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Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
October, 2013, Vol. 13, Issue 10
Searching for Simple Rules in Massage and Cancer Care
By Tracy Walton, LMT, MS
In a Facebook post, a massage therapist requested quick advice for working with a client with cancer. On Facebook, of course, everything is quick.Almost immediately, he was bombarded with massage recommendations, safety protocols, references to books and trainings and encouragement to get a note from the client's doctor before beginning massage therapy. Opinions were all over the place and some didn't agree, but most were strongly held.
There are many safety protocols in massage for people with cancer, depending on the approach, and some of them may seem strict and even intimidating. They may even call to mind an old-school style teacher with a stern face and pointer in hand, barking a lot of, "No!" and "Never!"
And it's just as tempting to condense the protocols into a "Ten Commandments" format, a simple list to keep everyone out of trouble, without having to think much more about it.
More Than One Disease
But real oncology massage practice is not as simple as a quick list and here is why: the word "cancer" represents more than 200 different diseases. Even "breast cancer" is not a single condition but is classified into several different types. Drilling it down even further, two clients with the same type of primary breast cancer can present very differently, depending on the extent of the disease, reactions to treatment and other factors.
With so many ways our oncology clients can present, a list of "10 Things to Remember for Massage for a Client with Cancer" would not begin to capture them all. This is disappointing for those of us who've come to expect our advice in neat 5- or 10-point lists, packaged and propagated on social media.
Moreover, many of us learned and practice massage contraindications based on a client's diagnosis. Massage is contraindicated for X or Y condition. Unfortunately, this approach has never been adequate for any condition. But it particularly backfired in the case of cancer, where we had a single, flat-out, send-them-home massage contraindication that endured for decades. That one never worked well for clients or therapists. All it did was keep them apart.
Things have improved since then, with plenty of literature and training on oncology massage, a growing cohort of oncology massage therapists and even a professional organization, the Society for Oncology Massage (www.s4om.org). Thanks to the Society, there are standards of practice and even standards of oncology massage education with a fleet of recognized instructors around the globe. Some massage schools, as well, have made improvements in instruction, with careful attention to this population.
But in some places, the thinking hasn't evolved much at all. In many circles, "Send them home," has been replaced with, "Work lightly and you should be fine." This single approach is hard to justify for 200 different conditions representing thousands of different client presentations. Unfortunately, a blanket contraindication is not any improvement over a blanket contraindication. Still, we cling to rules like this. Sometimes too tightly. We strive to follow them to the letter because, if we do this, we will be doing everything "right" and the outcome will be positive. Or will it?
Beware the Blanket
Take all the many different types of cancer alongside all the different types of PEOPLE in the world – age, gender, level of activity, health history, ability to bounce back from illness, responses to cancer treatment and the thousands of other factors that make up who they are – and there just isn't a blanket rule big enough to cover it all. Nor should there be.
At a recent oncology massage practice clinic, we had two clients with similar-sounding diagnoses. Both had been diagnosed with breast cancer within the past four years, had received similar treatments and were about the same age. On paper, they could have been twins, except for their answers to this question: "What kind of activities are you able to participate in?" "Client A" wrote "kayaking and yoga." "Client B" wrote "babysitting grandchildren." Without making assumptions, this was our first hint that one might be more active than the other.
On the day of the clinic, "Client A" sailed into the treatment room, looking robust and buoyant with energy. She greeted everyone with clear eyes and shook hands vigorously. "Client B" was much more careful with her steps, stopping for frequent rests on the way up the stairs, her gait slower than her "twin-on-paper." The difference between the two was immediately obvious.
Different Presentation, Different Massage
"Client A" needed some adjustments in massage – notably in stroke direction, placement and pressure over the arm and trunk compromised by missing lymph nodes. With lymphedema risk, she had to receive thoughtful work in that area, as described in Gayle MacDonald's epic text, Medicine Hands: Massage Therapy for People with Cancer.
