resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
The Death of the Travel Card
As long as I have been in practice, the travel card has stood as the primary style of documentation for chiropractic. It is quick, simple and direct. Unfortunately, the rules have changed.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
We Get Letters & Email
Is It Time for a Popeye Moment? The Flaw in Recommending Chiropractic as a Career.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Home Safety: Help Families Avoid Common Injury Hazards at Home
These days, many parents childproof their homes before a baby is even mobile. You will see an array of electrical outlet covers, bumpers on the corners of the coffee table and safety latches on the cupboards.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Foundation for Chiropractic Progress Announces First Group Member
The Michigan Association of Chiropractors has joined the Foundation for Chiropractic Progress as its first group member.
Are You Ignoring the 10,000-Hour Rule?
Having trained interns and mentored new practitioners, it has been my observation that their No. 1 clinical concern is adjusting skills. Their second clinical concern is their ability to read X-rays. Physical diagnostic skills are a distant third.
Avoiding "Just a Pop Doc" Syndrome
Yes, it's harsh. Patients don't like to admit it. They have an unspoken plan when they first visit you: to come one time, get rid of their pain and then get rid of you. They know it's unrealistic, but they'd like to pay nothing for this service.
Treating Acute and Chronic Neck Pain With Ischemic Compression and Exercise
There are many reasons not to manipulate the neck with cavitation: the patient is too old, their neck is too tight, etc. But the most common reason is that plenty of patients are afraid of "the crack," mostly because of the bad publicity about that procedure.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Are You Ready for the 2016 Patient?
In October, Apple released its iOS 8 operating system for the iPhone and iPad. The new system includes Health, a new app that will interface with an ever-growing number of other apps.
News in Brief
Life to Open Branch Campus in Italy; Northwestern Research Arm Benefits From Big Donation.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Step by Step: Long-Term Treatment of Soft-Tissue Injuries Combines Skill and Care
Treating soft-tissue injuries with long-lasting results starts the moment an individual enters the office. When it comes to pain, the only thing that matters to the patient is relief.
Why Drugs and Supplements Can't Cure Disease
Chronic diseases are the outcome of disease-promoting, goal-oriented behaviors. So, the notion that diseases can be cured with drugs or supplements should be abandoned. Hypertension is the best example of this.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Solving the Pain Puzzle
Legendary former New York Yankees baseball player Yogi Berra once said, "You can observe a lot just by watching." He would have been a great chiropractor. We are trained to become experts with our hands: palpation, adjusting, soft-tissue release, etc.
DC App – The Next Generation
According to a survey by technology firm CDW, health care professionals gain approximately 1.2 hours per day in productivity simply by using a tablet computer in practice.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
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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