resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
December, 2003, Vol. 03, Issue 12
We Get Letters & E-Mail
By Editorial Staff
Editor's Note: Some letters have been edited for space and clarity.
Concerns About Regulation and the NCBTMB
I read "Shades of Gray"(www.massagetoday.com/archives/2003/04/14.html) and was reminded of a negative experience I had with regulation.I graduated from an "AMTA-approved" school, passed the national certification examination, and became licensed by my state. After 12 years of professional experience, I relocated to New York, which has created a difficult set of hurdles to overcome in order to practice massage. My choices were to beg an existing therapist for "supervision" and practice a watered-down, standard massage (and fork over a portion of my pay for this opportunity), or go to a New York massage school for two years because [New York schools] are accredited by the state, and do not allow [students] to take only the courses [they] need to satisfy the board of education, which regulates the profession. Sounds like collusion to me.
I can't tell you how disappointed I am with the uselessness of national certification. I've jumped through their hoops and have only been inconvenienced. Who are these people, anyway? Their mission is never stated in their newsletters; there is no "letters forum" for any kind of peer debate; there doesn't appear to be a way to register dissent from within. Who are the "stakeholders" that they keep referring to? I get the feeling they aren't talking about massage therapists. It's all suspiciously vague.
I invested in a profession that I love, assuming I'd be able to take these wonderful skills anywhere and be welcomed. Now I'm considering going back to school to develop a new career. I do think students should be well trained before moving into the field, and that we should maintain complete mobility. I believe that it is through doing good work that we survive and thrive - not by having yet another piece of paper on the wall. It is unfair to run practicing therapists out of business by creating new hurdles. I strive to do world-class bodywork, and I come from a place of good intentions. I also have my limits. Practicing therapists should have universal grandfathering. Why doesn't the NCBTMB work on that? If no harm to the public has ever been proved and nobody is going after prostitutes (Regulate THEM for crying out loud!), why bother with regulation?
Robert Orzel, LMT, ex-NCTMB
I am writing as a concerned observer of the massage profession. In early June, my husband - a licensed and nationally certified massage therapist who is affiliated with three massage schools and has been teaching human sciences and advanced massage modalities for years - applied to the NCBTMB for certification as an "approved provider" to teach anatomy and sports massage. The process, which continues, has convinced me that massage therapists need to be deeply concerned about the direction the NCBTMB is taking.
First, the application was a nightmare, requiring redundant information in a rigid format that is designed for schools offering programs, rather than individual providers. It required months of effort and was expensive. Second, although the NCBTMB promises to review applications and respond within 10 weeks, it did not; in fact, it did not even respond to an e-mail inquiry explaining that we were moving and needed to update our address. When the response was finally sent, it went to the wrong address, and the meter date on the letter was postmarked two weeks later than the date on the (already late) letter.
Third, the application was "deferred," on the vague theory that "the content of both sports massage and anatomy were not appropriate for continuing education classes." This was puzzling, as there are NCMTMB-approved providers all over the Internet offering courses with nearly identical content for continuing education credit. And nowhere is there a clear delineation of "basic" versus "continuing" class content; moreover, the NCBTMB employee who responded to my husband's phone call had no background in massage therapy, appeared to be a career bureaucrat, and merely told my husband to put any questions in writing (initiating another delay of unknown duration).
Personally, I think that a delineation of "basic" versus "continuing" is impossible in this profession because each therapist's education is unique, and new interests evolve over the course of one's career. What is "basic" for one therapist is "continuing education" for another. Meanwhile, the application is still pending while my husband awaits responses to his questions.
I would be gravely concerned about the NCBTMB, if massage therapy were my profession. It seems to be an organization more concerned with collecting exorbitant fees and serving special interest groups, than serving the profession or its constituents. I hope I'm being unduly suspicious, but to an outside observer it appears as though some special interest group(s) have gained control of the board and are trying to prevent competition by limiting what others may offer. I know that, as a whole, massage therapists are more interested in service than in tilting with bureaucracies, but if they don't voice their concerns they may soon (if, indeed, they don't already) have a truly unmanageable bureaucracy on their hands that does little but make their lives miserable.
Massage Today recently ran a poll on the validity of the National Certification Exam as a measure of professional competency; an overwhelming majority of therapists believe it is not. Frankly, I think they should be asking far larger questions about the policies of the NCMTMB. The test may be the least of their worries.
