resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
June, 2004, Vol. 04, Issue 06
We Get Letters & E-Mail
By Editorial Staff
Readers can respond to letters at . Some letters have been edited for clarity.
Editor's note: The following letter is in response to Cliff Korn's April 2004 editorial concerning rule changes to the massage licensing law in North Carolina (www.massagetoday.com/archives/2004/04/11.html).Read Mr. Korn's comments regarding this letter in his June 2004 editorial at www.massagetoday.com/archives/2004/06/09.html.
North Carolina Board of Massage and Bodywork Therapy
As legal counsel to the North Carolina Board of Massage and Bodywork Therapy (Board), I am responding to your editorial in the April issue of Massage Today, which contains a number of false and/or misleading statements, and which inaccurately characterizes the work of this Board in its current efforts to revise its administrative rules. You have done your readers a disservice by publishing such inaccuracies, and you have unfairly discredited any agency which has been working diligently for the five years it has been in existence to meet the legal madate given to it in 1998 by the North Carolina General Assembly.
The sole mission of this Board, as established by law, is to adopt and enforce standards for practice of massage and bodywork therapy for the protection of the public. The Board grants licenses to therapists, approves massage and bodywork therapy schools, conducts investigations into possible violations of the laws and rules, and conducts a full disciplinary process.
The North Carolina Board of Massage and Bodywork Therapy is in a unique position among state massage boards for several reasons:
As you can see, this Board bears a high degree of responsibility under the law, but is severly limited in how its operations may be funded. Much of the startup work of the Board was provided on a volunteer basis by the Board members themselves--who were not compensated for their time. This contribution helped set the stage for professional staff to take over the ongoing administration of tasks.
The Board has been operating under its initial set of administrative rules which were adopted in 2000. Like any new endeavor, much has been learned in the process of licensing more than 4,600 therapists, issuing license renewals, conducting a comprehensive school-approval program for 26 institutions, and handling a large number of complaints from the public regarding unethical behavior of practitioners. In 2003, the Board voted to examine its current rules, and to consider changes to the rules which were needed to more effectively carry out its mission.
As legal counsel, I conducted the process of review and drafting of amendments to the rules with the input of the Board's Policy Committee. A set of recommendations were presented to the full Board for approval, the draft rules were published in the North Carolina Register, and a period of public comment was made available. For your information, the rule making process in this state is defined by the North Carolina Administrative Procedures Act, which applies to all agencies of government.
At present, the period for written and oral comment on the draft rules has ended, and the Board is in the process of reviewing and giving consideration to all comments received. A set of final rules will be introduced at a future Board meeting; once adopted, they will be sent to the North Carolina Rules Review Commission fo analysis and possible approval, if they meet all legal requirements.
Having provided some background on the legal operation and responsibilities of this Board, I would like to address some of the specific statements you made in your editorial.
You take issue with the Board's proposed increase to the fees for schools approval. The process of determining that massage schools are in full compliance with the rules is labor-intensive, and expensive. The proposed fee increase is based in the fact that the current school approval fees are covering less than 25 percent of the actual costs of the program. The Board cannot continue to use funds received from licensing therapists to conduct a quality assurance programs for schools, as that will compromise the Board's ability to enforce the standards for therapists. The proportional fee structure was chosen as the most equitable to both public and private institutions, as it is tied to the number of students at each institution, rather than the tuition charged. If the Board does not raise the fees, it will have to serverly cut back its school approval program, which, in my opinion, will most certainly affect the education of massage therapists and will compromise public protection.
Another proposed rule that you have deemed "draconian" is the requirement that schools submit the qualifications of instructional staff members for review and approval by the Board before they are allowed to teach. While it may be true the universities such as Stanford and MIT are not subject to such a requirement, they have to adhere to far more stringent standards as accredited academic institutions. This proposal was adopted from a school licensing in the Florida Administrative Code which currently applies to the more than 90 Board-approved massage schools in that state. The need for such a rule in the North Carolina standards was made evident by the failure of many schools to notify the Board of new faculty members hired, and failure to submit their credentials in the timely manner required.
