I have the single best job in the world for me, anyway. It is my pleasure and privilege to teach students of massage therapy about the role of bodywork in the context of pathology. I get to research and talk about diseases for several hours every week. This gives me the opportunity to renew my awe of the human body on a regular basis. I am honored to live in a state of constant appreciation for the elegance of our design and the strength of our recuperative powers.

As increasing numbers of people seek out massage as a way to take control of their health, it has become more important for massage therapists to be conversant with a wide variety of disorders. While it is tempting to "rubber stamp" some situations as indicated or contraindicated for massage, we all know that this is an impossible task.

The very word "massage" means different things to different people, and each modality carries its own set of rules and guidelines for working in the context of disease. The disease process may manifest completely differently from one person to another. Add other variables like basic resiliency, a history of receiving massage, diet, sleeping habits, medications, ad infinitum, and it becomes clear that making decisions about the appropriateness of massage must happen on a day-by-day, case-by-case basis.

My job as a teacher is to give students the tools to make informed judgments about the relative risks and benefits of their work, so that they can make the best possible choices for their clients. Sometimes that choice will be to alter their goals for the day; sometimes it will be to reschedule the appointment for another time. Sometimes it may even be to call a cab to get to a hospital. Certainly we hope that these are uncommon situations, but as massage moves further into the mainstream, our chance of being asked to work with clients who have precarious health situations increases every day.

The uncomfortable truth is, there are few hard-and-fast rules about massage in the context of disease, and most of those rules can be carefully broken, under the right circumstances. As a person who tries to stay current on the role of bodywork in the disease process, I am eager to find out what other therapists are doing with their clients who may be in ill health. My guess is that the majority of practicing therapists who went to school more than a few years ago received little or no training on the subject of pathology. We were told, "when in doubt, check with the doctor" an admirable, but rarely practical recourse. My experience with teaching this material to current students and therapists in pursuit of CEUs is that not many of us feel confident that our skills and knowledge are up to speed on this topic.

I hope with this column to open a line of communication between massage therapists. Let us share our concerns about working with clients who have complicated health pictures. I invite therapists to send me information about their experiences with clients whose health has made working with them a special challenge. My vision is for this to be a place where we can all share, in a setting that is respectful of each other and of our clients, our questions and concerns about massage: "Should I have worked with that client? Could I catch whatever this person has? Is there a better way to help someone with this condition? What could happen if I work with someone who has this disorder?" This respectful setting is an important issue. Few things elicit strong emotional responses from massage therapists like someone making pronouncements about health. Although this is a subject we all take seriously, I ask us all to be open-minded and open-hearted in our discourse. Let us aim for an attitude of positive support for each other in our chosen profession, not of judgment that "my modality is better than yours."

So here is how it will work: You, send me brief, true case histories of clients whose health picture caused you some concern. (It will be my job to protect the confidentiality of the massage therapists who contact me, and the confidentiality of their clients.) Let me know what you did that you think worked, or didn't work, or that you'd like to try if you get another chance. I will take the incoming stories and sort through them to come to a conclusion about what people want to read. Then, in a subsequent issue of Massage Today, I will discuss the disorder in question, in terms of how it affects the body, and the relative risks and benefits of bodywork in various forms. I will incorporate your information and try to draw some conclusions about how best to accommodate similar clients. I will also try to include resources where interested readers can go for more information.

Here's a news flash: I am not infallible, and there is a stunning lack of information about how massage affects most conditions. I make decisions, and I teach my students to make decisions, based on the knowledge of how a condition affects normal body processes, and how various types of bodywork can influence that progression. Sooner or later (probably sooner) I will write something that some of you will disagree with. I invite you to share your concerns with me, as long as it is done in a spirit of open-mindedness and open-heartedness that allows for mutual respect and benefit.

Looking forward to hearing from you.