During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
There are several types of research used in exploring the land of massage. They are categorized as basic and clinical research, quantitative and qualitative research, and analytical and descriptive research. Basic research is performed in a lab and involves the observation of massage on a cellular level. The knowledge obtained from basic research is then applied into clinical research, which is where experiements are carried out to determine how this knowledge may or may not be helpful in a practical setting. Quantitative research is the collection of data in the form of numbers, such as statistics and percentages. Qualitative research conducts interviews or analyzes pictures in order to understand human behavior. Analytical research looks at the why and how something has occurred and descriptive research is used to describe characteristics of an individual, group, or situation.
In my opinion, these are all valid types of research. Clinical research, or applied research, seems to be the most commonly used and, given that it is backed by scientific evidence, I can understand why. Clinical studies have helped us to understand the benefits of massage on a wide range of health ailments such as cystic fibrosis, eczema, and rheumatoid arthritis.
One of the best ways to determine the validity of research is through reputable sources. The internet contains a cluster of information. Knowing how to locate reputable sources will help to eliminate sifting and sorting through the cluster. Some examples of credible search engines include Google Scholar, PubMed, and Medline Plus. A good example of a reputable source is a peer-reviewed journal. Check for a level of consistency in information, such as with case series. Are there several different sources concluding the same results? This is a good indication that the information may be valid.
Science is a constant process of discovery, and the best way to improve out understanding of facts vs. myths is through research. Massage has been a healing modality for over 5,000 years. Within the last decade, we have learned a great deal about massage and its affects on the bdoy, both physically and emotionally, through successful research. Aa a result, massage has become more and more accepted for its healing properties in western medicine. It is important that we, as therapists, continue to expand our knoweldge of both new and old ideas. Through performing diligent research on both new and old ideas, we can improve the credibility of massage thearpy as a profession.
My reseach topic will discuss the idea that water removes toxins from the body after massage. Although this may seem logical, there is no scientific evidence that can atually back this statement. For starters, which toxins are we talking about? A toxin is a poison of plant or animal origin that induces an immune response. Often times, a therapist is referring to lactic acid, which is not considered a toxin, and a different topic all together. The human body has the ability to naturally cleanse itself of "toxins" through the liver, kidneys, and even digestive system. You can certainly promote the healthy function of these organs by drinking enough water, as well as avoiding stressors such as coffee and alcohol, but you will not be helping to flush toxins. In order for massage to gain acceptance in the medical community, we need to change the language we are using. When talking about "toxin," perhaps a more accurate term would be metabolic waste. Even then, it seems that this waste may be too chemically attached to targeted tissues to be released by massage. The National Center for Complementary and Alternative Medicine offers several theories on the affects of massage, but none point to toxin release. So, although offering your client a glass of water after a massage demonstrates good customer service skills, unfortunately it will not help them to flush toxins from their bodies.
In doing the research for this assignment, I have discovered that it can be easy to surrender to ides that have been floating around over a period of time. There are "truths" that we have been exposed to that simply need to be corrected. As a therapist, I certainly do not want to contribute to any false ideas about the effects of massage. I aim to be vigilant and to ask questions when in doubt. I want to encourage my clients to do the same.
References:
Chikly, Bruno, 2001: Silent Waves - Theory and Practice of Lymph Drainage Therapy. I.H.H. Publishing, Scottsdale, AZ, ISBN 0-970-05305-3.
Tarnopolsky, Mark. A., 2002: Metabolic myopathies and physical activity. The Physician and Sportsmedicine, 30 (6). (http://www.physsportsmed.com/issues/2002/06_02/tarno.htm)
Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther. 2007;30(3);215-27.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Using research in the arena of massage therapy to make decisions about treatment options for clients is a good idea. It can help address troubling theories such as the one that titles this paper. When making decisions that can significantly impact a client's well-being, it is certainly wise to look further afield for solid answers than just accepting an opinion of a fellow therapist or layman when not backed by solid evidence.
First, we should take a look at the question "What is valid research?" We need to look at what the types of research are currently found in the area of massage practices.
Research on massage therapy began to be published in the 1930's, with human and animal studies, on such topics as muscle atrophy and blood flow, although sample sizes were relatively small in these discussions. These studies were also flawed in that control groups were frequently absent. In the subsequent years, scientific research has rectified many of the rough tactics of earlier researchers. There are increasing amounts of research becoming available through clinical studies of a serious nature and the results are being made available to those interested through the means of professional journals and associations.
