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Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
December, 2009, Vol. 9, Issue 12
Learning and Unlearning
By Tracy Walton, LMT, MS
In oncology massage, we work with a diverse clientele, with wide-ranging clinical presentations. There are clients in survivorship, perhaps with lingering effects of cancer and cancer treatment in their bodies.There are clients in treatment, whose health can change from week to week, or hour to hour. There are clients at the end of life, whose body systems adapt gamely each day to shifting internal environments. And there are clients who are in the throes of diagnosis, in varying stages of health, navigating a barrage of information that we can only imagine, if we haven't been there ourselves.
In watching thousands of people with cancer and cancer histories, I am struck by how much information, and how many skills, patients learn along the way. They master medical information, often unfamiliar at first. They learn which people to bring into the loop, and whom to hold at bay. They learn how to care for their bodies, under "new normal" conditions. They discover how to filter information, and listen deeply to their hearts, their families, and their physicians.
Massage therapists learn, as well, alongside their clients with cancer and cancer histories. We learn how to listen better, and when to keep our beliefs or judgments about illness to ourselves. We learn to accompany someone along their path, following their lead, bearing witness, remaining present to the process that unfolds, however it unfolds.
Changing the Mechanics of Massage
We also learn and refine the mechanics of working with people in illness and treatment. We adapt many different massage elements, including our pressure, the movement of joints in the session, the client's position, our speeds and rhythms, and even the draping and lubricant we use. (MacDonald, 2007; Walton, 2006)
We adapt these and other things in response to myriad physical changes: bone metastasis, surgical incisions, medical devices, or vital organs functioning at less than ideal levels. We adjust massage to the risk of lymphedema, and to the reality of it. We accommodate symptoms, such as nausea, fatigue, and pain. We work around skin lesions, and adapt to easily bruised tissues. In order to work well and safely in these conditions, we also have to unlearn some things we might have previously held as true. I can think of three beliefs that we've reexamined.
The Belief that Massage Spreads Cancer
The belief that massage could spread cancer has persisted in our field, and it is still taught in some training settings. The belief has kept our hands tied. But with the right interview questions and complete client answers, skillfully applied massage is not expected to spread cancer any more than normal movement or exercise would, and these activities are typically encouraged by physicians, nurses, and PTs in oncology. There are numerous sources of thought and reasoning to help massage therapists unlearn this belief. (Curties, 2000; MacDonald, 2007; Walton, 2006)
Because the belief has persisted for so long, it takes thought, discussion, and full understanding in order to educate others. Simply casting off the belief, without putting proper massage precautions in its place, leads to an empty, uncertain, and unsafe application of massage.
Letting the Client Direct the Session
There are other things to unlearn, as well. We may have to unlearn our tendency to always follow the client's lead in directing the session. Although respect and empowerment of each client is important, as is handling a client's body within his or her comfort zone, there are times that a 100 percent client-centered session is at odds with what we know to be safe. Gayle MacDonald, author of Medicine Hands: Massage Therapy for People with Cancer, points out rightly that the oncology massage therapist may need to take a stronger leadership role in session planning, to avoid overstimulating a client in strong treatment, or injuring unstable tissue. (MacDonald, 2005)
This can be challenging, at moments, when a client wants the strong, vigorous massage that he or she had before cancer treatment. It can be hard to sell a gentler session, against protests that we are treating a client as though he or she is fragile. Yet our professional and ethical responsibilities mean that the client's safety trumps the client's preferences. In the best outcome, the therapist and client plan a massage session together: one that is safe, effective, and addresses the client's needs.
Intuition vs. Information
The role of intuition is another thing we examine closely, and question. For some of us, this means unlearning our reliance on intuition, alone. We may have been taught, "If you're not sure what to do, just follow your intuition, and everything will be okay."
In massage therapy, intuition is a highly prized decision-making tool. For good reasons, our intuitive skills are sacred. But intuition can be fallible. Not all of us have well-developed intuitive skills. Intuition may not be sending us clear signals every day, or we may not be interpreting them well. People tell me from experience that intuition may be "off" on days they've not eaten or slept well, or are under undue stress. Moreover, our own needs and fears, which may be easily provoked when working with clients who are seriously ill, can cloud our intuition and decision-making.
In the other extreme, our decisions are technical, based on information, alone. Intuition may be fallible, but information isn't always perfect, either. Information changes with the times, with the situation, and there are information gaps in our understanding of cancer. By working with people with cancer, we pledge to keep our information as current as possible. One of my favorite teachers taught me that the best combination of intuition and information amounts to wisdom.
Resources in Oncology Massage
For most of us, to unlearn and learn the important issues in oncology massage, we need live, hands-on training. In order to work well and safely, we need a classroom with the give and take of class discussion, opportunities to practice interviewing and massage planning, actual clients with cancer to practice with, and concrete cases to discuss. Others of us have the skills to educate ourselves: we can carefully study the literature, research practices in oncology, have access to the input of health care providers, and learn from our clients along the way.
All of us can turn to growing resources, like the Society for Oncology Massage (www.s4om.org), the newest edition of Medicine Hands by Gayle MacDonald, and the expanding body of research on massage and cancer. For convenience, I've indexed much of the literature on my Web site, at www.tracywalton.com.
The best massage decisions combine the sturdiest information available, professional experience, legwork, possible correspondence with a client's physician, and our own intuition. Sessions are planned in collaboration with the client, and designed to address the client's needs.
Learning and unlearning requires giving up old beliefs, and being open to new information and skills. This is a rich process, and sometimes a challenging one. On the way to wisdom, it's good to know that there are resources to support us.
Click here for more information about Tracy Walton, LMT, MS.
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