Home

Medical massage

My recommendations for the future of massage as a healthcare profession

Submitted by RST on Thu, 05/31/2012 - 07:19
Posted in

UPDATE, 7 March 2013: fixed to address the problem that Mended pointed out. Still not finished, but I'll leave it up so as not to inadvertently hide Mended's comment as well. Consider this a work-in-progress, rather than a finished piece. 

Elsewhere, I was asked what I thought massage needed to do in order to evolve into a healthcare profession.

Since that was a semi-closed forum that not everyone can access, I'll repeat those ideas here, and I've added some concrete examples of how to carry out those ideas.

  1. clearly and unambiguously distinguish ourselves from both prostitution and "cure cancer with baking soda"-style alternative medicine--perhaps through a tiered system with clearly-distinguishable names;

    Example: Getting involved in advocacy efforts to help get people out of "the life" of prostitution and human trafficking. Defending Our Good Name is a project in Washington state that educates massage therapists and others about the scope of the problem of human trafficking in the sex trade, how it operates in ways that affect the perception of legitimate massage practitioners, and what steps people can take to become involved in addressing the problem. Other organizations in the Seattle area, such as International Rescue Committee in Seattle, API Chaya (Asian & Pacific Islander Women & Family Safety Center), Refugee Women’s Alliance, and YouthCare, are also involved in coalitions that work to detect situations where people are unlawfully forced to work for others, and provides resources for them to escape. To make professional contacts with such groups, and to support their advocacy efforts, is a grass-roots way of emphasizing the professionalism, caring, and community involvement of massage practitioners.

  2. establish a minimum basic level of anatomical and physiological education that is not just memorized, but actively understood and applied, that you cannot graduate from massage school without demonstrating;

     
  3. have an open-source repository of evaluated evidence on massage that any stakeholder can access without a middleman, and that demonstrates the effectiveness of massage in a way that puts it outside of the opinions of other providers by demonstrating it objectively, and

     
  4. actively participate in the healthcare system building efforts that are currently going on, rather than withdrawing from it into our own little isolated silo.


     

Then, once all that is established, continue to work diligently to guard it from being watered down--because it will be a lot of hard work, and there will always be those who want the title without doing the work.

Complementary and alternative medicine (CAM) / Complementary and integrative medicine (CIM) -- how are they different?

Submitted by RST on Mon, 02/20/2012 - 12:53
Posted in

You will see many examples in the research literature where the definitions of complementary and alternative medicine (CAM) are confused or unclear. This is an example where the concepts of CAM are not universally understood in the same way, and so the terms get muddled.

For our purposes at POEM we will define the terms in the following way--there are actually 2 aspects of the complementary/alternative distinction: structural and functional, so it's not enough to just say "complementary" or "alternative".

To be clear about what we mean by "complementary" or "alternative", we need to specify whether we mean structurally or functionally as well.

Both aspects have the presence or absence of a basis for integration with biomedicine as the fundamental distinction between the two; the difference lies in how that distinction is used.

"Structural" refers to what is built into the system, and "functional" refers to how people use the system in real life.

Structural complementary medicine (SCM) or structural integrative medicine (SIM) has a basis for integration with biomedicine built into it, because it does not contradict the shared body of biomedical knowledge that all members have access to. Massage, as it is defined in PubMed's Medical Subject Headings (MeSH):

Group of systematic and scientific manipulations of body tissues best performed with the hands for the purpose of affecting the nervous and muscular systems and the general circulation.

 

does not entail any beliefs or claims that contradict the body of cumulative observed evidence from biomedicine, and so this kind of massage is a form of structural complementary medicine.

Structural complementary medicine provides a basis for integration with biomedicine because practitioners of SCM can send a consistent, unified message along with the rest of the healthcare team to a client/patient, so that the client/patient--in a time of stressful illness--is not faced with the additional burden of sorting out and judging among contradictory messages that underlie treatment plans and clinical decision-making.

Because SCM provides a basis for integration, it can loosely be considered as a synonym for "integrative", although "integrative" has connotations of a fully-developed, more mature profession that is still under development, rather than something that we've already achieved.

Structural alternative medicine (SAM) does not have a basis for integration with biomedicine built into it, because it does contradict the shared body of biomedical knowledge that all members have access to. The energy healing claims built into many systems of bodywork constitute structural alternative medicine, as the physicist Victor Stenger explains how those claims fundamentally contradict physics:

Much of Complementary and Alternative Medicine is non-scientific, violating many well established principles of physics and relying on anecdotal evidence of little scientific merit. In particular, no scientific basis exists for the notion of special vital forces or energy fields associated with living organisms. Medical journals should follow the lead of most scientific journals and not publish extraordinary claims without extraordinary evidence...Energy therapies and other forms of CAM are based on the ancient notion that living matter possesses some special vital force or energy that is separate from matter. Today this energy is mistakenly associated with electromagnetic or quantum fields. However, no evidence for any special vital forces, energies, or fields has ever been found. Modern physics has shown that energy and matter are the same entity and finds no evidence for continuous fields. The quantum fields of theoretical physics are directly connected, one-to-one, to particles, the quanta of the fields. A consistent picture of elementary particles and forces that successfully describes all current observations exists within the framework of the standard model.