What types of research are valid and why are they valid for the profession?
The gold standard for scientific research is to have a large sample tested using a control group in double blind testing. These studies should have as large of a sample group as is feasible in order to expect dependable results. While large samples have been arranged in the past, control groups often were given the alternate modality of a self-driven relaxation therapy. This would have to be considered single blind research, as the persons involved in conducting the experiment would be fully aware that massage was being compared to some other modality and could somehow skew the results. It is not such a simple situation as can be found in other treatment areas, where a blue pill might be given to everyone involved with the administrators being unaware of which blue pills had the actively tested ingredients.
This frequently caused problems for many reasons, including the fact that control clients needed to be actively involved in their alternate therapies and frequently did not follow through with their assigned parts. Since the discovery that moderate pressure is needed for most massage therapy to be effective (1), control groups are now often given light pressure massage. This allows the control group to expect some benefit from massage treatment and also allows a means of double-blind testing in that the participating therapist many not be familiar with the findings of the above-mentioned pressure studies. They likely surmise that only the effects of light massage vs massage with more pressure was being measured instead of the true test of if massage was a valid treatment at all for the condition being studied, thus making it as close to a double-blind study as is possible in this area.
What criteria do you use to determine if the information is valid or correct?
The internet is a big place where anyone can publish their ideas. The researcher has to use discernment in determining if the source of information that they are reading is valid or not. Beyond checking the date of publication to ensure that you are seeing recent findings, there are a few questions that you can ask yourself about whether or not the information that you are presented with is from a reputable source.
Good sources of health information include:
Is research important in the massage profession?
Because what we do as massage therapists can impact someone's health for better or worse, it is in everyone's best interest to make decisions on treatment based on solid scientific research whenever possible. It is true that a measure of massage falls into a general "feel good" category. Even so, research has overwhelmingly demonstrated that stress reduction is vital for continued good health and mental well-being.
Outside of that, there are many persons that come to massage therapists for relief from a wide range of physical ailments. Knowing which techniques and modalities help, which are ineffective, and which may even exacerbate a given complaint, with some certainty, is vital for a therapist to successfully treat these conditons.
Conditions may exist in a client that are not the reason for why they wanted a massage, such as in the case where they have a backache but also poison ivy. During assessment, these issues should be brought out and evaluated prior to formulating a treatment plan or even in deciding if it is advisable to offer treatment at all. There may be times when we, as the practitioner, should deny service to the client, in full or in part, either for their protection or that of ourselves. Knowledge is power and reliable research is key to gaining accurate knowledge in all of the above areas.
The reason why I chose to check into research on whether or not massage spreads cancer and if it should always be contraindicated is becuase I have a personal interest in this topic, since I have a close friend with cancer who is currently receiving regular massages.
Review of research
cancer cell
In a question found on the Breastcancer.org site from 2010 (1) titled "Does Massage Contribute to the Spread of Breast Cancer Cells to the Lymph Nodes?", the answer given by the staff expert, Tracy Walton, L.M.T., M.S., indicated that uncited research points to the fact that exercise and hot showers would pose more of a risk of spreading cancer cells than massage, if increasing blood and lymph flow were dangerous to the cancer patient.
Looking further, the American Massage Therapy Association site has a page where this topic is closely looked at in a well-cited article. (2) In it, the way cancer spreads, or metastasizes, is discussed. Four ways cancer can spread are brought out with focus given to the overwhelmingly prevalent way lethal cancers are found to metastasize, which involved blood circulation metastasis. Since massage therapy significantly impacts blood flow, concern is warranted in this area.
The three steps of the process of metastasization are looked at one by one. The first is when the original tumor sheds cancerous cells into the body. The conclusion made in the article was that if the tumor was close to the surface of the body, that vigorous massage or hydrotherapy should be avoided in that area to minimize risk of expediting this shedding of cells.
Next the cancer cells need to stay alive while moving through the blood or lymphatic system living off of whatever nutrients they carried until they could re-site. Their opinion was first that the more vigorous the flow, the less likely it would be for a cell to be able to root in a remote location before it ran out of nutrient. Also,because since more active patients tended to do better in the recovery process because of improved physiology, exercise, which inherently increased blood flow, is generally considered a positive influence.
