resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
January, 2003, Vol. 03, Issue 01
Introduction, With a Response to AMMA
By James "Doc" Clay, MMH, NCTMB
Clinical massage therapy has been around a comparatively long time.(Ben Benjamin has certainly been practicing it quite a while.) The various schools of myofascial release are clinical in intent. Bonnie Prudden, after being treated by Dr. Janet Travell, published a number of books and established her system of myotherapy. The Rolfers, Hellerworkers, and CORE myofascial therapists, with their approaches to structural alignment, practice what has to be considered a type of clinical bodywork.
Clinical massage therapy/bodywork is the product of a number of converging streams. The psychiatrist and psychoanalyst Wilhelm Reich, who began as a disciple of Freud, postulated the expression of character in body structure, and was certainly one of the first to develop an approach to treating mind and body together. Dr. Reich's system lives on in bioenergetics, an approach developed by his student, Alexander Lowen. Ida Rolf pioneered the manual treatment of the fascia to restructure the body. Traditional massage therapy began to expand to address specific pain problems. Travell and Simons explored myofascial trigger points and pain. Osteopaths such as Leon Chaitow contributed many procedures and techniques from the osteopathic tradition. We are heirs to all these ideas and practices that came before us, and are putting them together in a "bodywork synthesis"called clinical massage therapy.
But the perceptions of the public in general, and the medical profession in particular, have been limited largely to relaxation massage. I recently talked with Dr. Kathi Kemper, a pediatrician and the author of The Holistic Pediatrician, about massage therapy and pediatrics. She's quite interested in the topic, and thoroughly familiar with the work of Dr. Tiffany Field at the Touch Research Institute of the University of Miami Medical Center, but I found it nearly impossible to interest her in the effects of clinical massage therapy in the treatment of specific problems of myofascial pain and dysfunction (I haven't stopped trying!). Neonatologists know how effective massage is for helping premature babies gain weight, but pediatricians in general are utterly ignorant of the effectiveness of clinical massage therapy for treating headaches, earaches, and other childhood problems with myofascial components.
There are signs that the situation is changing. Recent articles have reported favorably on the effectiveness of clinical massage therapy for such problems as low back pain and neck pain, one even appearing in Reader's Digest. (I strongly recommend that anyone interested in keeping up with such studies subscribe to the newsletters from WebMD.com - they report such items on a regular basis.) Perhaps we needed some time for the public to become comfortable with massage therapy in general, before they were ready to accept clinical massage therapy as an option for pain treatment.
The purpose of this column is not to deal with clinical issues themselves - that's what we have Ben Benjamin for - but to address the variety of issues confronting clinical massage therapy as it develops and evolves. I want to do this in an interactive way, by soliciting your input. What do you think the issues are? What are your opinions about various aspects of the discipline we will have to deal with as therapists? How does clinical massage therapy differ from traditional relaxation massage in such areas as:
My decision to write a column on clinical massage therapy was well-timed, as it followed the publication of the American Medical/Manual Massage Association's (AMMA) guidelines for a medical massage curriculum in the September 2002 issue of Massage Today. This first column is an ideal place to reflect on that article. I find much in it to agree with, such as the recommendation for more thorough training in anatomy, physiology, and pathology, more intensive clinical exposure during training, internships in clinical settings, and a greater emphasis on problem-oriented therapy. However, I also found a number of points to take issue with.
1) I've heard the term "medical massage" used for several years, and have never been quite comfortable with it, for a variety of reasons. In Basic Clinical Massage Therapy: Integrating Anatomy and Treatment, I wrote:
Not only has our field rediscovered and revived a number of therapeutic techniques from the distant past and borrowed many techniques from other disciplines, we have taken advantage of our independence from traditional health care to explore and develop new techniques and new ways of understanding and applying old techniques. I can't help feeling that the use of the word "medical" in designating our profession betrays a desire to enhance our prestige by diving headlong into the medical field. We have seen what has happened to physical therapy as a result of just such a merger: the stifling of creativity and imagination. Although there are many outstanding and creative physical therapists in practice, the vast majority have been inexorably absorbed into the black hole of insurance and managed care, and have succumbed to the pressure to work "by the book." If we are to continue to explore and discover, and increase our effectiveness through creativity, we would do well to maintain our independence from more traditional disciplines.
2) AMMA may have already crossed that line. The article suggests that the training proceed from one body part to the next, learning the anatomy and typical pathology of each area before proceeding to the next area. The examples used are first the hand, then the elbow. Surely the authors are aware that most problems of the wrist and hand are traceable to muscles in the forearm, some of which cross the elbow - not to mention the common possibility of pain in the hand referred from the shoulder or chest! Yet we find the statement, "The medical massage treatment model is, however, neither a 'medical model,' nor is it 'allopathic.' Since it is massage therapy, the medical model is based on a natural and holistic philosophy of care." But the description we are given of a suggested curriculum is entirely reductionistic. Massage is not inherently holistic, and calling something holistic does not make it so. I see no reference anywhere in the article to posture as a causative or aggravating factor in myofascial pain, yet even the most authoritative physicians in the field of myofascial pain and dysfunction, Janet Travell, David Simons, and Robert Gerwin attribute a great deal of responsibility in this area to posture. I believe that most massage therapists are committed to a holistic view of health and the body, but such a view is not apparent in the AMMA statement.
3) The article says that, "Currently, massage education is fixated on 'hours in training,'" and later that "Time in training is not the central factor in developing good medical massage therapists; it is simply one factor." I certainly agree with that concept. However, a quick trip to AMMA's Web site (www.americanmedicalmassage.com), reveals that graduation from a 600-hour program is a requirement for membership in AMMA. Why 600 hours? Most programs I have come across span 500 to 600 hours, and I'm quite certain that most therapists practicing clinically are essentially self-taught, having gained the necessary knowledge and experience after massage school by attending workshops, reading books, watching videos, and working with clients. Among them are probably outstanding clinicians, but they would be ineligible for membership in AMMA.
4) AMMA tells us that, "It is important that the techniques and treatment protocols being taught conform to current and correct applications of medical massage therapy." What are those techniques and protocols? Is the jury already in? Am I to understand that all the research is done, all the exploration finished, our knowledge complete, and we now have a set of "techniques and treatment protocols" that are not only current, but even "correct?" Why wasn't I told? Since I'm just beginning work on my textbook on advanced clinical massage therapy, I hope someone will let me know about this. I'd hate to suggest incorrect approaches.
I find this statement from AMMA frightening. It suggests that we are in a great hurry to become frozen, petrified, closed-minded and institutionalized as a profession. And we should be duly warned that, if "correct" clinical techniques are established beyond question, we are not professionals, but technicians.
5) Finally, I can't overlook the article's reference to a "sore bicep [sic] muscle." Whether on the arm (biceps brachii) or the leg (biceps femoris), the singular of the word is "biceps" (the plural, in the unlikely event you should ever need it, is "bicipites") - there is no such word as "bicep." Perhaps that seems niggling and pedantic, but words are important, and for a group that emphasizes technical education, it's a point worth making.
It really isn't my intention to start a fight with AMMA. I encourage them, and I wish them well. But it is my intention to start (and maintain) an open conversation, because what we are doing is far too important to be left to a single individual or group to dominate or dictate. Having offered my criticisms this month, I will devote my next column to my own thoughts and ideas about clinical massage therapy education and standards, and welcome any feedback. Meanwhile, primum non nocere, and keep an open mind.
Click here for more information about James "Doc" Clay, MMH, NCTMB.
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