Living matter is composed of the same particles acted on by the same forces as non-living matter. Quantum mechanics provides no basis for paranormal or holistic claims while all of modern physics remains totally materialistic and reductionistic. No mega-paradigm shift occurred in the twentieth century comparable to that of Newton in the seventeenth century.

Reports of extraordinary claims should not be published unless the evidence is extraordinary. The violation of established physical law is sufficient to ignore such claims until extraordinary evidence is presented.

 

The lack of a basis for integration with biomedicine on the part of structural alternative medicine means that the system causes the client/patient to have the additional burden of sorting out conflicting claims from the people who are supposed to be working together as professionals for the benefit of that client/patient on a unified healthcare team.

Functional complementary medicine (FCM) is used in conjunction with biomedical treatment. For example, if a cancer patient is receiving chemotherapy, and also uses massage to deal with the nausea and fatigue resulting from the chemotherapy, massage would be a complementary treatment in this case.

Here again, there is no conflict between it and the work of other members of the professional healthcare team, because it makes no claims that contradict or undermine a unified message to the client/patient.

Functional alternative medicine (FAM) is used instead of biomedical treatment. If that same cancer patient fears the results of seeking medical care, or is uninsured and cannot afford it, and chooses massage as her only intervention instead, massage would be an alternative treatment in that case.

Although there do not have to be conflicting messages to the client/patient--either structural complementary medicine or structural alternative medicine can be practiced in a functionally alternative way--the lack of coordination with a professional healthcare team in the practice of functional alternative medicine can pose real physical, emotional, and financial risks to the client/patient.

 

An intriguing suggestion from Sandy Fritz for developing healthcare professionalism

Submitted by RST on Wed, 11/09/2011 - 09:28
Posted in

A lot of ideas from different origins are converging on the same destination.

If we want to become healthcare professionals, as many of us say that we do, we are going to have to up our game dramatically.

The call to become more professional in our training, in our encounters with clients/patients, and in the information we provide them--as well as suggestions for how to do so--are coming from many different places across the US and around the world.

I just came across a blog post from Sandy Fritz, where she presents an original and practical way to gain access to the shared knowledge and culture among people who work in biomedical and hospital environments.

As she explains:

While at the AMTA convention in Portland I had a very interesting conversation with a Doctor in a position with a major health care delivery organization about limitations for employment of massage therapists. Not surprisingly cost was the major factor and I asked what wage/salary would be able to be absorbed by the organization without reliance on insurance reimbursement.  Then I explain what follows below from my textbook "Clinical Massage in the Health Care Setting". His response was that if this was widely known and properly implemented it could greatly increase the use of massage therapists in health care. So yup 2012 may very well usher in a time of reality checks and I think our profession needs one. 
 
By "reality checks", I take it to mean that she's referring to an economic bubble, an interpretation which makes sense when she compares the salaries and relative training of emergency medical technicians (EMTs) in the US to MTs. The comparison is enlightening, and indicates a discrepancy--the economic bubble, or reality check that Fritz refers to--which is currently operating but which Fritz thinks is likely (and I agree) to experience some degree of correction, even massive, over the next few years.
 
We don't have to like or approve of these changes to recognize that they are coming unrelentingly at us, and we need to be well-prepared to deal with them. The alternative--to just passively let history sweep us along--is likely to be too painful, disruptive, and distressing, and we cannot take that chance.
 
She provides a practical solution, which empowers MTs by breaking down our isolation from members of the hospital- and homecare-based health team, and gives us access the language, culture, and basic knowledge shared at the foundational levels of those professions:
 
If you are interested in providing massage in health care then I strongly suggest you take this to heart and cross train as a Certified Nurse Assistant [CNA] which will provide necessary skills to work successfully in hospitals and other health care environments.

 

Not every one of us has the time, money, energy, resources, or inclination to cross-train as a CNA or other healthcare professional, just like not every one of us can pursue a PhD or an MPH, and take part in basic or clinical research.

But some of us can, and will do one or the other, or both, and the diversity that they will bring back to massage will only help us to gain the solid foundation that we need to operate in hospitals and other healthcare environments if--as we say--we aspire to become true healthcare professionals.

http://sandycfritz.blogspot.com/2011/11/it-is-november.html " target="_blank">Click here to go to her blog and read the post "It is November". It's worth the time.

