Hot Stone Massages Have Incredible Benefits

Although some massage therapists and clients may consider hot stone massage to be simply fashionable, the use of stones and gemstones for healing purposes dates back thousands of years.

A Part Of History
Both verbal and written history confirm the Chinese used heated stones more than 2,000 years ago as a means of improving the function of internal organs. Stones were also used for healing work in North America, South America, Africa, Europe, Egypt and India.

 

These traditions included laying stones in patterns on the body, carrying or wearing stones for health and protection, using stones for the diagnosis and treatment of disease, and for ceremonial uses, such as sweat lodges and medicine wheels.

A Source Of Healing
The healing practices of curanderas (literal translation: “healers” in Spanish) and other female caregivers often included dealing with disease as well as pregnancy and childbirth. These folk healers used heated stones to diminish the discomfort of menstruation, plus the application of cold stones to slow bleeding after labor.

Some sources also cite instances of cultures in which women believed that simply holding stones during labor added to their strength and endurance.

Ancient Greek and Roman cultures have a long recorded history of many forms of massage and bodywork. The Roman Empire, which dates from 27 B.C. to 476 A.D., is noted for its creation of the Roman baths.

This ancient tradition is still with us today in the form of modern hydrotherapy practices. The Romans also used stones in saunas and combined the effects of hot immersion baths with the cooling effects of marble stone and cold pools.

An Old Technique Is Reborn
The use of heated stones in massage was reborn with the introduction of LaStone Therapy, created by Mary Nelson, in 1993. Stone massage has blossomed since then into a multimillion-dollar industry.

Stone massage, done correctly, is one of the most relaxing forms of massage a person can receive and because of its popularity, has once again traveled quickly around the globe.

The full-body, hot-stone massage has evolved to include deep tissue-specific work, hot-stone facials, hot-stone pedicures and manicures, and hot-stone meridian therapy. Because of their incredible energy, stones are used in reiki, polarity therapy and cranial sacral work.

There are many therapists who use their own variation of stone massage, from just placing stones on the body to a deep-tissue massage. Two important safety factors, however, apply to all uses of hot stones in massage therapy:

Never place a hot stone on bare skin without moving it.
Always use a barrier, such as a specific textile product designed for stone placement, or at least a sheet or towel to protect the skin.
The Evolution Of Stone-Supply Companies
With this massage modality growing in popularity, the need for sources of hot stone massage became a necessity. To this end, stone-supply companies evolved, such as Desert Stone People, TH. Stone, RubRocks and Nature’s Stones Inc.

The next challenge came with the need for heating the stones; incredibly, the initial suggested means of heating stones was in a turkey roaster.

Other options included crock pots, electric skillets and warming trays, all of which carried the possibility of overheating the stones and burning the client.

The problem, of course, was that all these options were actually kitchen appliances as opposed to being professional heating appliances manufactured specifically for spas, chiropractor’s offices and massage-therapy treatment rooms.

After much collaboration and cooperation between Nature’s Stones Inc. and the Metal Ware Corporation (makers of Nesco products), the Spa~Pro Massage Stone Heater, a unit designed specifically for hot-stone massage, was created.

The Value In Hot Stone Massage
As therapists recognized the value of working with massage stones, they also saw the need for high-quality instruction in the use of massage stones. Nelson assembled a team of therapists to teach all around the world. Sonya Alexander from TH. Stone was busy teaching, while Carollanne Crichton, founding director of The Institute of the Healing Arts in Rhode Island, then produced a video showing her method of stone massage.

As one of the first therapists on the East Coast to do stone massage, I was busy designing protocols for different modalities and teaching in Europe, the Caribbean and across the U.S.

Please look for future articles on www.MASSAGEmag.com, as I explore the exciting arena of stone massage. I will write about safety issues, contraindications, the expansion of stone therapy to different modalities, the evolution into cold-stone therapy with marble stones and now the resurgence of stone massage with the innovation of carved basalt stones.

I will also discuss accessory products, such as massage oil, essential oils, heaters, textiles, DVDs and seminars. I look forward to an ongoing conversation with you.

Massage Therapy Helps Thyroid Conditions

An estimated 10 million Americans suffer from a known hypothyroid condition, and 10 percent of adult American women may have some degree of such conditions, according to endocrineweb.com.
January is National Thyroid Awareness Month, sponsored by the American Association of Clinical Endocrinologists, a time when massage therapists can learn how clients with thyroid disorders might benefit from massage therapy.

Signs of a Challenged Thyroid
Hypothyroidism

The term hypothyroidism encompasses any condition witnessing the thyroid gland’s inability to produce adequate levels of hormones known as T3 and T4. Hashimoto’s thyroiditis, an autoimmune inflammatory condition that destroys the thyroid gland, is the leading cause of hypothyroidism. The other major cause indicates a broad medical treatment term that includes surgical procedures to remove all or a portion of the thyroid. Removal of cancerous tissue in thyroid cancer patients is a prime example of this cause.

Major signs and symptoms of hypothyroidism include fatigue; muscle weakness; fluctuations in weight without an obvious reason; dry, thinning hair; rough skin patching; cold intolerance; depression; abnormal menses; decreased libido; and cognitive challenges.

 

A patient may be difficult to diagnose by her physician due to not manifesting many of these symptoms initially. Insidious changes occur slowly, leaving a patient wondering why he feels off-balance. Most people will not think to consider their thyroid as the culprit, resulting in symptoms worsening slowly over time. Serious complications can occur, including heart failure, coma and severe depression.