You have also taken the Board to task on its proposed new rules which give further delineation to the Standars of Practice licensees. Through dealing with enforcement issues, the Board has foudn that its current rules on professional conduct do not contain the level of specificity which is necessary to define the roles and responsibilities of a licensed massage and bodyword therapist. In developing these new standards, the Board looked to the only national agency which has established a set of comprehensive standards for practitioners -- the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB). While the Board found the NCBTMB standards document to be well-crafted, the form of the language and some of the provisions did not apply to the legal needs of this agency. Therefore, new rules governing Standards of Practice were drafted, working from the Board's existing rules, and integrating certain provisions from the NCBTMB document.
As a former Chair of NCBTMB, you should know that there is a significant difference between a national certifying agency which administers a voluntary competency assurance process -- and a state massage board which conducts a mandatory licensing process with full investigative and enforcement responsibilities. In order to protect the public, this Board had determined that more detailed standards are necessary to define what constitutes the safe and effective practice of massage and bodywork therapy. For enforcement purposes, such rules must be framed as requirements for all licensees, rather than optional recommendations which licensees themselves determine if they apply.
Many of the comments on the proposed rules which have been received by the Board involve the Standards of Practice. There is a mistaken impression (which you have echoed in your editorial) that these standards are an effort by the Board to coerce massage and bodywork therapists into a clinical or medical model of practice. This is simply not true. Since its inception, the Board has had a commitment to creating a regulatory program which would allow for the greatest possible range of methods and treatment philosophies to be offered to the public. Some of the provisions in the new Standards of Practice --such as the requirements to obtain informed consent, discuss a plan of treatment with a client, and to document the work performed -- may be satisfied in a variety of ways, according to the treatment setting, and the prerogative of the therapist. The Board is not mandating SOAP notes as documentation, or forcing therapists to spend an extra 30 minutes with every client in every session just to comply with the rules.
Finally, you claim "moral outrage" that therapists in this state would be required to report violations of the laws and rules within 10 days, "or be subject to the same penalties as the person causing the violation." To set the record straight, North Carolina licensed massage and bodywork therapists are already required to report such violations, pursuant to Rules .0501(10) and .0506. The only change in the proposed rule in the addition of a 10-day reporting requirement. It is not true that failure to report would result in the same penalty as the person committing the violation. Failure to report is a minor fraction, which would result in smaller fines and a lighter disciplinary sanction than major infractions, such as sexual boundary violations, or practicing without a license. Because the Board has limited resources, it must rely on the community of licensed massage therapists, approved schools, and consumers of massage and bodywork therapy to report unethical or illegal behavior, which may then be investigated.
I hope this provides some clarity on these issues for you and your readers. I would suggest that the next time your publication is interested in writing about the activities of the North Carolina Board of Massage and Bodywork Therapy, you actually contact the Board for this information.
Charles P. Wilkins, Counsel
Editor's note: The following letters are in response to James Waslaski's article, "Orthopedic Massage vs. Medical Massage: Are We Using the Correct Terminology?" which appeared in the Feb 2004 issue (www.massagetoday.com/archives/2004/02/02.html). Read Mr. Waslaski's follow-up article, "Defining Medical Massage," in the June 2004 issue at www.massagetoday.com/archives/2004/06/03.html. Due to space limitations, some of the following letters were not published in the print version of Massage Today.
The Orthopedic/Medical Massage Debate
I agree with you on most counts; however, you may be misunderstanding the definition of "medical" massage, or at least the definition according to Medical Massage Practitioners of America (MMPA), which says: "Medical Massage is result-oriented and the treatment is specifically directed to resolve conditions that have been diagnosed by a physician. The therapist may use a wide variety of modalities or procedures during the treatment, but will focus that treatment only on the condition, which is related to the diagnosis."