Finally, the cells need to latch onto tissue in the new spot to complete the migration. There appears to be no solid evidence, either for or against massage, as having an effect in this end stage of metastasizing. The article ends with summarizing that firm, vigorous and direct stimulation to superficial tumors should be avoided. This is best done through a careful pre-massage assessment which would include determining the exact location of any known tumors in the client.
Finally, continuing on to find some results of an actual double-blind study is information from the Journal of Pain and Symptom Management Report on a study conducted at the prestigious Sloan-Kettering Cancer Center (3).
The results indicated that massage should be applied to relieve symptoms in patients with cancer. This practice was, up until the time of this test, only supported by evidence from small trials and anecdotal evidence. No study had examined massage therapy outcomes in a large group of patients. In the Memorial Sloan-Kettering Cancer Center testing, patients reported symptom severity pre- and post- massage therapy using a 0-10 rating scale of pain, fatigue, stress/anxiety, nausea, depression and "other" categories.
Changes in symptom scores, and the modifying effects of patient status (inpatient or outpatient), and type of massage were analyzed. Over a three-year period, 1290 patients were treated. The findings? Symptom scores were reduced by approximately 50%, even for patients reporting high baseline scores. Outpatients improved about 10% more than inpatients. Benefits persisted, with patients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up. These data indicate that massage therapy is associated with substantive improvement in cancer patients' symptom scores. See figures in original article.
Do research findings support the statement/treatment or not and in what way?
After reviewing the cited articles and research, the information that I found tends to refute the statement that massage spreads cancer and is always contraindicated. While there are aspects that the practitioner should be mindful of when treating a cancer patient, research supports a viewpoint that massage is actually helpful to cancer patients in the areas of relieving pain, fatigue, anxiety, nausea, depression and other side effects of treatment of the disease, while posing no significant risk of spreading the tumor(s). Any modality or treatment with that sort of success rate should not be put aside out of groundless fear, especially when there is no clinical proof that massage has caused any harm to these patients.
Local contraindications do exist however, and it appears to be prudent to take them into account. These boundaries include:
What implications does the knowledge have for you and your practice?
Based on what I discovered in the research, and articles that I have reviewed on this topic, I believe that massage is not globally contraindicated, but, in fact, is actually useful to the cancer patient. It reaps significant positive results so long as appropriate boundaries to the client's individual situation are maintained. Since the benefits to the cancer patient are well documented in reputable research findings, and include a wide range of physical and mental improvements for the client, I would be happy to include such treatments in my practice using caution.
Additionally, since the population in our country trends toward older as well as heavier individuals, which are more prone to cancer, it can be expected that the number of incidences massage therapists see in this area will also increase. I foresee an expanding market for these services and it could even be wise to consider specialization in providing relief for this group of clients.
Sources
(1) Massage spreads breast cancer cells? http://www.breastcancer.org/treatment/comp_med/ask_expert/2005_03/question_13 Tracy Walton, L.M.T., M.S.2010
(2) Could Massage Therapy Promote CANCER Metastasis? https://www.amtamassage.org/articles/3/MTJ/detail/1803 Debra Curties Sept. 21, 2000
(3) Massage Therapy for Symptom Control: Outcome Study at a Major Cancer Center http://www.jpsmjournal.com/article/S0885-3924(04)00262-3/pdf Barrie R Cassileth2004, Andrew J Vickers September 2004
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
There are many types of research, each designed for a specific purpose, or to answer a particular type of questions. A few examples are exploratory, explanatory, qualitative, quantitative, descriptive (such as a case-study, observation, or survey), correlational (case-control study, observational study), semi-experimental (field experiment, quasi-experiment), experimental (experiment with random assignment), review (literature review, systematic review), meta-analytic (meta-analysis), and mixed methods research (such as the integration of quantitative and qualitative components). Any type of research that clearly shows empirical data relating to a research question, and answers that question in a clear and unbiased manner with evidence well designed to apply to the question at hand would be valid for massage therapy.
When determining if information found on a topic is valid and correct, it is important to make a few considerations. Who published the information? Where did they find it? If the information came from a research study, how was the study designed? How was the study performed? There have been cases, for example, where a research study was designed to produce an unbiased result; however, in the performance of the study, it became apparent that there was an inherent bias skewing the outcome. One way to test for bias is to replicate the study, something that often happens through peer review. For this reason, information is more often generally accepted as valid once it has been proven through a research study which has been published in a peer reviewed journal, and even more so if the study has been replicated, with those results also published. It is through this process of study, replication, and review that a body of work is built for s specific field of study.