Incidentally, my husband, who had a nearly perfect score on the test long before he applied to become an approved provider, indicated when asked at the end of the test that he would be willing to serve in developing it because he believes the test needs drastic revision to be a measure of professional competence. He has never been contacted, which suggests that this organization does not genuinely welcome the participation of others within the profession.
Ohio Massage Tax Creates a Stir
I read with interest (and not a little amazement and concern) the article about the Ohio state service tax being levied for massage therapy services (www.massagetoday.com/archives/2003/09/01.html). I am a 17-year massage therapist, and I have to confess that, while I have seen lots of changes in our profession over the years (some good, some not), this one scares me.
Those of us who have been around for a while have worked long and hard to make our profession seen as reputable health care, and we've made some great strides. Suddenly, a state legislature strapped for money decides to make massage therapy a "personal care service" to make it eligible for tax collection. Are we going backwards, or what? There is even an acknowledgement in the statute that massage therapy performed by a physician (as if they have or take the time) or prescribed by a physician is exempt from the tax collection requirement. So, what are the problems here? Here's a short list:
The new law places most massage therapy summarily at the same level as getting one's hair or nails done, and while there is nothing wrong with those endeavors, they are not health-related. What we as massage therapists do is clearly health care. I was surprised that comments from therapists in your article only included statements about how this might impact the finances of massage therapy. While I would agree that there are fiscal considerations, the issue here is much larger than just financial. This puts to the test how our profession is looked at in the community and in the legislature.
I encourage Ohio massage therapists to go back to the legislators and ask that this measure be reconsidered. This law, while it serves the fiscal needs of the state, is in direct conflict with the intention of the laws that Ohio made in order to recognize and legitimize massage therapy. Laws can be changed. Passing this one was a mistake, and sets a dangerous precedent for what might happen in other states.
Thoreau would encourage "civil disobedience." It would be unlawful to not pay the tax, so I would propose a lawful approach. One way to do that would be to refuse to perform massage until the law is changed. No massage, no revenue. Yes, that would have a direct impact on our pockets, but how long would it take for our clients to demand that the law be changed? Encourage your clients to write to the legislature and make those demands now. You can bet if this tax were levied on physicians' services, they would not stand for it. Neither should we.
Bruce Hunt, CMT
Massage therapy is a limited branch of medicine and has been in the state of Ohio since 1915. Ohio massage therapists are governed by the medical board because they provide a service that affects and changes the health of individuals.
According to the Ohio state medical board's administrative rules (referring to massage therapy): "4731-1-05 Scope of practice: massage. (B) A practitioner of massage shall not diagnose a patient's condition except as to whether the application of massage is advisable. In determining whether the application of massage is advisable, a practitioner of massage shall be limited to taking a written or verbal inquiry, visual inspection, touch and the taking of pulse, temperature and blood pressure."
This part of the code clarifies the ability of a therapist to make the determination of need for therapy without any other medical professional's involvement. It does not require a prescription from a doctor; rather, it leaves the determination to the professional opinion of the massage therapist. The medical board (which decided on the level of training for massage therapists) decided that this training qualifies the therapist to determine, on their own, one's need for therapy. The services rendered are, in fact, medical. According to the new taxation rule, massage therapy performed or prescribed by a doctor or chiropractor is exempt because it is a medical service.
Massage therapists performing massage under the order of a doctor are also exempt. Therapists acting according to code 4731-1-05 (B) are following the rules set by the medical board and are depending on the patient's condition to determine whether massage therapy is advisable, so therapists are also legally determining the need for this medical service, but in this case, it is considered a luxury and taxed.
I am confused. Are we therapists or masseurs? Under the new law, we are capable licensed therapists in the medical field on the one hand; on the other, we are no different than the masseur with no training. The hat we wear depends on an expensive paper: a prescription from a physician. Take a stand, make a choice. Either we are therapists or untrained masseurs.
When the Ohio medical board took us in, they took on the responsibility of protecting us as they protect the doctors under its wings. I don't see them doing their part. Taxing our services not only serves the state's need for more money, it feeds the need of doctors to gain control over our services. Without their OK, we are stripped of our credentials. Why is the medical board not screaming and kicking to protect our professional dignity? Could it be because the doctors head the medical board and they are benefiting greatly from this decision?
