resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
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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