definition of massage, our competencies, our body of knowledge and our core educational content into a unified statement.

The EMS model gives us an idea about how other occupations did these things.

 

Vocational education is appropriate for entry level massage practice based on clock hours.

 

Based on EMS scope of practice example the 500-600 model for entry level massage education may be more accurate than we think.

 

We should be using “outside of the massage community” experts to help us do this.  

WE NEED TO BE INFORMED !!!!!!!!!!!!!!!!!!!!!!!!!!!

 

 

 

 

 

RAVE-RANT-HOPE

 

Rave- .give high praise: to give praise in a very enthusiastic way

Rant- speak in loud exaggerated manner: to speak or say something in a very loud, aggressive, or bombastic way, usually at length and repetitively

Hope- want or expect something: to have a wish to get or do something or for something to happen or be true, especially something that seems possible or likely

 

This blog series has the intention to identify great things going on that affect the massage profession,  speak candidly my opinions about issues that impede and complicate these great things from happening and  express my hopes (and suggestions) for the future of this needed and important profession.

I am going to use the word profession in a hopeful way. A profession is : Occupation, practice, or vocation requiring mastery of a complex set of knowledge and skills through formal education and/or practical experience.

We are close. We could do this so I begin this blog series with HOPE.   

I do not believe that entry level massage practice needs to be a degree level program and support vocational training (certificate/diploma)  for initial training .  I also think that the Board Certification process now offered by the National Certification Board for Therapeutic Massage and Bodywork http://www.ncbtmb.org/ is an important step in differentiating entry level (licensing-novice) practitioner from those who have committed to the next level ,not because they have to  (licensing) but because they want to  strive for excellence.  I think that the educational requirement post-graduation is too low but we have to begin someplace and it is only one part of the qualifications for BOARD CERTIFICATION.  So NCBTMB gets a qualified RAVE from me and the board certification process and future specialty certification that can be a pathway to higher degrees such as bachelor’s degrees for those who want to achieve a high degree of excellent in that manner.

RANT: WE NEED AN AGREED UPON DEFINITION OF MASSAGE.

RAVE: 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.

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

COMTA gets a RAVE from me even though at this time my school is not accredited due to current economical struggles.  I hope COMTA can find a way for small school like mine not wanting to participate in financial aid can achieve affordable programmatic accreditation. .  I know they are trying to do this but have to be accountable to their own compliance issues. Until then I run my school in a COMTA ready process and encourage others to do this as well.

I have a qualified RAVE for the MTBOK and believe that if the scope of practice statement were eliminated and a few changes were made to the entry level knowledge, skill and abilities (KSA) section following the review done by the Alliance for Massage Therapy Education (http://www.afmte.org/education/mtbok/ ) that is  an important document in a statement of professionalism and unification of the massage profession.  I have a big RANT as well.   There is no reason for that document to be sitting on the webpage shelf and ignored.  It is not perfect but it is a great source of information.   It should not be minimalized and ignored but actively improved and integrated into the unifying statement of the massage profession.

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.

 I give the work group a RAVE for being open to discussion and support them in the work they are doing but also encourage then to continue to reach out the research experts and subject matter experts in massage that want to help this initiative be successful.   They need support and input and I believe they will listen and respond.   So comment- elapmassage.org

A finial RANT for this blog: All organization serving the massage profession-STOP WORKING BEHIND CLOSED DOORS. PROVIDE REGULAR UPDATES ON WHAT YOU ARE DOING AND REALIZE THAT YOUR INDIVIDUAL PROJECTS ARE ONLY PART OF THE WHOLE.

A finial RAVE for these same organizations working together and please keep in up with even more inter-cooperation.

And a closing HOPE. 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.

Additional Link list for gathering information.

http://www.afmte.org

http://massagenerd.com

 http://massagenerd.tv/

http://www.youtube.com/massagenerd

http://lauraallenmt.com/blog