But outside these careful measures, "Client A" could take slightly stronger work in places, and that's what she received that day. Afterward, she was relaxed, glowing and effusive about the massage therapist's skills.
"Client B" needed the gentlest massage – light pressure, slow speed, even rhythms, gradual transitions and a host of other adjustments to the information in her history. Also at risk for lymphedema, she received similar work in the at-risk area. After such a gentle session, she looked blissfully relaxed. A stronger session could easily have wiped her out. Instead, she seemed to float out the door as slowly as she'd entered it.
After thoughtful interviews and sound clinical reasoning, each client received an individualized session. But had we practiced with a "go lightly and you should be fine" mentality, Client A and Client B would have received identical sessions. Client A would have received the massage meant for Client B, with the possibility of a much less satisfying experience.
This has serious consequences, because without customized care, we can lose clients. Why? Because they can feel as if they are not being heard or being seen for who they are beyond the "cancer" label. We want to stay far away from the possibility of causing injury to our clients with cancer, of course. Our hearts are in the right place. But if we are TOO careful, we can be seen as being out of touch with what our client really needs and what they are capable of safely receiving.
Some of those harder-and-faster "rules" are easy and there is comfort in that ease. But sometimes, in our quest to compartmentalize and label and follow rules X, Y and Z, the client themselves – how they present, what they want, who they ARE – gets pushed aside. When our client comes and sits down in our treatment room for the first time, they deserve more than an imaginary "cancer" stamp on their forehead.
A Place for Protocols
There is a time and place, certainly, for sticking closely to protocols that we have been taught so that we can deliver a safe massage. I'm a fan of protocols as a place to start.
But I also like principles – general guidelines to use in different scenarios with thought as to how they are applied. These wear better than rigid, inflexible rules. In my book, Medical Conditions and Massage Therapy, I offer principles to follow. One is the Unstable Tissue Principle, which states, "If a tissue is unstable, do not challenge it with too much pressure or joint movement in the area." Tissue can be unstable for many different reasons, but in the "twin clients' case," lymph node removal put them both at risk of lymphedema. (A carefully structured, gentle approach was necessary and it's impossible to describe it fully in a sentence or two.)
There, the clients' similarities ended. The Activity and Energy Principle states, "A client who enjoys regular, moderate physical activity or a good overall energy level is better able to tolerate strong massage than one whose activity or energy level is low." Client A could take more. Not lots more, because of some lifelong changes that can be caused by cancer treatment. But more.
Yet, by themselves, even principles are not enough to go on without good thought, good interviewing and solid hands-on skills for this population and other medically complex scenarios. Neither of the principles above captures the full range of clinical possibilities in people with cancer or cancer histories. That's the point.
We have to step back from the name of the disease, from the so-called "rules," and even from the friendlier "principles." Zoom out and see how the condition presents in this one person, this one individual so different from anyone else. This person living this person's life, not someone else's life. Then, a client receives the massage for the client; not the massage meant for someone else.
This is what we figure into our interview and hands-on work. Instead of one-dimensional, black-and-white rules for massage contraindications, critical thinking, clinical reasoning and interview skills deserve emphasis in massage education and clinical practice.
Some massage therapists can figure out what is needed by reading, self-teaching or prior experience with medically complex populations. But most need training in these skills. Training is just as important for learning what we can do, as what we should not do. That's where the Society for Oncology Massage comes into play. They laid a foundation; now the rest of us don't have to reinvent the wheel.
And there are many other resources out there. On my website (www.tracywalton.com), there are several bibliographies, a blog, and I've put up webinars about massage in cancer care for an intro to the deeper issues at work. For my own education, I read everything on oncology massage that I can get my hands on and I ask my students and colleagues to as well. Unlike 20 years ago, there is now plenty of literature available.
And plenty of clients deserving great, customized care.
Click here for more information about Tracy Walton, LMT, MS.
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