resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
June, 2005, Vol. 05, Issue 06
We Get Letters and E-Mail
By Editorial Staff
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be edited for space and clarity, and published in a future issue or online.Please send all correspondence by e-mail to or regular mail to:
Regarding the National Certification Board
It's been said that criticism is free advice offered by people who truly care. So on behalf of the NCBTMB, thank you for caring about national certification and for the chance to share an insider's view ("Lots of Stuff," May 2005, www.massagetoday.com/archives/2005/05/07.html).
Things are not always as they appear. Tempting as it may be to point fingers when the going gets tough, the board is sensitive to the recent controversy and takes personal responsibility for the decisions and leadership of the NCBTMB. That said, the nomination process was flawed and required intervention. The board made changes to the process and continues to review policies that ensure propriety, and help us practice what we preach.
Losing two executive directors, a board chair and chair-elect, has been extraordinary. While others may view them as detrimental, these events have helped the board reconnect with the principles of consensus and accountability and thus made it possible for us to let go of an 11-year relationship with our management company. Quite simply, the NCBTMB is transitioning from adolescence to young adulthood, and growing up. We appreciate that a mature organization values its stakeholders, understands its purpose, recognizes its strengths, identifies how it needs to grow, and implements strategies to that end. By electing Elizabeth McIntyre - an experienced and qualified board member - as chair-elect, seeking an executive director whose loyalty is to certificants, and hiring personnel who value the industry, we hope to demonstrate our learning and that we're listening to those we serve.
Cliff, please continue to voice your concerns as you see them and join us as we begin a new era for the NCBTMB. Together we can discover the good that is yet to come.
Garnet Adair, chair NCBTMB
I appreciated your article in the April 2005 issue that puts some serious questions to representatives of the National Certification Board ("Winds of Change Blowing at NCBTMB," www.massagetoday.com/archives/2005/04/01.html). One point that I would like to highlight and would like to see addressed further is the following quote from Garnet Adair:
This statement makes it sound as though the candidates who take the test actually get to discuss any concerns they have over difficult or unclear questions with someone who can do something about it; this is decidedly not so. When I took my exam back in December 2000, I was not even allowed to see which questions I missed - just that I passed the exam. And as I understand it, candidates are also not allowed to remove test questions from the test site. How are they supposed to remember the unclear questions after answering 160 test questions? And to whom could they even address these concerns?
Real "beta testing" in the computer software world involves users who actively test a new piece or component of software and offer feedback to the programmers and designers about how it can work better. As I see it, there is no feedback mechanism to the NCB. I am beginning to agree with those who feel that the NCB's power is getting out of control.
Andrea Porter, LMT
I had the opportunity to read the article and interviews regarding the NCBTMB and just had to e-mail you. I certainly had to chuckle when I read the reply to Massage Today's question regarding the monopolization of the massage therapy profession by the NCBTMB and AMTA. The response was: "They are another professional related organization. One is a membership organization; one is a voluntary certification."
Voluntary? It has been my experience in dealing with states that use the NCBTMB as their certifying exam that it is anything but voluntary. I just needed to voice my opinion.
Marie A. Ruberto, Managing Director
"Rather than reinvent the wheel, let's clarify our use of already defined terms"
Since every profession needs a clear scope of practice, it was refreshing to read Ralph Stephens' March 2005 editorial titled "What Scope of Practice?" (www.massagetoday.com/archives/2005/03/11.html). While I agree with Mr. Stephens regarding our need for a well-defined, cohesive scope of practice, any massage legislation must be inclusive of our entire profession to represent more than special interests. As a 25-year practitioner and massage educator, I am often dismayed with the widespread impression of many massage graduates that they are medical practitioners able to treat condition Y with technique Z. How did a "medical" scope of practice - that a massage therapist can evaluate, diagnose and treat soft-tissue disorders - seep into so many massage training programs?
This approach creates several problems. First of all, massage therapists generally lack training in a preliminary step of this cause-effect equation - evaluation X. Before being qualified to evaluate soft-tissue disorders, physical therapists undergo four to six years of education and training. Also, they are often required to gain some years of clinical experience before being allowed to practice evaluation on their own. Although competent and well-trained manual massage therapists help many people with soft tissue problems, it is doubtful that evaluation skills could ever be adequately taught in 500-1,000 hour massage therapy programs.
Second, evaluation is prohibited by the scope of massage practice defined in many state laws. Both the American Medical Massage Association (AMMA) and the American Medical Massage Therapy Association (AMMTA) recommend and/or require specific continuing education classes to standardize evaluation and treatment skills in medical massage (Mr. Stephens' classes are on both lists).
Yet 24 states with licensing laws include statements to this effect: Massage is defined as excluding the diagnosis or treatment of illness or disease or any service or procedure for which a license to practice medicine, nursing, chiropractic therapy, physical therapy, occupational therapy, acupuncture, or podiatry is required by law. Since many of the manual therapy techniques advocated as medical massage arose within the practice of medicine and physical therapy, conflict is inherent if we practice them within an X-Y-Z medical protocol.
While my preference is for the more personal, holistic approach to manual therapy offered by "medical" massage therapists, as both a client and practitioner I will continue to rely on medical professionals for evaluation and diagnosis.
Consulting with them about the medical conditions of our clients builds bridges between our professions. Furthermore, given the history of costly legislative battles between chiropractors, physical therapists, occupational therapists, and others squabbling over "turf," it is highly unlikely that even a well-organized massage coalition will ever be able to afford the lobbying clout to change the laws already on the books. And do we want to?
Rather than be PT wannabes, let us own and promote what massage already offers: effective methods that promote deep, profound relaxation; pain, muscle tension and stress reduction; and the enhancement of health and well-being. Practitioners can still practice "medical/orthopedic massage" within a remedial / holistic context (already written into many state laws) to alleviate symptoms and improve the structural balance of a client.
Rather than reinvent the wheel, let's clarify our use of already defined terms. Since "medical" is defined as relating to the science or practice of medicine or treatment of disease, "medical massage" should be inclusive of all massage methods applied to people with medical conditions. Many agree that what the AMMA and AMMTA call medical massage is better described as orthopedic massage. Why not call it what it actually is?
Third, advocates of the medical/orthopedic massage would separate the profession into relaxation and therapeutic modalities. Why? Relaxation massage is therapeutic. It just may be the truest application of medical massage for the injured, ill and dying today. Medically based relaxation massage deserves more acknowledgment than it receives.
Since I may be ill and for sure will be dying some day (as will you), I take great comfort in knowing that many massage therapists today practice in hospitals and hospices. Read the state laws and it becomes apparent that massage does have a defined scope of practice that is fundamentally holistic. We simply need to hone it and then collectively and proudly own it.
Mary Ann Foster, BA, CMT
I completely agree with Mr. Stephens that a simple scope of practice is easy to sell politically. The scope of practice he describes is essentially diagnosing and treating minor myofascial conditions using manual manipulation, mechanical and electrical devices, and nonprescription medication. This scope of practice is proven to be successful, as it is the scope of practice of the chiropractic and/or physical therapy profession.
Allowing a massage therapist to use electricity, manual manipulation or to diagnose is a difficult political sell. First, it infringes on the chiropractic and PT professions. More importantly, it is difficult convince most people that a vocationally trained massage therapist is capable of diagnosing problems. At present, diagnosis of myofascial problems is limited to college-educated people. If you strip out the controversial language, the scope of practice becomes the treatment of minor myofascial conditions. This may work.
Bruce Klein, ND
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