We require a physician's prescription with a diagnosis for treatments and recommend therapists refer to the appropriate physicians on any patient/client who tests positive during any one of our 40 orthopedic assessment tests, which are administered prior to treatment. Our 84-hour program contains a fully comprehensive range of study, and students are monitored while performing the hands-on segments, followed by a written test before certification is given.
We agree the focus of treatment is on correcting postural distortions and restoring structural integrity through balancing the neuromusculoskeletal systems, and feel the term "medical" massage more accurately reflects the full range of therapies available to a patient/client. For example, a physician may refer a person for stress reduction, and the patient would receive a Swedish massage, which would fall under medical massage, but not orthopedic; or a patient presenting with trigger points in the occipitalis muscle would be treated with trigger-point techniques, and not classified orthopedic. Therefore, orthopedic massage, like neuromuscular, trigger point, myofascial, etc., falls under medical massage. Whether you use the terms "orthopedic" or "medical," we must be aware of contraindications and pathology, and not hesitate to refer to the appropriate specialist.
Medical massage has been an accepted approach throughout the world for centuries. To imply this title is "just a buzzword" does not give justice to a highly respected dimension of our profession. We believe a higher education is necessary for those wanting to enter this endeavor, and we have been actively involved in supporting higher levels of education at the school and continuing education levels. MMPA's 84-hour medical massage program is just the beginning. We encourage students to continue improving their knowledge base, and to be open-minded to the diverse range of educational opportunities available to them.
Herb Levin, LMT, MMP
Hurray for James Waslaski! His focus on the perils of inadequately trained massage therapists, and the danger they pose to their clients and to our profession is right on target! Only doctors are allowed to diagnose and treat medical conditions, yet workshop ads continually state that participants will learn to "evaluate/assess and treat" certain conditions! Most even offer a "treatment protocol"! How is this legal?
I always cautioned my students against the "weekend workshop warrior syndrome" with this true story: A friend of mine was hit in the head by an elevator (don't even ask!). She went to a doctor, who took X-Rays and diagnosed her with lateral whiplash. Months passed and she continued to experience problems. She visited many doctors to no avail; her pain persisted, and the diagnosis remained the same.
Finally, a doctor ordered an MRI, which revealed that the disc between her C6 and C7 vertebra was pressing directly against her spinal cord, putting her at risk of paralysis with any sudden movement or even a fall! Would a 12-hour weekend workshop qualify a massage therapist to treat such a person? If "first do no harm" is the rule of thumb, the answer must be a resounding "No way!"
Instead of wasting time and energy focusing on how many hours are required to train entry-level practitioners, we need to protect the public from those who do pose a threat -- therapists practicing beyond the limits of their training!
Gail Frei, LMT, NCTMB
Greetings from Austin:
I just wanted to thank James Waslaski for his article. I have practiced massage therapy in Texas for 17 years and physical therapy for seven years. I agree that some massage therapists are practicing out of the scope of their training and experience. It takes a lot of personal and professional integrity to refer people on to other health care professionals when we are in over our heads (and we have to be able to recognize when that is), but that is exactly what we need to do.
I have heard therapists make sensational claims that are doing their clients a disservice and, frankly, border on malpractice. I like your ideas about medical massage and, no matter what you call it, the bottom line is that massage therapists are practicing within their scope of training and experience for the highest good of their clients. I teach continuing education courses here in Texas, and I am amazed at the lack of knowledge and expertise of some of the massage therapists that take my courses, as I'm sure you are. Thanks for being courageous enough to express yourself publicly.
Mark Uridel, MSPT, RMT
I just read James Waslaski's article. Some things I just skim over in the magazine, but this article was great. I have been licensed in massage for 13 years and I am an EMT, as well. It is important that as practitioners, we always keep learning. I had a person come to me one time for what he called a pulled chest muscle from playing golf. The man was having a heart attack; the only symptom he was having was just a little soreness in his chest. There was no tightness, etc. Since we are not allowed to diagnose, we have to trust our instincts. I suggested he go to the hospital or doctor right away. Thank goodness he took my advice and went to the doctor. His wife called later to thank me.