(I also like her picture on "kitty wisdom" very much ☺.)

 

Source: http://upload.wikimedia.org/wikipedia/commons/d/d8/Frankfurt_Airport_tunnel.JPG accessed 9 November 2011

 

I also like this photo for representing "convergence", as the lines and planes of the shot converge in the distance--a classical illustration of representational perspective. And the people in the shot, in my opinion, add to the symbolism. Do you see what I mean, or do you have any other ideas about how to interpret it? Tell us in the comments.

Creating new massage knowledge: A hypothesis about reducing surgical infection risk by promoting skin integrity with massage oil

Submitted by RST on Wed, 11/02/2011 - 08:23
Posted in

Can we take the knowledge from last month's Journal Club and put it together with different research in a different specialty with a different population of clients/patients to produce a new and testable hypothesis about how massage oil (with or without massage, as appropriate) can provide benefit to those clients/patients?

Information that will be relevant to us is summed up in these comments from Journal Club:

 

Let's combine what we know from Journal Club with the following information:

Heal and her team tested a single application of a strong antibiotic, chloramphenicol, in the prevention of infection in minor dermatological surgery.

Heal CF, Buettner PG, Cruickshank R, Graham D, Browning S, Pendergast J, Drobetz H, Gluer R, Lisec C. Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. BMJ. 2009 Jan 15;338:a2812. doi: 10.1136/bmj.a2812.
 
Abstract: OBJECTIVE: To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery. DESIGN: Prospective randomised placebo controlled double blind multicentre trial. SETTING: Primary care in a regional centre in Queensland, Australia. PARTICIPANTS: 972 minor surgery patients. INTERVENTIONS: A single topical dose of chloramphenicol (n=488) or paraffin ointment (n=484; placebo). MAIN OUTCOME MEASURE: Incidence of infection. RESULTS: The incidence of infection in the chloramphenicol group (6.6%; 95% confidence interval 4.9 to 8.8) was significantly lower than that in the control group (11.0%; 7.9 to 15.1) (P=0.010). The absolute reduction in infection rate was 4.4%, the relative reduction was 40%, and the relative risk of wound infection in the control group was 1.7 (95% confidence interval 1.1 to 2.5) times higher than in the intervention group. The number needed to treat was 22.8. CONCLUSION: Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053. [1]
 
So the chloramphenicol worked, but the improvement was not clinically significant (meaning, it was not relevant on a practical basis for a clinician trying to decide whether it makes sense to use it).
 
In a response to the article, Grey, Healy, and Harding argue that:
In clean minor surgery meticulous preoperative preparation and aseptic technique by appropriately trained practitioners with access to appropriate facilities will prevent most surgical site infections without antibiotic prophylaxis [preventive treatment]. [2]
 
Weatherhead and Lawrence point out that:
Heal and collegaues report a reduced risk of wound infection with topical antibiotics after minor skin surgery. However, the control group had a high risk of infection and the influence of pre-existing carriage of skin pathogens, as shown by the appearance of the lesion's surface, was not considered.
 
Our prospective study shows that patients whose lesion preoperatively had a crusted or ulcerated skin surface were significantly more likely to develop clinical wound infections than patients whose lesion had a normal or scaly surface.
 
...
 
The risk of infection was significantly increased (P<0.05) for crusted and ulcerated skin surfaces compared with intact skin surfaces, and for ulcerated surfaces compared with scaly surfaces. It was not affected by perioperative topical antibiotics, site of the lesion, closure technique, or surgeon experience. Staphylococcus aureus was the causative organism in 18 out of 20 infections. Patient age was a significant risk factor, and older patients were more likely to have lesions with a broken surface. [3]
 
 
Taking all of this information together, can we come up with a testable hypothesis that might--if validated by research--help this group of clients/patients avoid infection after minor surgery in a safe, effective, and cost-effective way?
 
What is the first question that you would ask--what do you want to know in order to start thinking about whether massage or massage oil would be appropriate for these clients/patients?
 

The spirit of open access in massage: AMTA publishes educational handouts from its 2011 national convention

Submitted by RST on Thu, 10/27/2011 - 08:01
Posted in

The timing for these links could not be any more appropriate--in the middle of both Massage Therapy Awareness Week and Open Access Week is the perfect time to call attention to these links made available by presenters at the AMTA National Convention, and published by AMTA.

Click on any of the links below to see the PDF handout from that session. These links are also permanent under the "Added Links" menu in the upper part of the POEM page.

 

 

cheers, to Margo F. Bowman, Mr. or Ms. Brown, Bruce Costello, Thomas W. Findley, Kathy Ginn, Kim Goral-Stevenson, Mr. or Ms. Hummel, Annie Morien, Kirk Nelson, Al Souma, James Waslaski, and to AMTA!