The Enlarged Thyroid
Goiters, or enlarged thyroids, may be witnessed in hypothyroid patients. These result from an

Thyroid Gland

overproduction of thyroid-stimulating hormone (TSH) from the pituitary gland. The constant stimulation from TSH will cause the thyroid tissues to swell. If the thyroid gland still cannot produce adequate T3 and T4 hormones, the patient will be considered to have goitrous hypothyroidism.

It is important to note that the presence of a goiter does not always equate to hypothyroidism. Other conditions featuring the development of a goiter include dietary iodine deficiency, the patient taking lithium carbonate, infectious disease, postpartum complications or a rare fibrosis condition called Riedel’s thyroiditis.

A massage client with hypothyroidism could be on one of several different medications for the treatment for hypothyroidism. The most common drug is a synthetic thyroid hormone usually sold under the brand name Synthroid or Levothroid, according to the website of the Mayo Clinic. The generic name of the drug is Levothyroxine. This drug is a synthetic form of T4 hormone (the most significant of thyroid hormones) and is used to replace one’s T4 hormone levels. Evaluation of dosage can be tricky for some patients. Proper communication with the endocrinologist is key to determining the proper dosage daily. An annual evaluation of the drug’s effectiveness is expected as well.

The half-life of Levothyroxine is six to seven days, meaning it takes this time period for the drug serum levels to drop significantly enough to become insufficient in the patient. Because of such a long half-life, massage therapists must communicate effectively with the client to determine how the drug is affecting the client at the time of massage treatment.

Common side effects of Levothyroxine and other hypothyroid medications include chest pain, changes in menses, headache, fatigue, heat intolerance, hives, facial swelling, breathing challenges, fainting and tremors, according to the Mayo Clinic’s website. Overdosing symptoms include changes in consciousness, skin pallor, vertigo, changes in pulse, confusion and sudden headaches, aphasia and apraxia. It is important for massage therapists to recognize these signs and symptoms with their hypothyroid clients.

Massage for Thyroid Patient Health
Massage therapy and related bodywork can benefit the hypothyroid patient in many profound ways. First, a significant reduction in the patient’s symptoms can be witnessed with the usage of acupressure. This benefit was demonstrated by a research study in Russia conducted in 2011. Reflexology and Gua Sha technique were also utilized in this study involving Chinese medicine theory in addressing hypothyroidism.

A second benefit of massage therapy for the hypothyroid patient is aiding improved blood and lymphatic circulation. Since proper blood and lymphatic flow is vital for all endocrine organs, the thyroid could benefit from improved circulation.

Reduced inflammation is a third benefit derived from massage therapy and related bodywork. Research through the Buck Institute for Research on Aging in Novato, California, and McMaster University in Ontario, Canada, indicates that massage therapy may create a result similar to anti-inflammatory medications at a cellular level. This benefit will aid the hypothyroid patient with Hashimoto’s thyroiditis or similar inflammatory concerns.

A fourth benefit of massage treatment is reduced stress within the body. This benefit can decrease cortisol and other stress hormones to help manage weight healthily.

Finally, increasing muscle strength will combat the fatigue and weakness often felt by the hypothyroid patient. A Swedish massage including a large percentage of petrissage strokes can enhance the size, strength and stamina of muscle tissue.

Eight Ways To Ensure a Long Massage Therapy Career

Whether you have two years’ experience or 20, you have no doubt discovered that building and maintaining a full-time massage therapy practice places a large physical demand on your body. Massage therapists often develop overuse injuries from repetitive movements of the upper extremities. Many learn too late that self-care is critical for enjoying a long and pain-free massage therapy career.

These physical demands are growing, too, as the size of our clients grows. According to the U.S. Centers for Disease Control and Prevention as reported by CBS Atlanta, American men’s average weight is approximately 30 pounds more now than it was in 1960; American women’s weight is approximately 26 pounds more.

How can we respect and protect our maturing, possibly injured bodies—and continue to deliver consistently superior sessions?

Here are my favorite career-extending self-care strategies:

1. Clothes-On, No-Oil Treatments
I made the switch to clothes-on treatment more than 20 years ago and have never looked back. The clothes-on approach enhances a client’s mobility, resolves potential modesty issues, and brings a more clinical focus to your practice.

I ask clients to wear a well-worn, cotton T-shirt and sweatpants, because both offer a modest amount of friction; I can take a position and press through the clothes, and my fingers do not slide.

It takes more effort and energy from me to deliver deep pressure and glide at the same time on oiled skin. Through clothing, I can deliver consistent, sustained pressure with less force coming from me. Less force means fewer repetitive injuries for the therapist.

Another benefit of the clothes-on approach is that it frees you from using oil or lotions. From a practical standpoint, it’s a treat to not have that continual cleanup and expense.

2. Side-Lying Position
Clothes-on massage eliminates draping, which opens up the all-important side-lying position. You’ve likely had many times you were out of position, leaning over a client in prone or supine position, using poor body mechanics, stressing yourself to get into an area that needed to be addressed. The side-lying position solves that.

I use pillows under the head, knee and feet to make a client comfortable, relaxed with muscles on slack, and therefore much more approachable. Treatments then require less pressure from me and are delivered from a place of proper posture, my back straight, without leaning over.

Also, in the side-lying position you don’t have to lift a heavy arm or leg to massage it properly.

side-lying massage position
David Morin demonstrates clothes-on, no-oil massage with the client in a side-lying position.

