resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
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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