resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
June, 2005, Vol. 05, Issue 06
Medical Conditions in Massage Practice: Intake Forms and Questions, Part I
By Tracy Walton, LMT, MS
Whether massage therapists call it "medical" massage, "therapeutic" massage, or "relaxation" massage, we work with people with many complex medical conditions. No matter which setting we work in - spa, private practice, sports or medical settings - we see a range of health conditions that ask us to investigate appropriate contraindications.
In this three-part series, I'd like to offer my thoughts on interviewing for those contraindications.The purpose of this series is twofold: to support therapists in their work with people and to invite dialogue in the field. I'll begin this installment with observations of the intake process for massage therapists then offer a sample question for the health history. Each subsequent article will feature one or more health history questions and ideas for how to use the client's answers.
In my work with therapists with different backgrounds and working in different settings, I've discovered a common theme: most are much more comfortable providing the massage than interviewing clients for contraindications. When I ask why this is, most tell me the language of their hands is their chosen language. After using my hands for 15 years in massage practice, I must agree. My hands engage in wordless, soundless and sometimes sacred exchanges with clients. The interview, in contrast, can seem like mere business.
But massage therapists tell me there's more to this than a simple preference for hands-on work; most say they did not get solid schooling in conducting an intake interview. The most acute gap for many of them is in interviewing for medical history. Fifteen years ago when I graduated from massage school, we could purchase commercially available, preprinted health history forms for massage therapy. I remember them on heavy paper, four pages, lists of medical questions, and questions about diet and nutrition, all very comprehensive. I suspect the form was borrowed from a medical setting, as many of the questions were way out of the scope of the average massage therapist. Still, seeing little else in the massage literature, I dutifully purchased a stack of them to begin my practice.
There was a small problem with this approach: I had not the slightest idea how to use them. I knew how to ask the battery of questions on the form, but I didn't know what to do with the answers. How would it change my massage to know that my client followed a certain diet, that he drank four to six alcoholic beverages per week, that she had had most of the common childhood diseases, that there was a family history of heart disease? In a nostalgic mood recently, I dug the form out of cold storage and marveled at its length. I can't believe I got through so many interviews without being asked, "Why are you asking me this?" before I switched to designing my own intake forms.
Mind you, I had graduated from a strong, two-year massage therapy program with many hours of training in hands-on work, communication skills and the sciences. The profession shared my interviewing uncertainty. In 1990, literature about massage contraindications was scarce. We had little shared understanding of what we had to know to massage safely, and a few alarmist stories about someone who had done something in a session somewhere and the client got sick afterward. We relied on this lore in the field, a very basic understanding of the body, and our wits to keep our clients safe and ourselves out of trouble.
Changes in the profession have made it much easier to identify client problems that we need to act on, avoid or treat with caution. Ruth Werner took our uncertainty in stride and produced A Massage Therapist's Guide to Pathology1 the first widely available text from which we could finally draw some links between health conditions and massage contraindications. Many other useful texts appeared as well, including books on medications and massage,2,3 other rich pathology texts, and even some texts for massage specialties, such as massage in the hospital setting.4 Articles are appearing on work with a wide range of clients. Together we're getting our feet under us about individualizing massage for clients in all states of health. Together we're figuring out the information we need to practice safely.
But we still need to work on how we gather that information without interviewing the client all afternoon. What is important to ask about a client's health? And, more importantly, how do we use their answers in massage design? How do we find out what we need to know in a brief interview format? How do we follow-up on clients' answers?
I have designed intake forms for my own practice, a massage school with a large clinic, and a training setting where we run one-time clinics for clients with cancer-with some medically complex individuals. I have seen countless intake forms in the literature and at the schools I visit. There are some basic, all-purpose questions that bear asking. In this series of articles I will focus on a few of them: "What is your activity level and the kinds of movement you do during the week," "Are you taking any medications," and "Are you currently in a physician's care?" I will also propose how to use our client's answers to these questions.
What is your activity level? What are the types of activities you engage in during the week?
This question often elicits a guilt response: "I should be going to the gym more"; "I'm afraid I'm something of a couch potato"; or "I'm at a desk all day." But it still can lead to valuable information for massage therapy. First, it can lead to tension patterns produced by a client's activities. This conversation can go a number of useful places. Chronic telephone use: which ear? Chronic neck and shoulder tension on that side. Massage with focus on the neck, attachments at the occiput, shoulders and lateral pecs. Massage therapists know where to find these tension patterns and ease them. Questions like this provide an early tip-off to where the session might go.
Questioning about activity and movement can be helpful in other ways, too. For an elderly client, one with a systemic illness or in strong medical treatment, the activity level can help a therapist assess how well the client can tolerate massage. For example, in general, it is important to work conservatively with people in cancer treatment, starting with gentler work. It may be advisable to introduce stronger massage in small increments over weeks of monitoring the client's response. The activity level of the client can help you assess where to start and when to add increments.
One client in her late forties has been in ongoing treatment for metastatic breast cancer for several years. She has been building a deck, clearing her land, cycling long distances. Another client has pancreatic cancer and is in strong chemotherapy. She is 83, and beginning to find the stairway to my office a challenge. Both require specific massage adjustments to their treatments for complications such as lymphedema risk, bone metastasis, and several other factors. But the first client, after taking those into account, may tolerate a reasonably vigorous massage and benefit from it.
The second, older client, clearly weakened by complications of her disease and in strong treatment, requires a gentler session. Tolerance of exercise can be used in assessing tolerance of massage therapy. Activity levels provide useful data for the massage therapist who can then change the length of the session, the pressure used, or even how gently or vigorously to stretch or range a joint in a session. A more customized session is then possible, rather than a single protocol for a client who checks "yes" in response to the question about cancer history.
The activity level and the types of activities are useful information for the massage therapist. Answers to these questions can provide key information quickly. This is especially important in high-volume massage settings with limited time for interviewing and documentation. Interviewing has its challenges, but we've come a long way from preprinted forms and our empty, uncertain use of them. As the profession continues to develop and we share more information with each other, the process of interviewing will become clearer and easier for us all.
Editor's note: Look for part two of Tracy's series in the July 2005 issue.
Click here for more information about Tracy Walton, LMT, MS.
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