3. Use Tools
In the late 1970s, when I studied Neuromuscular Therapy with Paul St. John, the training included work in the lamina groove using wooden tools with a soft tip. One was rounded and one was beveled. The design didn’t fit my hand very well, so I redesigned the T-shape into an L-bar, changed the dimensions a bit, and ended up with what I have for 20 years been calling the Thumbsaver and the Beveled L-Bar.

I turned to these tools to save my career because my thumbs gave out; in fact, repetitive glides and strokes have left my thumbs profoundly changed. This wasn’t caused so much by delivering direct pressure as it was by turning and twisting to get my thumb into the right place. Pressing in with my thumb tool cradled comfortably in the palm of my hand, I can provide sustained pressure—moderate or deep—for as long as needed without using my thumbs. For sensory input, I use the tips of my fingers to track alongside the rubber point of the tool, so I can feel for just the right amount of pressure in just the right spots.

Especially though clothes, your clients will not be able to tell the difference between a tool and your overused thumbs.

4. Use More Pull, Less Push
Massage is all about pushing and pulling—usually much more pushing than pulling. In the side-lying position particularly, I can brace one hand on a client’s arm or leg to provide a stabilizing, opposing pressure, and with the other hand work a variety of pulls that greatly reduce the wear and tear on my body. Again, less repetitive pushing and greater diversity, using pulls, mean fewer injuries for the therapist.

Examples:

Cross-fiber Tibialis anterior in side-lying position. Brace the client’s ankle with one hand while using your fingertips to cross-fiber the entire length of the muscle.
Brace the ankle as above while using a thumb tool to apply direct compression along the lateral head of the gastrocnemius and soleus. Notice how little pressure it takes to get excellent results.
Forearm to Vastus lateralis in side-lying position. With one hand on the client’s lateral knee, either brace or move in opposition to the opposite forearm that is applying direct compression or cross-fiber treatment the entire length of the muscle.
Brace the elbow when treating anterior and medial deltoids in supine position.
Stabilize opposite forehead when treating suboccipital muscles.
Brace foot in the air in prone position while pulling on peroneals, gastrocnemius and soleus.

5. Specialize
Particularly valuable to therapists who are so damaged they are ready to give up their careers is the move to specialize in treating the head, neck and jaw exclusively. This greatly reduces the mechanical stress on the therapist, and at the same time opens the door to establishing a referral network with both physicians and dentists for treatments on headaches and temporomandibular joint dysfunction.

I specialize in medical massage therapy and employ the full range of clinical protocols: assessments, measurements, treatment plans, remedial exercises and more. So for me, a client session is more diverse than just hands-on manipulation. That means less wear and tear on my body.

Clients come to me to achieve targeted results on specific problem areas, and we work toward those goals. I rarely, if ever, give a full-body massage. This allows me to focus and position myself in the most beneficial posture to do what must be done.

6. Invest in a Rolling, Adjustable Stool
Clients with painful conditions and injuries usually require extensive treatment in specific areas. Neck and jaw treatment, for example, have always been paramount in my practice. It takes time to be thorough, and being seated on a rolling stool brings my body back into good posture.

7. Teach Client Self-Care
Teach your clients a self-care program of using daily hydrotherapy and active range-of-motion exercises to enhance their care. Clients often get better more quickly, and the therapist’s work becomes easier. This therapeutic relationship encourages personal responsibility and eases the expectation that healing is only the responsibility of the massage therapist. However, note that in some states even recommending exercise is outside the scope of practice of massage therapy. First, make sure you are acting within the law.

8. Take Care of Yourself
We all need to counterbalance the repetitive nature of giving massage with regular active range-of-motion exercises for the shoulders, back, arms and hands. A comprehensive self-care program is an important key to a long and healthy massage therapy career.

by David Morin

Working With Clients Who Are Medically Fragile

About 15 percent of the current U.S. population is 65 years or older, and as the baby boomers continue to age, the size of this group will continue to grow. Combine this population with those who are chronically ill or have suffered a serious injury, and it’s easy to see how now and in the future you may have clients who are deemed medically fragile.

Although the benefits of massage therapy are likely similar for medically fragile clients, there are a wide array of things that will be different when working with these clients. Read on to learn more about what you can expect—and what’s expected of you—when working with medically fragile clients.
What Is Meant by Medically Fragile?

A medically fragile client can be loosely defined as someone with serious and complex medical conditions and a frail constitution. These clients will likely fall into one of three categories: chronic or terminal illness, suffering from severe injury or advanced age. Some other common terms that are used to describe the medically fragile are medically frail, medically complex or technology-dependent.

Because medically fragile spans such a large range of conditions and client demographics, massage therapists are going to need to be prepared to evaluate how the definition of medically fragile may vary across clients. Julie Goodwin, a massage therapist and educator, considers a wide array of variables when thinking of how a medically fragile status may apply to her clients. “To me, assignment of a medically fragile or medically frail status evolves from an interview, observation, assessments of medical treatment and medication side effects, physical and social risk, and a review of medical records or treatment transcripts,” says Goodwin. “This often represents multiple health conditions from which recovery or rehabilitation is unlikely, medical treatments and medications that create side effects that interfere with daily functioning, and impairments to mobility and cognition.”

Remember, there is really no “typical” medically fragile client, so you’re going to need to be able to adapt quickly and be flexible.
When Massage Is Beneficial

Even though the session for these clients will be different, the benefits they receive are similar to the benefits massage provides to all other clients. “All the reasons why a non-fragile person would want a massage would be applicable here, too,” says Susan Salvo, a massage therapist and author who specializes in the medically fragile. Goodwin echoes this sentiment. “In my practice, pain relief, relaxation and increased range of joint motion are typical reasons for seeking massage therapy,” she explains. “Most of my clients I have deemed medically fragile are elderly (over 65).”