 

Creating new massage knowledge: Why I won't be getting foot rubs in the hospital anymore

Submitted by RST on Tue, 10/18/2011 - 09:14
Posted in

Every MT, no matter how experienced in practice and study, is a lifelong learner. We create new knowledge by integrating previously-separate information.

Here's an example of the process, leading to a change in what I practice and accept as a client, based on new information and recommendations from Susan Salvo at her blog:

Thrombocytes, or platelets, are the blood cells used to form clots. Thrombocytes have a life span of about 10 days.

If your client has had surgery, avoid massage on lower extremities for 10 days starting from the time the client is ambulatory and no longer confined to bedrest.

 

 

Salvo reasons in the following way:

  1. Inactivity and bed rest, such as that following surgery, can lead to stasis, which in turn can lead to blood clots.
  2. Thrombocytes formed before the client/patient is fully ambulatory are at a higher risk of clotting, due to that stasis.
  3. That stasis and the resulting clot may not show up immediately, but may even happen late in the life span of the thrombocyte.
  4. Thrombocytes have a life span of about 10 days.
  5. Therefore, even a few days after the client/patient begins walking again, the thrombocytes circulating in their blood are still potentially at some risk for thrombosis, due to their earlier inactivity.
  6. The safest way to lower the risk of thrombosis is to wait for those potentially at-risk thrombocytes to be replaced by brand-new ones that were never exposed to inactivity and potential clotting.
  7. That is the source of the 10-day recommendation: approximately 10 days after the client/patient becomes ambulatory again, the thrombocytes exposed to inactivity and clotting risk should pretty much have been replaced by thrombocytes that have always experienced activity, and thus are less at-risk.

 

Her reasoning is solid, and the recommendation makes sense.

 

But are clients/patients in hospital to be deprived of massage during the post-surgical and pre-(ambulatory + 10 days) period? That, in the experience of the client, is potentially a tremendous loss.

 

I've written about it myself here at POEM, when I described what it meant to me when I spent a month in the hospital for surgery following a blood clot that led to the loss of 3 feet of my small intestine:

It's hard to describe what it feels like to come so close to death, and then to have to work my way back slowly away from the edge of the cliff. "Alone", "frightened", "vulnerable"--these certainly all were part of it, but they're insufficient to depict the experience. My family, friends, and graduate program were wonderfully supportive, but no matter how much they were there for me, there are some things you just have to go through alone.

While I was in the hospital, I was moved to a floor that had a volunteer MT come in once a week to offer patients a massage. I remember it was Wednesdays when she made her rounds.

The first Wednesday, she came around and offered a free hand and foot massage, which I gratefully accepted. It's not that I was touch-deprived, not exactly--but the touch I was getting in the hospital was almost universally invasive touch--blood draws, infusions of dye for CAT scans, IVs for feeding and painkillers. Although there was lots of touching, I was definitely "good touch"-deprived. Her simple offering of a hand and foot rub turned into one of the best experiences in my life.

The next Wednesday, she returned, and once again, it was the high point in a week that had very few other good experiences.

The next Wednesday, I waited eagerly, my anticipation heightening from minute to minute for another of the massages I had grown to love. When it finally dawned on me that she wasn't coming this time, I cried and cried inconsolably.

 

When something has that much meaning to a client/patient, how can we deprive them, even in the face of risk?

 

Fortunately, we don't have to totally deprive them: a head/neck rub or a back rub, depending on their tolerance for it, should be perfectly safe (unless there are other factors for a particular client/patient that you need to consider). And although a hand rub is technically "massaging an extremity", arms have not been shown to run the risk of blood clots (deep vein thrombosis) that legs do.

 

Based on Salvo's recommendation, if I am ever a hospital patient again (and I hope that never comes to pass!), if an MT offers me a foot rub, I'll ask for a back or head rub instead, until I have been fully ambulatory for at least 10 days.

 

And when I am offering massages to bedridden hospital patients, I'll make a point to offer head, neck, back, and hand rubs--but until they're up and walking, and have been for at least 10 days, I think I'll pass on the foot rubs as well.

 

As small or as large as the risk may be in any particular case, I have no way of judging it, and I have perfectly good options to offer instead that do not carry any particular risk of thromboembolism.

 

cheers, to Susan Salvo!

 

Source: http://upload.wikimedia.org/wikipedia/commons/7/73/Aterialthrombosis.jpg accessed 18 october 2011

Medical massage

Submitted by RST on Thu, 02/24/2011 - 08:25
Posted in

 


 

 

 

Foundational information

 

Visualization

 

Discussion

 

References

 

 

Contains Content: 
no
Syndicate content