Did the medical board throw us to the wolves, fogged by a promise of profit with no investment of time and effort?
Ilona Trommler, LMT, CD
The following letters were not published in this month's print version of Massage Today.
More Feedback on Breast Massage
I am grateful to Jody Learned of New York who prompted the great response by Cliff Korn regarding breast massage (www.massagetoday.com/archives/2003/10/12.html). There are no stupid questions and to challenge the legendary and truly admirable Cliff Korn takes courage; I hope Jody will hear and understand the important salient points of his answer.
I had been professionally practicing massage for 27 years when I attended the wonderful 2001 AMTA Annual Meeting in Quebec City, Canada, and experienced Debra Curties outstanding continuing education class on breast massage. The class consisted of two parts, one dealing with the theory and the other with the practice of the technique. The theory segment was ripe with fear-filled speculation and tense ambiguity about the appropriateness, legal restrictions, and need for breast massage. Debra Curties and her colleague, Pam Fitch, clarified, challenged and cut through that atmosphere of "taboo" surrounding the subject.
They presented excellent facts (as Cliff Korn replied) that breast tissue, while not muscle, benefits from increased flow and circulation in both blood and lymph systems, and the ductile mammary glands also benefit from appropriate manipulation. Debra and Pam cut through the speculative fears about legal restrictions and provided clear guidance for informed consent, draping options, and other practical issues which make it clear that in most places if a client asks for it, breast massage can and should be provided.
In the practical segment I worked with another male and two female classmates. While one of the women worked on my breast, she felt, and I experienced a "release" of a "blockage" that startled us both; the experience underscored the fact that men have breast tissue, too, and while less controversial an issue, men can benefit from the breast massage techniques.
There will be an opportunity for those who missed that learning experience in Quebec City, Canada, to attend the same training at the AMTA-Alabama Chapter Annual Meeting at Orange Beach, Ala., Apr. 30-May 2, 2004. I highly recommend it.
Thanks again, Jody, for raising an important set of questions, and thanks again to Cliff Korn for sagely answering them point-by-point. We are all able to learn and grow from this healthy dialogue.
Here are a few more tips for your discussion on breast massage. I teach a 3-day "Lymphatic Breast Care" (LBC) class, I wrote a book on the subject, and published an article ("Lymph Drainage Therapy: An Effective Complement to Breast Care") in the 2001 June/July issue of Massage & Bodywork. They call me "the happy breast doctor," no kidding!
A gentle technique like lymph massage can be very efficient for numerous pathologies. We also suggest that therapists have clients sign a release explaining why we touch the breast tissue, etc., and that at any time, the client can ask to stop.
Some applications and pathologies in which breast massage can help include:
Bruno Chikly, MD, DO (hon.)
I would like to compliment Mr. Korn for his handling of the "breast massage" controversy. Although I am no longer practicing massage, I have been asked by more than a handful of female clients (with ages ranging from mid-20s to 70s!) to massage their breasts. On each and every occasion these women gave me valid reasons, specifically, for lymph drainage - and no other reason. Obviously, these were regular clients with whom I had a great deal of confidence and trust established, so I had no problem honoring their requests. Next time, I hope anyone who has a need to write [a letter to the editor] will perform their research prior to making accusations!
Maurice Gilbert, NCTMB
I have been following the ongoing bantering [in Massage Today] on the breast massage issue. My letter is surely not the last one you will receive on this heated matter. I have been a registered nurse (RN) for 38 years, and a full-time massage therapist for 15 years. My nursing experience was in oncology and breast cancer. I have been an NCBTMB-approved continuing education provider since 1994. One of my trainings is specific to breast cancer, mastectomy, breast surgery and massage. Many (not all) of my clients receive breast massage as part of the session, including men. Breast massage, whether for medical reasons, health maintenance, prevention, and/or well-being, is one of the most overlooked and beneficial techniques a massage therapist will do for their client; however, it may not be appropriate for everyone, and I certainly do not recommend adding breast massage to your practice without a good educational program.
Many of the statements made by the responders to your column seem to lack correct information. Breast massage is a big liability if not approached with previous knowledge, which is why continuing education classes are available. For those interested, explore; for those who find it appalling, don't go there. No one is saying every therapist should add breast massage to their sessions, but those that are interested should take a class - education will give it a whole new light.