While massage therapy is effective for many of the same reasons as it is with more typical clients, there are still some reasons medically fragile clients seek out massage therapy that are more common than others. The most common therapeutic reasons include pain and stress management, decreased swelling, improved range-of-motion, relief from nausea, fatigue, insomnia, and a feeling of calmness and improved mood. Massage can also be beneficial for clients who suffer from psychosocial issues such as isolation, hopelessness, depression and anxiety. “Massage can bring comfort to these clients and their caregivers,” says Salvo, “which can be especially important when spoken language is difficult or impossible.”
What You Need to Know

Space. When working with medically fragile clients, the location of the massage therapy session is going to depend in large part on the client, and can range from your practice location to the client’s home to a medical facility or nursing home. For each of these settings, massage therapy sessions will need to be adapted. For example, Salvo recommends scheduling all appointments at your practice during daylight hours.

Here, too, you need to think of how you can make the space easy for the client to negotiate, like making sure there is enough space between furniture and walls to accommodate wheelchairs and walkers. “Modifications in my location include lowering the table to ease access and assisting the client around the treatment space,” says Goodwin. “Working with the client only in a semi-reclining supine position, avoiding repositioning and working with the client clothed are other modifications I often make.” You should also consider using linens in contrasting colors for those clients who might be visually impaired.

Alternatively, if you see medically fragile clients on an outcall basis— either in their home or at a hospital or long-term care facility—different accommodations need to be made. Evening hours, for example, are sometimes better in these settings because there will likely be fewer disruptions. Space is limited in these settings, too, so don’t bring a portable table or massage chair. Instead, assume you’ll massage the client where they are, whether that’s in bed, in a wheelchair or while seated in a recliner. “If the client is in bed, the bed is often placed against a wall, limiting access to all sides of the body,” adds Ann Catlin, owner and director of the Center for Compassionate Touch.

Working with the care coordinator or nurses is a must. Ask for specific instructions, Salvo encourages, and when you go to the client’s room, obtain their permission before entering. Many times, these clients may have people in their room, too, whether medical staff or visiting family, so don’t be afraid to introduce yourself and explain why you’re there. A curtain pulled around your client often indicates a health care professional is performing care that requires privacy, says Salvo, so you should wait outside the room or in the hallway until they’re finished.

Other things Salvo suggests considering include:

Safety. Some medically fragile clients are going to be unsteady on their feet or experience dizziness, and so falling will be a big safety concern. You need to make sure you don’t allow a client to move without assistance from a member of their health care team, whether that’s from a chair or their bed. Also, if you need to step away from a client, make sure the bed rails are raised before doing so.

Accessibility. You aren’t going to want to move furniture from a client’s room, but you can try to make as clear a path as possible around the bed or chair to facilitate your work. If you need blankets or pillows or linens, however, ask someone to help you locate these items instead of looking for them yourself or bringing your own.

Emergency. Be sure you ask about the facility’s emergency protocol in advance so you can take proper measures. If an emergency occurs, Salvo recommends raising the bedrails to keep the client secure and then stepping out into the hallway to call for help instead of pushing the call button. Many times, you’ll get a quicker response this way.

Intake. Intake is always important, but especially so with medically fragile clients. The length of intake will differ based on the client, but make sure to have extra time allotted as most times you’ll need to talk with these clients longer. “Intake is extensive, and likely to comprise most of the client’s initial visit,” says Goodwin. “I prepare the client ahead of time by letting them (or the person making the appointment, who is often a family member) know what information to bring, including a list of health conditions, a list of all prescribed and over-the-counter medications, and the names of primary and specialist health care providers, to name a few.”

Remember, however, that when working in a hospital or other care facility, you won’t always have access to a client’s medical records. “It’s important to note that a massage therapist will only have access to the medical record if they have a formal relationship with the organization, either as an employee or a contracted service provider,” Catlin cautions.

Also, be sure the room is well lit and relatively quiet. Turn down the volume on the TV or radio, for example, or ask the nursing staff to hold calls while you’re conducting your intake. Salvo also suggests being systematic in your intake, asking how the client is feeling before moving on to more in-depth questions.
The Massage Session

Flexibility. As with most special populations, massage therapists need to be flexible when working with medically fragile clients. “Therapists are challenged to remain flexible and adaptive,” Catlin explains. “You’ll need to let go of preconceived ideas about how a session will unfold or how the client will respond.”

Positioning. Of all the differences you might notice when working with a medically fragile client, the massage therapy session itself may be where you see the biggest contrast, starting with how the client is positioned. “They’re rarely going to get disrobed,” says Salvo. “Depending on how medically fragile or how mobile they are, you’ll have to be willing to massage through clothing or just with what they have on, which might be a hospital gown or leisure clothing.” Before beginning, remind the client that they should let you know if anything hurts or causes discomfort so you can make the proper modifications.

When considering positioning, the client should be in a supine, semi-reclining, side-lying or seated position. If you’re working in a long-term care facility or hospital, many times the nursing staff will prefer to position these clients if they can’t manage on their own, so be aware of that before starting the massage. Prone positions, too, are not appropriate if there are any medical devices on the anterior surface of the chest or abdomen, like drain tubes or IV lines.

