Massage Therapy Body of Knowledge

Comment

Comment by Carl W. Brown on October 3, 2009 at 3:11pm

You mention evidence based practice. That is what is needed to produce a valid BOK. It is like developing a scientific theory. Develop a hypothesis and then objectively test it. Look to see what parts of the theory are dependent and what is superfluous. It reminds me of an exhibit I saw at a science fair. There was a piece of paper with red and blue lettering. Above the lettering was a glass rod acting as a lens. Look through the lens and the blue letters inverted and the red did not. The reason the red didn’t was that they were symmetrical. Color does not make a difference.

A BOK is a model and as such is only a useful tool if it reflects objective reality. If it does not reflect reality it is not worth the paper it is written on. A valid BOK can be used for certification by numerically correlating any testing to the BOK. If the BOK is wrong the certification is meaningless except to say you passed the test of arbitrary material. It does not correlate with outside performance.

I see tests such as the MBLEx and NCE tests of shopping lists. To base the BOK on these tests is to perpetuate the myth. We are a profession that seems to gravitate to fantastic theories that most people view as being more religious in nature than anything grounded in reality. If we are ever to improve our public image we need to put our feet on the ground and measure our competencies objectively.

Comment by Bert Davich on October 3, 2009 at 1:03pm

Carl,
You are completely correct on the deep tissue misconception by neophytes and the improperly trained. My observation (and that of many clients I have worked on) is that the improperly trained think 'deep tissue' means 'more pressure' so they slap some oil/lotion on, mash harder and bruise clients painfully. Nothing could be further from the truth. A deep tissue practitioner understands the layers of the body and can go to the layer needed and without remarkable pain, unless there is an abnormality.

I DO agree that if it is going to happen, the BOK should definitely be tailored for basic Swedish for the simple reason that is what the 'diploma mills' are churning out and could offer reasonable protection to the public without quashing innovation and making other effective treatment difficult to obtain

The problem with acupressure being defined as a modality is that there are numerous methods involving "finger pressure" that have been called "Shiatsu" (translation: "finger pressure") by the Japanese for hundreds of years. For example some schools of thought use intense 6 to 8 second pressure, some 30 second or longer until release, some use a 'rub' in a specific direction of the meridian with more pressure forward and less pressure backward until numbness, and some include pressure on places in the muscle that are not necessarily on a meridian for specific treatments. (Does this sound like some form of trigger point?) Now, the massage therapy school versions of "Shiatsu" (Like 'Zen Shiatsu' which I have studied) looks like "Tai Massage" with some variations.... So who is going to decide which one is 'anointed as 'approved' and for what? Additionally a Chinese Tue Na practitioner I speak with who was taught in the traditional method (father to son), has shared with me his belief that the "points" are not always exactly where you might expect to find them and you have to find them on each person. Also I find that my knowledge of anatomy has been extremely helpful with "finger pressure" often leading me to the correct point based on anatomical knowledge.

My concern is that this modality compartmentalization will hamper those of us who practice integrated massage therapy. I practice integrated therapeutic massage and often use a combination of techniques drawing from numerous 'modalities' and sometimes drawing from different versions of a given modality. I like to end sessions with Reiki and Pranic work which has the effect of relaxing the client and allowing the work the client has received to sink in to 'muscle memory'. So Am I going to have to take hundreds of hours in each modality I use? Will I need a separate license for the energy work? Or is there going to be a classification for "integrated massage"?

I think I will have to support your contention of a basic Swedish BOK since it appears this is going to happen.... for better or worse.

Comment by Carl W. Brown on October 3, 2009 at 12:02pm

To do the BOK properly you need to isolate yourselves from contamination for other standards such as the NCE. The NCE has lots of arbitrary thinks and yet may not be complete. To do that and insure that you cover harm to clients go to the insurance companies and see what claims they settled (not dismissed claims) where a person was practicing within the scope of practice. Make sure that the BOK covers the education necessary to prevent harm that was caused by inadequate training.

Next look at what the old timers do. New practitioners will remember what was taught in school that taught to the NCE even if they do not use it in their work. For example they will remember appropriate anatomy but often forget what they don’t use. Foe example is it important to know that the tonsils are part of the lymphatic system. Even people who do lymphatic drainage do not touch the tonsils. When is the last time you massaged a mitochondria?

