resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
October, 2012, Vol. 12, Issue 10
Understanding the Difference Between Clinical and Spa Massage
By Christy Schumacher, NCTMB
As most of us in the massage profession recognize of late, we are splitting into two fairly divergent, yet equally important industries. The most prominent and popular industry is the personal services massage industry.Many refer to this as "spa" or "relaxation" massage (for the purposes of this article I will refer to this as spa massage). The second and more recently emerging industry is "clinical" (or medical) massage therapy. These and other terms get thrown around a lot, and can cause a tremendous amount of confusion for massage therapists, but more importantly, for consumers. I hear many massage therapists and consumers denigrate spa massage as lesser than clinical massage, and each time it makes me cringe; all professional massage has therapeutic value! However, I also hear an equal number of therapists misrepresent clinical massage. I would like to provide clear and reasonable distinctions to these two types of massage, and hopefully help move both industries forward in a productive way.
It is important to understand that the type of modality that is practiced, from Swedish to Myofacial Release, from Cranio Sacral to Proprioceptive Neuromuscular Facilitation, or from Trigger Point Therapy to Lymphatic Drainage, in no way puts a massage therapist in one category versus another. A spa massage therapist and a clinical massage therapist can, and do, practice all types of modalities in both industries. The ultimate difference is the focus. In spa massage, the therapist is ultimately focused on the satisfaction of the client. The session is often intuitive and compassionate. The environment is private and often includes luxuries that put the client at ease. essions are defined and charged by a set number of minutes the hands are on the body, and tipping is expected. Attention to details such as music, table warmers, aromatherapy and high-end linens is common, and often required to stand out to consumers to get them to return.
In clinical massage, the ultimate focus is on functional outcomes. There is an evidence-based reason why a therapist applies one modality over another and most importantly, results must be measurable. Client satisfaction is often not assessed until the completion of a limited number of treatments, referred to as "treat and release," or the achievement of a specific therapeutic outcome. Finally, the length of the session is often shorter and the number of minutes that are spent with the hands on the body is not a focus point for the session (no more clock watchers!). Prices are defined more often by third party payers (insurance companies), in 15-20 minute increments, and tipping is rarely involved.
Training is another important difference between clinical and spa massage. Basic massage education (often around 500 hours) rarely provides the education required to practice in a clinical setting as a new graduate, but is sufficient for many spa settings. This allows for a new therapist to begin practicing, build their skill set, and most importantly, make money! A new therapist can get a spa massage job and gain the necessary experience and continuing education to tailor their future career to what works best for them. A typical massage graduate requires a period of professional practice and substantial continuing education to be qualified to practice in a clinical setting. Knowledge must be gained that includes assessment and proper documentation of functional pain, lifestyle and ranges of motion. Advanced understanding of pathology and kinesiology also is important.
Credentialing is another important distinction. To practice spa massage, a therapist often is required to be licensed and carry liability insurance. In many clinical settings, additional credentialing is often required such as National Certification, additional professional certificates, continuing education hours and sometimes even professional licenses such as nursing or physical therapy may be helpful to bill insurance (in the interest of full disclosure, I have been a Director for National Certification for Therapeutic Massage and Bodywork since 2009).
Most importantly, various details of ethics must be observed and practiced with care. This includes knowing not just your scope of practice as a massage therapist, but also the scopes of practice of your fellow allied health professionals. Clinical massage is often practiced in team-based settings that include colleagues such as physical therapists, occupational therapists, acupuncturists, psychologists and orthopedic physicians. Referrals are important. Knowing when to refer your client out and how to communicate that effectively is an important part of clinical massage. Likewise, communicating to allied health colleagues about their patients, and when your skill set may be a more suitable therapy, takes time and patience to develop.
This is certainly not to say that a spa massage therapist does not require proper ethics training to ensure public trust and safety. Basic massage education will include training on maintaining proper records of informed consent, contraindications and limited SOAP note documentation. However, for spa massage, documentation of time and place of a session is often ethically sufficient. When the focus is on measurable outcomes, documentation is just as important as the session itself.
The Bottom Line
I come in contact with numerous massage students and recent graduates at my integrative health clinic. Almost universally, these students and professionals will tell me that they have no interest in working at a spa and want to practice massage that actually "does something." Spa massage does accomplish something! The ability to provide essential relaxation and stress relief is a powerful therapeutic tool. In fact, stress and tension is often the root of physical pain, and needs to be addressed concurrently with any clinical or spa massage.
As a new massage graduate, it is important to recognize that the differences between spa and clinical massage are quite muddy for consumers. If you want to develop your career as a clinical massage therapist, there are important steps to take. First of all, recognize that the best way to get there is getting your hands on as many bodies as possible to develop your skills. A job at a spa is a great place to do this.
Communicate with your clients about why they are on your table and track lifestyle or stress outcomes. If a client comes in with low back pain, ask them on a scale of 1 to 10, how bad is it now? How bad does it get when it’s at its worst? Ask them what number they are at after your session. If they are coming in for overall stress relief, ask them what their stress does to restrict or impede their lifestyle. How is their sleep, anxiety levels and depression levels? Assign a numeric scale to these questions, document your findings and ask these same questions again on a follow-up visit. Upon their return, ask them the same question and remind them of their previous answers. And above all, DOCUMENT.
Those of us who have been in this industry for a long time recognize that a lot of massage therapists want to be a part of clinical health care teams. More and more opportunities are becoming available, but will require dedication and commitment from the next generation of massage therapists if they are to grow in number. Continue your education. Learn what your allied health colleagues can do to further improve your client’s pain, lifestyle and range of motion limitations. And above all, recognize that any massage you provide for your clients, whether it’s at a fancy spa or in a semi-private clinical setting with bright lights, you are providing them with an invaluable tool to improve their lives.
Christy Schumacher is a medical ethicist and massage therapist who works with integrative health care practitioners to improve access to and utilization of professional massage therapy within conventional medicine. She has a strong background in public health, evidence-based medicine and outcomes-based models of care.
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