Catlin suggests thinking of ways you can work with the current location and position of the client to help with positioning. “For example, use the hospital bed controls to adjust the position, or use pillows to support the arms or raise the feet off the mattress,” she says.

Timing and Technique. Although the time you spend actually massaging these clients may be shorter than usual—typically from 15 to 45 minutes, according to Catlin—the length of the session when you include intake will still be an hour or more. Remember, too, that these clients are often going to need more time for activities such as using the restroom, drinking water or getting comfortable, and they may like to share personal stories, so you need to be patient.

“Technique modifications include shortening session duration to avoid overtiring the client, limiting or eliminating techniques that may stimulate systemic circulation, and decreasing pressure and increasing lubrication,” says Goodwin. “Also, choose a lubricant unlikely to trigger an allergic reaction, and take extra steps to preclude transmission of infectious pathogens.”

Salvo echoes this caution, advising massage therapists to use only unscented products or products that have a scent that is familiar to the client. Additionally, a different container should be used for each client whenever possible, or single-use lotion packs or the client’s own lotion could be used, with permission from the client, of course. Be sure to sanitize exterior surfaces both before and after use.

Whatever technique you use, making sure the level of pressure is appropriate is a must and requires you to continually check in with the client to ensure they are comfortable.
After the Massage Therapy Session

When the massage session is over, be sure to replace a client’s eyeglasses if you’ve removed them, as well as their socks or slippers. You might also ask the client if they need anything, Salvo suggests. After placing used linens in the hamper and sanitizing your hands, make sure to complete your session or SOAP notes. “Be sure to let the patient care coordinator know if you found unreported issues, such as swelling, redness or bruising,” Salvo adds.

Clients who are considered medically fragile often want—and need—the very real benefits offered by massage therapy, but you might have to modify your approach to accommodate the unique needs of the medically fragile client. Learning ahead of time what you’ll need to know when working with this population is a great place to start.

The M Technique for the Hand

When working with medically fragile clients, Susan Salvo recommends
a technique developed by Jane Buckle called the “M” Technique. This
technique uses a patterned sequence of three repetitions and light pressure
that remains unchanged, allowing the client’s body to become used
to the new stimuli and eventually relax. Following is the “M” Technique
sequence for the hand:

1. Alternate hand stroking to elbow
2. Lateral movements palm down
3. Joint circling
4. Scissor hold/pressure point/stroke
5. Turn hand over
6. Little finger links
7. Lateral movements, palm up
8. Handshake
9. One-hand stroking to elbow

Source

A Golfer’s Worst Nightmare Rehabilitated Through Massage

For many golfers, the only meaningful way to spend a sunny day is out on the links. With 18 holes to look forward to — the sun’s rays caressing the greens, blue skies inviting deep breathes, and the warm leather grip of a favored club in hand — nothing much can break their joy of being alive.

Until, that is, pain strikes. Pain in the physical sense such as a muscle tear or unstable joint, or the pain they feel from a continually declining game performance. For a die-hard golfer, the two pains are equally worrisome. And, left unresolved, grow to become their worst nightmare: the end of their golfing and no more need for sunny days.

Massage therapists are all well aware that, as the human body ages: muscles atrophy, tissues lose elasticity and overall flexibility declines. What many therapists have yet to fully understand, however, is that static stretching of muscles is rarely enough to correct these affects (Siff and Verkhosansky 1993, Siff 1994, and 1998). And even dynamic stretching is an incomplete course of treatment for many of our clients — especially those who golf.

Kinematic Sequencing and Therapeutic Improvements

To effectively assess and treat the unique needs of a golf client requires that the therapist first acquire an advanced knowledge of body dynamics, namely, the kinematic sequencing of the golfer’s body.

Kinematic sequencing refers to the specific order that the body engages its muscles, bones, joints and balance to perform a movement. In our golfing clients, the movement is striking the ball.

For an efficient golf swing to take place, the process of kinematic sequencing looks like this:

  • First, the pelvis is engaged and rotates towards the ball.
  • Second, the trunk engages and follows the pelvis.
  • Third, the arms engage and follow the trunk.
  • Fourth, the hands and club follow the arms until the ball is struck.

Once the ball is struck, the body again engages in a kinematic sequence, this time of deceleration, with the pelvis engaging first, followed by the trunk, followed by the arms, followed by the hands and club. That is good sequencing.

As massage therapists, the better we understand kinematic sequencing — especially in our rotational athletes who play golf, tennis, baseball, bowling and soccer — the the better we become at assessing our clients’ pains, restrictions, limitations and frustrations.

And the first step to better assessing our clients is to perform better evaluations. Specifically, how they present when they take a static posture and when they take a dynamic posture as they describe their pains, restrictions and issues.

Static posture is, of course, the position of the body at rest, sitting, standing or lying down. This is typically what we see most often as massage therapists. Our clients sitting or standing before us or perhaps already laying on the table as they describe their pains and wait for us to treat them.

Dynamic posture, on the other hand, has the patient: move, twist, lift, pull, push and balance in order to reveal the likely causes of the client’s pain or imbalance. The difference in evaluating your client’s condition using dynamic posture as well as a static posture is often the critical and missing step in properly assessing and treating our patients (Doctor Vladimir Janda “Upper and Lower Cross Syndrome” 1979, cited in Lewitt 1999).

To only evaluate your client in a static posture would be missing the holistic nature of human dynamic motion and posture. Sure, you can look at a left hip internal rotation when your client is on the table and find a deficiency of say 15-20 degrees, but that won’t give you an accurate picture of what’s really affecting the golf swing until you ask your client to stand up and perform the very movement that causes the trouble. So to replicate the golf swing, you must ask your client to do an internal rotation so as to move the trunk over the hip.

