resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Thinking About Cohen's Kappa
Let's think about some notions of reliability and validity, and about what it means for diagnostic examiners to agree in meaningful ways. Diagnostic tests must obviously be both reliable and valid.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Why More Patients Don't Come to Your Office
Every so often, something turns out to be much easier than anticipated. It's like ordering a piece of furniture or a child's toy that comes in 167 pieces.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
We Get Letters & Email
It was with great interest that I read "Trouble in the Wellness Waters?" in the May 1, 2015 issue of Dynamic Chiropractic. I heartily applaud Dr. Hayes for his insightful and informative article.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Managed Care Subverts Chiropractic
A study published in the American Journal of Managed Care underscores why so many chiropractic patients go out of network in order to get the care they need: Managed care may be effectively locking them out.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Do You Have a Post-ICD-10 Strategy?
Post-ICD-10 planning is critically important to the health of a practice, in part because ICD-10 is brand new to providers, payers and related affiliates alike.
Dietary Fat and Prostate Cancer: An Important Update and Review of Mechanisms
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Active Care for Ankle Sprains
An ankle sprain is a common injury, since this joint is required to perform complex movements under high forces during normal walking. In fact, 10 percent of all emergency-room visits are ankle-sprain related and an estimated 25,000 ankle sprains occur in the United States daily.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Troubleshooting: Billing Multiple Fees for the Same Service
I am afraid I may doing something illegal. I have heard I cannot bill different fees for the same service.
A Tribute to a True Chiropractic Leader
President of Texas Chiropractic College (alumnus, class of 1950) and the American Chiropractic Association (ACA) Board of Governors. President of the Texas Chiropractic Association and twice-appointed member of the Texas Board of Chiropractic Examiners.
When Patients Lie (Bribe or Flatter)
Recently, a new patient told me about what I thought was a novel twist on the doctor-patient relationship. She felt she had to lie to her DC to discontinue her treatment.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
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
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