You brought up some really important facts. We can do harm if we don't know what we are doing. Again, thanks for the great article. Let's hope people take note.
Carole Poffinbarger, LMT
I can not tell you how happy I was to read James Waslaski's article. I have worked in the medical clinic for Boeing for the last year. I have owned my own clinic for the past six years and do nothing but treatment work on occupational injuries in both. I have many therapists inform me that they are medical massage therapists -- most after just one class -- when they apply for work. With the knowledge I have and the unique situation I find myself, I do not feel as if I am capable of claiming a title of "medical massage therapist."
Since my patients come to me through the medical community (Boeing's doctors or doctors located throughout the community), I am capable of dealing with most situations that can happen on my table. I always have a medical provider available to me (an MD or Pa-C), but even with those safety nets, I do not feel that most massage therapists have the ability to distinguish between muscle pain and severe medical conditions.
With terms like medical massage being thrown around, it makes it difficult for those of us who believe in something more. The doctor in charge of Boeing went so far as to ask me to take one of those classes so that I would be qualified in medical massage (because it would look good to have the title). I was thrilled when I read James' article and I look forward to taking some of his classes (this is a hint for him to come to the Pacific Northwest).
J. Dale Newman, LMT, NCTMB
I just read [James Waslaski's] article on medical massage and was glad to see that he is teaching safety in manual treatments, such as massage. I am an instructor at the West Coast College of Massage Therapy in British Columbia. I currently teach orthopedics at our campus (3,000-hour program). I liked the way James presented the information and have similar goals to educate practitioners in orthopedic treatments. I have courses called Arthrokinetic therapy and have taught in BC, Seattle, and West Virginia, with great interest and have plans to teach across the U.S. and Canada. I have 17 years of practice experience and 12 years of teaching experience in assessment of orthopedic conditions and differential diagnosis.
I just had to respond to James Waslaski's article. Thank you so much! I am a Canadian trained massage therapist with over 2,400 hours of medical massage training. Having spent two years submerged in neurology, pathology, splanchnology, cardiac physiology, etc., it's nice to read an article that very clearly addresses an enormous concern of mine.
I am now living and practicing in Naples, Florida, and am amazed on a daily basis by new grads claiming to do medical massage. My frustration exists because I have treated numerous clients who have been improperly treated by these so-called "medical massage" therapists. My largest concern is the fact that Naples has an enormous population of retired citizens (over 65), of which heart problems are a major concern. Upon speaking with some of the therapists in town, I'm always surprised that they do not know that they are performing regular massage, and not modifying the stroke and working by quadrant, they could very easily put their clients at risk for an MI.
I appreciate the emphasis you placed on differentiating between orthopedic and medical massage labeling. Again, kudos to you.
Tabatha Petersen, LMT, RMT, CMT
James Waslaski experienced a very personal wake up call when his mother presented with symptoms that suggested a tight iliopsoas, but was actually a dissecting aortic aneurysm. Performing an iliopsoas release could have killed her. Unfortunately, the implication is that a "competently trained" medical massage therapist should be able to recognize her signs as a medical emergency, not just a psoas issue; yet even his mother's MD thought it was a kidney problem until an MRI proved otherwise.
These stories are extremely helpful educational reminders of the plethora of possible medical conditions underlying apparent muscle pain and dysfunction. We should tell them often, and report them as case studies in our literature. All massage therapists should have solid training in physiology and pathology to recognize potential signs for masquerading medical conditions and exercise caution if they have any doubts.
I recently escorted a client to the ER who had textbook signs of acute appendicitis. The ER MD told her she had gallstones, and left her unattended for several hours while her signs escalated. I attempted to intervene on her behalf with my concerns, and was told in no uncertain terms by the doctor that my efforts were not appreciated or appropriate, and that this was not a medical emergency. The appendix burst at 3 AM.