Frankenstein on the Golf Course

Here’s an example from my own clinic. I recently had the opportunity to work with a golfer who had bilateral hip replacements, a right knee replacement, and a left shoulder injury that was never repaired. I hate to say it, but he walked like Frankenstein and, as you can predict, his traumas lead to a continuing decline in his game performance.

When golfers ready themselves to strike the ball they bend their knees into a semi-squat formation. So to properly assess my client’s condition, I asked him to squat, slowly, all the way into a chair. And as he did so, I observed his ankles, knees, hips, trunk and motor control. I then asked him to stand on one leg. His ability to maintain a one-legged posture lasted less than three seconds. I also noted that he could not even begin to touch his toes; and he had limited trunk control, pelvic and spinal rotation. He had a forward head posture, kyphosis, and evaluation of his left shoulder joint presented the arm well in front of his ear instead of the proper placement which is beside or behind the ear. As you might infer, he clearly needed better flexibility. But, because of his hip prosthetics, it would be inadvisable to stretch his hips into internal rotation.

For this client, I began by making a basic golf movement better. Namely, the squat. Simply by teaching him to use his hips better, it allowed him to stay in a golf posture longer which helped with his swing path, tempo and striking distance — and his enjoyment of the game. We always combined our sessions with manual therapy, focusing around the hip rotators, to help him improve his hip hinge.

If you are ever presented with a client suffering with similar impairments, begin by writing down your assessment of how each muscle is affecting the joints in the lower extremities. Look at the flexibility of the feet as they relate to overall stability during weight shifts. Create more ankle mobility by addressing the dorsiflexors and removing myofascial restrictions. Check the client for the ability to do inversion and eversion of the ankles. Attempt to lengthen the quads, hamstrings, adductors, IT band, gluteals and psoas. Your goal is to increase the length of the flexor chain and increase strength to the extensor chain.

Once you’ve completed all of the above, recheck the client’s movement by asking your client to perform another squat or the movement pattern that is causing the concern. If your client has yet to improve, it may indicate that just stretching the lower extremity is not enough. Adding mobility without adding stability may not change the movement pattern. You may need to become a teacher of the squat. Put a chair behind the client, have them do an isometric press into their hands to activate the core, and teach them to hip-hinge back into the chair. Then repeat your manual therapy and re-check your client’s range-of-motion. Continue to do this as many times as necessary throughout the session to reveal how much your client’s motor control is improving. You will often see minor improvements during the first session and noticeably bigger improvements during subsequent appointments.

This is the protocol I implemented with my own client and he improved dramatically. In just three months, I had him transform his gate from that of a B-movie monster to that of a young man walking with a kick in his step. He also lowered his golf handicap, feels younger, stands taller and more importantly . . . he is now free of his worst fear — that of believing that he’d never again enjoy playing 18 rounds of the great game of golf.

References

  1. Supertraining: Yuri Verkhoshansky and Mel Siff.
  2. Manipulative Therapy in the Rehabilitation of the Locomotor System: Karel Lewit, Third Edition 1999.
  3. Superstretch : Mel Siff 1994.
  4. Facts and Fallacies of Fitness : Mel Siff 1998.

Massage Education’s Future

Education is a sensitive and divisive topic within the massage therapy profession.

On one side of the argument are those who believe that today’s non-degree vocational school system is both egalitarian and in line with traditional massage therapy practices.

On the other are those who believe the current system penalizes those who want to become full participants in the health care industry. They advocate for an educational spectrum that also includes bachelors and advanced degrees. But while some form of tiered credentialing seems to be the preferred solution on both sides of this argument, it seems there are many directions for that path to take.

“I know there’s a segment of the massage population that wants to increase the hours and scope of practice for massage therapists. They want to see more evidence-based massage research and more acceptance by the allopathic medical field,” said Cherie Sohnen-Moe, WIBB blogger, author and business coach. “While I would like to see this as an option, I don’t want to see it as the main path for massage. If we do this, we will be pricing massage out of the range of the average person. As it is, most people claim they can’t afford a massage on a regular basis, if at all.”

massage education Monetary arguments can be powerfully persuasive in a profession where the average salary can hover around $30,000 per year for experienced therapists and around $10,000 per year for a first-year therapist.

“The more training you require for entry, the higher the cost of the training, the more evidenced-based you need to be to justify it, the more people you eliminate from practice and the higher the cost to the consumer,” said Keith Eric Grant, senior instructor of sports and deep tissue massage at the McKinnon Institute in Oakland, Calif., and a board member of the California Massage Therapy Council.

However, others suggest that advanced degrees can present new and important opportunities for therapists and consumers.

“Having advanced degrees available in massage therapy will open many doors for us in the research world and in the public health policy world,” said Ruth Werner, President of the Massage Therapy Foundation. “It is so frustrating to realize that right now we are missing out on a once in a lifetime opportunity to be in on the beginning of a new health care paradigm that encompasses preventive care and wellness. We’re doing our best, but it is an uphill battle largely because of this educational disparity.”

Portrait of the Profession

Most therapists today are female, in their early 40s and enter the profession as a second career, according to recent studies by the American Massage Therapy Association (AMTA) and market research done by Massage Today. The industry itself was estimated to be $12 to $17 billion in 2010. According to a 2010 U.S. Department of Labor estimate, employment for massage therapists is expected to increase 19 percent from 2008-2018, faster than average for all occupations. According to the AMTA study, between July 2009 and July 2010, approximately 48 million adults received a massage at least once.

