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News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
April, 2002, Vol. 02, Issue 04
Scope (Not the Mouthwash)
By Cliff Korn, BS, LMT, NCTMB
"Scope of Practice" is a term that, like many others, seems obvious, but means different things to different people. Strictly speaking, a scope of practice is the legal limit of practice options available to a regulated practitioner.However, in common usage, associations develop scope-of-practice guidelines for professionals in a field independent of regulation. A practitioner's scope of practice is predominantly measured by definition, and definitions change depending on who is doing the defining. Laypersons and regulators may define terms we use internal to our work differently than we do.
An example of this can be found with the term "massotherapy." From a school website comes this definition: "Massotherapy is a scientific method for treating disorders of the human body through manipulating the soft tissue, by hand or other modality, to affect relaxation, relieve pain, increase range and mobility of joints and ligaments, reduce certain types of edemas, affect blood and nutrition, improve metabolism, promote circulation, and beneficially influence the nervous system." Another school's site defines the same term as: "Massotherapy is a hands-on application that consists of a number of techniques executed on living tissue with the objective of promoting a general well-being. This type of therapy has an effect on the skin, muscles, tendons and ligaments (referred to sometimes as soft tissue) and aims for a physical as well as a psychic well-being since the last two are closely related." Yet a third defines it as the following: "Massotherapy is massage therapy or a systematic and scientific manipulation of the soft tissues of the body."
They all make the term seem pretty synonymous with "massage," don't they? My favorite choice for definitions is Webster's New World College Dictionary, Fourth Edition. My copy defines massotherapy as "a physical therapy by means of massage." My guess is that individuals looking to initiate state regulation/licensing of massage would get fewer objections from the physical therapists if they studiously avoided Webster's definition!
Individual state regulators can and do choose how they wish to define terms and scopes of practice. This can drastically affect a scope of practice from one jurisdiction to another. A classic example of this is colon hydrotherapy, which until recently was (in one state) not allowed in a licensed massage establishment, while in a different state required those performing colon hydrotherapy to also be licensed massage therapists. In another state, a practitioner of massage may treat temporomandibular joint dysfunction only if a physician has directly referred the patient in writing for such treatment. One state allows the application of non-prescription topical substances on the body within its scope of practice. This has led massage therapists there to offer facial massage, which really irritates the estheticians, who consider the word "facial" to be theirs alone.
Certainly massage therapists deal with overlapping scopes of practice all the time, but regulatory definitions, scope limitations and educational requirements make it particularly difficult within the broad umbrella of massage therapy. Many well-meaning massage boards have developed broad massage definitions so that other professions aren't able to exclude massage therapists from the conduct of emerging advances in the field. A side-effect of this is that many people get swept up in the regulations that feel like they don't fit a definition of massage. Reiki practitioners in all but the most hard-nosed jurisdictions have been able to exempt themselves from most massage definitions. Other methodologies, which frequently wish to opt out of massage regulation, are reflexology and polarity. They make strong cases for not fitting the definitions of massage in many instances, but my trusty Webster's defines reflexology as "a practice involving the use of acupressure or massage of the hands or feet to relieve pain in other parts of the body, reduce tension, etc." The International Institute of Reflexology also lists itself as approved for continuing education by both the Florida Board of Massage and the NCBTMB. Do you think a regulator or layperson reading that definition and noting those approvals would see the merit in granting reflexology an "out"?
Similar difficulty with structural integration, Bowen technique, Asian bodywork, Trager, watsu, CranioSacral Therapy, etc., stems from differences in definition. One I found humorous was Webster's definition of Rolfing. It states, "service mark for a form of painful massage intended to relieve emotional tensions by relaxing and repositioning the muscles." My guess is that the Rolf Institute's public relations team will soon be petitioning Webster's publisher for a definition change!
The differences in state-by-state definitions and scopes of practice are particularly stressing to massage therapists. As a group massage therapists tend to be a mobile lot and the ability to cross state borders relatively seamlessly should be a boon. An organization had been in place to attempt to find common ground in regulatory language. Unfortunately, the National Alliance of State Massage Therapy Boards is all but dead. It has no leadership and no plans to meet again. Perhaps there can be a grassroots effort to get it re-established.
Thoughts on scope of practice are always affected by definitions. Here are a few (from Webster's, of course!) to ruminate on when next you are discussing the benefits of accepting or rejecting regulation, embracing or delaying continuing education, or contemplating whether you are a professional or a hobbyist in massage:
My high-school biology teacher used to use a phrase that still stays with me: "Ontogeny recapitulates Phylogeny." It refers to life cycles of individual organisms affecting the life cycles of groups of organisms. When we choose to define our scopes of practice, we affect more than just ourselves. As that teacher was alluding to with his jargon, what happens to one is indicative of what happens to many!
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be published in a future issue of Massage Today. Please send all correspondence by e-mail to , or by regular mail to the address listed below:
Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.
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