I personally think that the BOK should be tailored to basic Swedish because I think that bead way to learn massage is in steps. Once you have been practicing massage for a while and get the feel of bodies in your hands then you can think about training in other things like deep tissue. Make that a separate BOK with Swedish as a prerequisite. I see too many people come out of schools loaded for bear with deep tissue in their minds but not their hands. It is not the uneducated who do bad massage but the improperly trained.

Comment by Carl W. Brown on October 3, 2009 at 11:37am

Bert, I agree that this is modality creation. But I think that it is a good thing. I took a course on acupressure and discovered that my orthopedic massage training was getting it the way. I did not see yin/yang or the five elements but anatomical parts. I believe that to do acupressure justice I would have to put my anatomy out of my mind, learn Chinese and live in China for a few years to learn to think in Chinese. Then I could start learning acupuncture not some distortion of the original.

I think that what we teach in schools is not true acupuncture because we do it for Western thinkers who come from a different culture nor do I believe that one can master medical massage and Asian modalities. It is like believing in different religions.

I lived in Brazil from 10 to 18 during my formative years. I knew that I was not Brazilian but when I came back to this country I did not think like an American either. Much of a modality is attitude and the way you think. I had to unlearn my Swedish massage thinking to be a “Muscle whisperer” and now cannot do competent Swedish. I actually tried for a Katrina benefit, gave up and turned my client over to another therapist.

I see Swedish to be like a dance. You have to feel what you are doing from the core of your own body. I am drawn to the tissues speaking to me and my focus moves from my body to theirs. I feel things that interrupts gliding stokes and sometimes tell me to use tools that won’t work with draping. Deep tissue was the first to go. I could “feel” the tissues screaming when I went deep and found that I could coax them to get the same results through subtlety. People have to go where there talents take them and clients need a diversity of options to meet their needs.

The BOK should be for a specific modality and define that modality in a way that insures consistency. The point is that when you say Swedish massage you know that the person has the training to do that modality properly.

Trying to define all of massage in one BOK is impossible. I don’t believe that one can be master of all modalities. So pick one.

Some modalities build on others but some are mutually exclusive. I don’t believe that a person who does good medical massage would also do Reiki. Some modalities like Bowen specifically prohibit mixing with other modalities.

I think that a good therapist will also network with other bodyworkers and refer them to others who do things differently. My last client also goes to Feldenkrais practitioner. Together we help him is ways that neither of us could do alone.

Comment by Bert Davich on October 3, 2009 at 12:25am

Keith, I am happy to see you in this discussion and you are right on. Unfortunately, with the exception of some in this form, I think you are either preaching to the choir or talking to people who cannot possibly comprehend what you are saying, just as it has been documented that it can be ascertained at around age 12 that some people simply do not have the capacity to understand quantum physics (about 60%). When I hear the term "Progress" in regard to the first draft of the BOK I cringe as I did when I read the part about energy work. This BOK does not feel like it is about progress, It feels like it is about some peoples desire to control this profession and those who practice it. If there was any real interest in a National Standard that could be recognized by all states this BOK should be about 'standards of practice' which could be described in 2 pages. Read the Missouri statutes. http://www.sos.mo.gov/adrules/csr/current/20csr/20csr.asp#20-2197. I may not agree with all of them but they are simply stated standards that apply to all touch therapy without quashing innovation. This BOK first draft is more about 'modality' monopoly creation and protection than standards of practice. Let's take "Sports Massage" I'll bet you can't show me a single 'sports massage' technique that was not previously used in a number of modalities some of which are over a hundred years old, such as "shiatsu", or more recently Rolfing. Sports Massage is an 'Approach' as is Structural Integration, not some newfangled invention. So where does the following line come in other than modality monopoly? If it is about something else, would someone please explain?
769 standard techniques and documentation strategies to determine appropriate modality treatment

Comment by Keith Eric Grant on October 2, 2009 at 8:12pm

To answer Carl's comment on my example of DOMS, I did not state the level of understanding that a massage therapist should have. What I stated is that the word "understand DOMS" by itself is not an adequate specification. The depth of understanding and the level of proficiency needed are dependent on enabling the practitioner to perform specific tasks. Thus optimally, the item of knowledge would be tied to the task or tasks that require it. In other words, it's outcome based.