Most therapists work an average of 15 hours a week providing massage (this includes time spent on other business related tasks). Therapists charge an average of $60 for a one-hour massage and earn an average wage of $41 an hour (including tips) for all massage-related work. The AMTA study also found that today’s therapists are heavily reliant on repeat business. The average annual income for a massage therapist in 2010 (including tips and working approximately 15 hours per week) was estimated to be $31,980.

Current Education and State Regulation

According to the AMTA survey, there are more than 300 accredited massage therapy schools nationwide and nearly 90,000 nationally certified therapists. What does it mean to be nationally certified? According to the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), to meet this standard, a therapist must demonstrate a mastery of core skills and knowledge, pass an exam, adhere to a code of ethics and established standards of practice and take part in established continuing education standards.

Massage therapists have an average of 660 hours of initial training and take an average of 22 hours of continuing education per year. Perhaps the most interesting piece of information from the AMTA study was that 92 percent of massage therapists strongly or somewhat agree there should be minimum education standards for massage therapists.

An argument can be made that you really can’t look at massage education without looking at the regulation of the industry, as the regulation generally set the educational criteria that must be met. Currently, 43 states and the District of Columbia regulate massage therapists or provide voluntary state certification. And with that certification, a specific educational requirement must be met. However, each state is different in what they require to be considered certified or licensed. For example, the state of Texas requires 500 hours of board-approved education, while Alabama requires 650 hours, Arizona requires 700 hours and the state of New York requires 1000 hours.

Not only are the number of hours different, so too is the mix of classes the various states require. For example, according to the Texas Department of State Health Services, its 500 hours of massage therapy course work must be “directly related to the theory or clinical application of theory pertaining to the practice of massage therapy and the manipulation of soft tissue, massage therapy laws and rules, business practices, professional ethics, anatomy, physiology, hydrotherapy, kinesiology, pathology or health and hygiene.” While the New York State Education Department requires its 1000 hours to be “complete coursework in anatomy, physiology, neurology, myology or kinesiology, pathology, hygiene, first aid, CPR, infection control procedures, the chemical ingredients of products that are used and their effects, as well as the theory, technique and practice of both oriental and Western massage/bodywork therapy. Within the 1000 hours of education, you will have to complete a minimum of 150 hours of practice on a person.”

“I think massage therapy education the way it is today is a natural outgrowth of many factors,” said Werner. “The advent of Title IV funding was, predictably, a blessing and a curse. It actually made massage school more expensive, but also made it more accessible to a wider market. You can also argue that it raised the bar for minimum expectations above what people in my generation of students got from one teacher teaching every aspect of a course.”

It can be argued that with so many accredited schools nationwide and requirements varying from state to state, that this educational environment only seems to perpetuate the problems involved in portability and the perception among other health care professionals that massage therapists might not be qualified to be a contributor on the health care team.

Grant believes more needs to be done in the current system before degree programs should be considered. “Current 500-hour requirements are very vaguely defined in terms of evidence-based outcomes. If we are truly interested in credibility, then we have a lot more that can be done in terms of validity and reliability (consistency) within the hours we already are requiring,” Grant said.

Werner agrees that standardization is important. “One major factor is that each accrediting agency has different standards and schools often choose whichever is the least expensive to work with, or the least expensive to comply with. I don’t know much about the accrediting process, but I know that some accredited secondary or vocational school systems don’t have requirements about the order in which people take classes — they just put people in the stream and hope for the best — then you get students who are learning deep tissue massage before they learn anatomy. Who thinks that’s a good idea? But the institution is accredited and it’s the cheapest way to put people through the system, and who gets short-changed? The student.”

Ralph Stephens, a nationally recognized massage therapist, author, and continuing education provider believes that, “until we have standards for massage therapy instructors, degrees will not in and of themselves accomplish much of anything.” Stephens thinks any changes made in education must be done with one question in mind, “what will provide the public with a better massage?”

The Debate

The issue of portability has been a longstanding thorn in the profession’s side for many years now. One possible solution being considered is tiered credentialing, that is, a system that includes college baccalaureate degrees and beyond.

“Their was a time when I felt like our profession could not handle tiered credentialing because it is just so hard to organize massage therapists,” Werner said. “But as I have seen more [through my work with the Massage Therapy Foundation] about what the potential for our profession is if we make the opportunity for people who want to pursue advanced education — but we should not require it.

“I’m determined that however our profession moves forward when we think about the evolution of our education, there needs to be space for people who are not bookish, but do their work and they do it brilliantly, as long as they do it safely. But what we’re missing now is space for people who are bookish.

“Right now, if you want to get an advanced degree in massage, what we’re talking about is a master’s or PhD in public health, nursing, psychiatry or gerontology. Those are the only advanced degrees I know of. It’s time for us to have bachelors, masters and doctoral degrees in massage therapy — and not for everybody — but for the people who want to do it,” Werner said.

However, not everyone feels this is the best move forward for the profession.

“Our traditional medical system is a failure, why jump on that boat when it’s sinking?” asks Sohen-Moe. “In terms of baseline requirements, it does not take a rocket scientist to perform a safe, effective massage. While I am personally an advocate of lifelong learning and would hope that practitioners would choose programs that offer some depth as well as breadth, basic programs need to be offered.”

Stephens wholeheartedly agrees. “We need to reach the public with a better product as an alternative to the allopaths, working with other alternative providers to challenge the monopoly of the pharmaceutical-allopathic cartel.”