Mr. Waslaski has years of college-level training and continuing education in physiology and pathology. My ER doctor had even more, and yet made a life threatening error. Waslaski's mother's doctor had years of training, but didn't have X-ray vision to see an aneurysm about to burst. How many hours of additional training are we going to require of massage therapists to "keep the medical community from looking down on us" when the medical community, with all their extensive training, frequently doesn't get it right themselves?
Beyond yet another "higher level of certification, created by a panel of experts," massage therapy education has to lay a solid foundation for the most common types of medical conditions that may mimic or masque themselves as muscle and joint dysfunction; massage therapists at all levels need to stay current through their journals on real life incidents like these, continuing education, good interviewing skills, and ultimately learning to listen to their intuition given certain signs, symptoms, age and lifestyle, whether they are medical, orthopedic or "just" Swedish.
But ultimately, we are not doctors. I could spend years in universities and a not-so-small fortune (that I could never recoup from my massage fee) to protect myself and my clients from a potential "missed diagnosis," that I'm not even supposed to diagnose in the first place!
We also have to be consistent in our critique. In the same issue, Dr. Upledger responded to a letter reporting that a growing body of evidence showing CranialSacral Therapy technique ineffective in adults. His response was to report his years as a researcher and the number of clinical trials he has conducted over the years; in other words, lay out his credentials as an expert researcher and evaluator. Not coincidentally, all his studies empirically prove the effectiveness of CST.
I personally value CST, but if this were a pharmaceutical company reporting research on its own drug, or a doctor reporting research on his or her own new surgical technique or cancer cure with no independent verification of test trials, we would be very critical and suspect of the results.
We must ask for and expect the same independent testing in our own field. Without it, success stories are still anecdotal evidence, not scientifically valid "proof."
Jennifer Reinbrecht, MS, CMT
"Cupping therapy poses a threat"
Regarding "Massage Cupping Therapy for Health Care Professionals," by Anita J. Shannon (Feb. 2004, www.massagetoday.com/archives/2004/02/04.html), as a New York State licensed massage therapist and student of acupuncture, I would like to point out that cupping therapy poses a threat of spreading blood borne pathogens to the practitioner and the practitioner's clients. Cupping, especially if left on for a time, draws blood to the surface. Some of this blood can escape and contaminate the cups and possibly touch the practitioner. The blood may not be visible. Universal precautions dictate that cups be sterilized after each use. The practitioner should wear a glove on at least one hand that may come into contact with blood, usually the one not holding the cup. Some blood borne pathogens, such as Hepatitis B, are extremely hearty, difficult to kill and pose a real danger to health. Persons with compromised immune systems are especially at risk.
Oscar Abraham, LMT
Anita Shannon Responds:
Thank you for the letter. I spoke with some traditional Chinese Medicine professionals, and was told that, indeed, there are rare occurrences of blood passing through the skin. This happens with very aggressive cupping, usually the stationary cupping method. Client conditions should be taken into account and universal precautions should be taken, especially if the client has a questionable medical history. This is a great illustration of the fact that training in any modality is so important. While I include a section on sanitation procedures and safety/contraindications in my massage cupping classes and video, I will be sure to mention this potential situation to all my students.
Anita Shannon, LBMT
Skeptical about California Massage Licensing
Got dreams? AMTA has a dream: Licensing in California. Much of the article ("Spotlight on California: Moving Toward Regulation," www.massagetoday.com/archives/2004/02/01.html) is misleading. It is hardly true that "the vast majority of massage therapists work under onerous local government," and merely scratches the surface of misleading statements. The article claims that because of budgetary problems in California, the bill was held in committee at AMTA's request. This was hardly the case; it was the overwhelming opposition that stopped the bill. What was supposed to be a tabling of the bill ended up being a more poorly rewritten Assembly Bill 1388. There is not a community in unity in support of licensing, as the AMTA-California Chapter would like to have us believe. In fact, in addition to me, many other AMTA members are opposed to the bill and will not lie down and let it fly. This article is nothing but AMTA leadership propaganda.
Robert Flammia, AMTA member
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.