Breast massage is no different than massage for any other part of the body, but we have made a big thing out of it. Remember the purpose and intent. Another important aspect is the confidence of the therapist. Proper training and practice will instill this. Some therapists have issues with breast massage as they may have issues with their own breasts. I respect anyone with personal body issues - they are not to be taken lightly.
It would be ideal if breast massage was accepted as a regular part of the massage, but it is not. If you do not feel comfortable performing breast massage, at least discuss the value and importance of breast care. All of my female clients are educated on the importance of moving the lymph with a simple fluffing technique. I hope this will give another perspective on this controversial subject. It's all about knowledge and education.
Cheryl Chapman RN, HNC, NCTMB
I missed the original piece on the breast massage subject but was pleased with [Cliff Korn's] response to Jody Learned. It is too bad that in order to administer breast massage to those that have no objection, there has to be "a medical reason." Yes, breast massage has health benefits but it also just feels good as does the rest of a relaxation massage. Just as massage and nudity are not automatically sexual, neither is breast massage. We live in a culture where virtually everything is promoted with sexuality; it's no wonder that most people, including massage therapists, cannot separate nude from lewd.
As for special training, anyone who has graduated from a decent massage school knows that breast tissue is not muscle and must be treated gently, especially when working on the pec major muscles. Increased lymph flow is inherent in Esalen-Swedish massage. As with most things in life, including massage, intent is of paramount importance. I have practiced for well over 10 years and have had no problems in this area. Many have thanked me for working the pec/breast area because that is where the problem was, and other therapists missed it.
Daniel Vasquez, LMT
I went to Praxis College of Massage in Oklahoma City, Okla., where the instructors taught us breast massage. We discussed how to talk to a client about breast health, breast massage and bras. We spent many hours reviewing the technique in a classroom setting and we were required to practice on each other outside of class. According to our instructor, he has trained thousands of students on how to do breast massage.
Education and the lack of consistent, uniform training requirements is the real problem. Until there is a national foundation (or something like that) that regulates and monitors massage education, this kind of emotional response from people who do not understand the subject will continue. Keep up the good work.
Ralph Troute, CMT
My husband received prostate massage for a medical condition. Just because it is for a medical condition and just because it has got "massage" in its name doesn't mean that I, an LMT, have any desire to practice it. The same goes for breast massage.
Jackie Stephen, LMT
While I support [Cliff Korn's] stance on breast massage, I feel you were much too harsh in your response to [Jody Learned]. As editor, you must take the high road and refrain from personal attacks on letter writers. I feel sure that that young woman was in tears after reading your response - that is no way to win someone over to your point of view.
My hat goes off to [Cliff Korn] for the intelligent, logical response to Ms. Learned's complaint regarding breast massage. She indicated that your "bad knowledge and bad advice" regarding breast massage rendered her appalled. I can only think that Ms. Learned has her own personal agenda and fears regarding this issue.
All too often, individuals enter into the massage therapy profession with their own uncomfortable values about the human body, touch, body image, etc. Combined with the underlying fear of inappropriate touch (some people confuse therapeutic touch with erogenous involvement), the formula renders an individual ineffective because they become uptight.
Five years ago, I received a massage from a "sports" massage therapist who felt that massaging my gluteals was somehow "inviting" a sexual experience. He could not have been farther from the truth. I was (an am) a runner; as a result, gluteals (as a sports massage therapist is aware) take a beating from this strenuous exercise. As a massage therapist myself, often there is a fine line between therapy and sensuality. Thank you for making this distinction in your response to Ms. Learned's tirade. I am a massage therapist and a college writing and communications instructor. Your "communication" is right on! Keep it flowing.
"Have you had problems with the NCBTMB?"
Dear Massage Today Readers:
We are seeking the pros and cons of those who certify through the NCBTMB. Our experience has shown us no difference in competency or quality between those who do and do not certify; moreover, we have found NCBTMB's testing process to be untimely and not cost-efficient. We are compiling a record of problematic experiences candidates have had, and would appreciate any experiences candidates would like to share. Our hope is to one day have an examination process that will indeed credential a therapist of higher competency, whether it be through improving NCE or creating another [test]. We look forward to your feedback.
Selena Belisle, President
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