However, this leads to the question, if an expanded scope of practice were offered with degree-level training, which theoretically leads to more acceptance by the allopathic medical field, would more patients seek out massage as an option for care of pain management or musculoskeletal issues as opposed to seeking out a prescription for drugs? Ultimately, would this type of program lead to more acceptance in the mainstream health care community and are massage therapists ready to play in that field?

Ruth Werner absolutely thinks so. “There is a new emphasis on wellness and prevention and massage deserves a seat at that table and can absolutely play in that playing field, but if we scream and kick and pound our fists and demand a seat at that table, people with doctorates will look at us and say, ‘500 hours? Really?’

“The amount of money spent on massage therapy research is not commensurate with the amount of money the public spends on it and the reason for that is that there are not enough people who know how to write a good grant proposal,” Werner said. She continues, “the reason there aren’t enough people who know how to write a good grant proposal is because there is not a good degree program for massage therapists.”

Those that feel massage therapy is generally less scientific and more about the art of touch, say that something important will be lost if the profession pushes ahead with an advanced degree program.

“I fear the loss of the art of massage as we swing the pendulum to the scientific aspect of massage,” said Sohnen-Moe. “I’ve already witnessed a lot of that change in the past 15 years. Less and less people get into this field as a calling. I’ve had many technically accurate massages, but the newer practitioners seem to have something missing in their work.

“I think the way to go about addressing the education issue is to have specialty national certifications rather than advanced degrees. While I know this is a difficult and expensive process, I really think it’s the way to go,” said Sohnen-Moe. “We need to make sure our core competencies are there. Board certification is more valuable and gives us much more credibility. Doesn’t it sound better to say, ‘I am a massage therapist board certified in…whatever your specialty is.'”

And yet there are still others who feel the time for action in this area is now.

“There are enough of us who are standing up and saying there is a segment of our profession that needs to step it up and accept those higher standards and stop trying to get everyone to agree because we’re not going to agree,” said Lisa Curran-Parenteau, WIBB blogger and marketing and practice development specialist. “Let that natural separation happen. I love the nursing model. You’ve got nurse practitioners, registered nurses and licensed nurse practitioners and they all have a great vocational opportunity for themselves and they all spent different amounts of money for their education. They have a structure and everybody knows that it is and it’s portable.”

Is it now time for the profession to take responsibility for itself and the direction it wants to go? Is it time for therapists to “step it up” to market themselves and effectively communicate their experience and education? With licensure not required in all states, no portability, no defined education standards or consistent school requirements, does moving to a degree program make the most sense in providing a legitimate platform for qualified and motivated therapists to compete in this evolving health care landscape?

Where do you stand in this debate? Do you think that more people will be dissuaded from entering the profession because of the increase in educational costs if the profession required a degree? Do you think there should be a tier system with a college-level degree as an option? If there was a degree option, do you think more people would choose massage therapy as a first career rather than a second? Do you think a degree would provide more legitimacy in the mainstream health care system?

Neural-Muscle Connection Discovery Could Help People with Muscle Fatigue

Motivation. Strength. Will power. Physical condition. Stamina. All of these have long been known to contribute the extent to which humans are able to voluntarily activate muscles. But for the first time, investigators have discovered neuronal processes that are responsible for reducing muscle activity during muscle-fatiguing exercise.

The investigators say their discovery opens up new areas of research to help people who experience muscle fatigue related to illness.

“The findings are an important step in discovering the role the brain plays in muscle fatigue,” said investigator and neuropsychologist Kai Lutz. “Based on these studies, it won’t just be possible to develop strategies to optimize muscular performance, but also specifically investigate reasons for reduced muscular performance in various diseases.”

In an earlier study, the researchers showed that nerve impulses from a muscle, much like pain information, inhibit the primary motoric area during a tiring, energy-demanding exercise.

In a second study, using functional magnetic resonance imaging, the researchers were able to localize the brain regions

that exhibit an increase in activity shortly before the interruption of a tiring, energy-demanding activity—the thalamus and the insular cortex—and are thus involved in signalizing the interruption. Both of these areas analyze information that indicates a threat to an organism, such as pain or hunger.

The latest study indicates the inhibitory influences on motoric activity are mediated via the insular cortex. In tests using a bicycle ergometer, the researchers determined that the communication between the insular cortex and the primary motoric area became more intensive as fatigue progressed.

“This can be regarded as evidence that the neuronal system … not only informs the brain, but also actually has a regulating effect on motoric activity,” said investigator Lea Hilty.

Prolonged reduced physical performance is a symptom that is frequently observed in daily clinical practice, a press release noted. “It can also appear as a side effect of certain medication [and] … chronic fatigue syndrome is often diagnosed without any apparent cause.”

Masasge and How You Feel

Therapeutic Massage has been around for over 3000 years, but there has never been a more important time for massage than now, with people sitting at their desks for long hours working at their computers, the poor economy causing additional stress and people taking jobs that their bodies are not used to, to name a few.movie Mine streaming

The Value of a Massage

Eases low-back pain, neck pain and shoulder pain
Increases range of motion
Stimulates lymph flow—the body’s natural defense system.
Stretches weak and tight muscles
Prepares the athlete and helps recover him or her from vigorous exercise
Improves joint flexibility
Lessens depression and anxiety
Reduces spasms and cramping
Relaxes and softens injured, tired, and overused muscles
Relieves migraine pain
Relaxed muscles improve posture
Provides relaxation and stress relief producing a sense of well-being