As to Mike's comments. Ultimately tests connected with regulation have to be, as Carl suggests, based on protection of the public. But a body of knowledge goes beyond that. What one does, again optimally, is to take a compact area of endeavor (by analogy, a city, in what I've previously written). One then looks at the physical and cognitive tasks needed to perform competently. In other words, you are essentially creating a job description or descriptions with defined tasks. You then break down the for each task, the knowledge, physical skills, and other abilities (i.e. communication skills, listening skills), that are required along with the proficiency levels required. You then collect all of this and it becomes a body of knowledge. In the industry, this is termed "competence management" or "proficiency management". It allows you, for any individual, to identify learning gaps in their profile that, if filled, would bring them into compliance.

It is, based on such information and other relevant information, the right and responsibility of the individual states to determine what requirements fulfill their needs for regulation in the public benefit.In short, based on the best analysis available. What FSMTB does is provide a framework for discussion toward areas of consensus on what fulfills that responsibility. By taking this to the level of tasks and proficiency, one can argue specifics -- i.e. that provides a needed benefit to the public or not. A licensing test would be part of the embodiment of that determination. A private certification test could meet or exceed licensing requirements or be aimed, as medical board certification is, as post-licensing specialty certification.

If all of the discussion occurs in an open and transparent framework, and if feedback and comments are collected, then there is both a basis to modify and evolve the defined tasks and a historical documentation for periodic reevaluation/review.

Regulation, by it's very nature is reactive, while job descriptions and tasks evolve with the times to an extent. One example would be the likelihood these days of a "city" of task around spa services.

Comment by Carl W. Brown on October 2, 2009 at 5:48pm

This is why we need to design the BOK to reflect how we as professionals see our field. If we follow distorted laws then we only have ourselves to blame for perpetuation the folly. The lawmakers do not understand us and this is a great opportunity to set things straight. If it becomes apparent that our laws are bad then so be it, the problem is with the politics. But if we do this honestly the way the laws should be structured should become apparent. When we have states that require hundreds of hours of massage training to practice reiki what happens? The practice goes underground and thousands of people just flaunt the law. This hurts the law abiding practitioners because people do not expect practitioners to be law abiding.
Currently I am studying for the MBLEx to get around the law. I well then be a “Certified Massage Therapist” who does not practice massage. How stupid? It does nothing but show contempt for the process and this hurts our public image. With a good BOK maybe we can modify the law to improve our public image.

Comment by Mike Hinkle on October 2, 2009 at 5:07pm

What you say may be true, but the blue laws are still law and so are State Boards and the rules they have been authorized by state law to enforce.

Comment by Carl W. Brown on October 2, 2009 at 4:58pm

We seem to be straying from BOK and I will move the discussion of practice acts vs title acts to the legislation discussion group.

Comment by Carl W. Brown on October 2, 2009 at 4:30pm

Mike – “State Boards are charged with protecting the public”. Under that idea you should base the law on preventing harm to the public. If so then start from documented harm and develop the BOK based on preventing documented harm. If it does not cause harm then it should be outside of the scope of the license.

The whole point of the health freedom acts are that as long as what you do does not cause permanent harm then it should be excluded from licensing. So you should make sure that you do not impinge on forms of bodywork that do not cause harm.

As I said before this all reminds be of computer programming licensing that would have made personal computing illegal. Imagine that you would have to learn and prove yourself competent in COBOL or FORTRAN before you could buy a PC. Licensing needs to balance harm verses innovation. It needs to restrict itself to the absolute minimum needed to prevent harm.

Look at it from this point of view. If massage is dangerous that we need to protect the public from people who practice it for free as well. Just charging for the service does not affect what we do.

I think unless we can prove that massage causes real harm we need to have title acts not practice acts. So fare our insurance rates indicate that the insurance companies do not feel it is a dangerous profession and they look at the numbers. With title acts we don’t have the problem of limiting the BOK to just cover provable harm but rather can gear it to target a minimal level of competence to do a professional job.

I think the BOK should identify what is essential to prevent harm such as universal precautions and what is appropriate for title protection.

99% of the MBLEx and NCB have nothing to do with protecting the public.

A good example of laws gone bad is a piece done on by UC Davis on Barber licensing in California. Again you should practice good hand washing but a bad haircut is not permanent harm that cannot be compensated by the courts.

http://www.cpil.org/download/BBC_Letter.pdf

The way current massage laws are constructed it is not about protecting the public any more that the blue laws. Like the blue laws attempted to enforce a moral code, the current laws are an attempt to squelch innovation just like the computer licensing law.

• ‹ Previous
• 1
• …
• 46
• 47
• 48
• 49
• 50
• 51
• Next ›
• Page