Is research important in the massage profession? The importance of the research may vary, depending on the audience and the research topic in question. Let's consider a client that has been receiving massage therapy throughout their entire life, and, with each session, they experience an increased sense of well-being, incomparable to that achieved by other services that they may have received. This person very well may not be interested in the why and the how of the benefits of massage. Instead, they may be content with the proof of their own experience. On the other hand, we may also consider someone who is new to the massage profession, and who has had few or no massages. This person may not be sure about whether or not continuing to receive massage is worth the time and financial commitment massage sessions entail. In this case, it may be beneficial to be able to share scientifically objective information with this person, helping to paint a larger picture of what benefits they are likely to experience through undergoing massage therapy. It is also critical to have objective answers to questions about massage and disease, especially when it comes to contraindications or treatment for a condition.
Many people have heard the phrase "You should not massage the feet and ankles of a pregnant woman." It is something that comes up often on message boards and pregnancy blogs, with many women very concerned about the possibility of inducing preterm labor. Unsurprisingly, this idea inspires quite a bit of anxiety in someone who is, or may be, pregnant while seeking massage. This idea may have come from the fact, according to Pacific College of Oriental Medicine, that a small amount of oxytocin--a natural chemical involved in contracting the uterus--is produced by foot massage.
However, there is also a lot of contradictory information available. Livestrong.com actually contradicts themselves on this issue. In the article titled "Pressure Points to Avoid While Pregnant," author Erica Roth states that "according to the American Pregnancy Association, pressure points near the ankle are contraindicated during pregnancy, because, when manipulated, they can cause the pelvic muscles and uterus to contract. Contractions well before a woman's due date can lead to preterm labor, which is not safe for the child." Similarly, in the article "Foot Massage & Pregnancy," writer Jean Jenkins quotes a certified prenatal massage therapist, Rebecca Leary, as saying that "There are acupressure points in the legs, ankles and feet that correspond to the reproductive system. [Therapists are] trained to recognized and avoid these points on the feet of pregnant women, as they could send them into early, naturally induced labor." However, Jenkins also mentions the counter argument that "many professionals in the medical field disagree, not with foot massage in pregnancy per se, but with claims that massage and reflexology can be powerful enough to induce labor." Jenkins also states that "most obstetrician/gynecologists agree that foot massages, done gently, help to decompress agitation and anxiety and therefore, can make the experience of pregnancy more comfortbale and enjoyable, for both mom and baby."
In an article on the website for the Associated Bodywork & Massage Professionals trade organization, abmp.com, titled "Proceed with Caution: Foot/Ankle Massage for Pregnant Client," Leslie Stager writes that "despite the prevalence of this contraindication, there is no evidence that ankle massage is dangerous. The concern may have developed from specific information that was gradually altered through oral transmission, eventually becoming generic and essentially useless."
From the information presented, it would seem that the idea that acupressure points on the feet and ankles could inadvertently trigger contractions, and possible preterm labor, is more myth than fact. While based in small truth, it is a story that has been told, and retold, and become part of the fabric of common knowledge. However, common knowledge does not hold the same weight as empirical, fact-based, evidence and there is no evidence found to support the claim that massage and reflexology can be powerful enough to induce labor in pregnant women, at any stage of pregnancy.
As a massage therapist considering performing massage on pregnant clients, it is always best practice to be certified in prenatal massage, and make sure not to work outside your scope of practice. If you feel unsure, or unsafe about massaging a client, it is always best to err on the side of caution until you have acquired more and valid information of the subject. Take CEU classes on pregnancy massage, talk to certified prenatal massage therapists, and keep up with the latest research in respected research journals.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
I. Why research?
Research design common in the field of massage therapy includes randomized, controlled studies; case studies; and untested theoretical frameworks. While less common, survey research is certainly a viable option for determining client experience or perceived results. In theory, all these types of research are valid, but we must remember a study is only as valid as its methodology. Theoretical framework must be solid; it is not sufficient to collect random data from a sample, of, say, pregnant women in the hopes of finding something interesting. If I hypothesize that regular prenatal massage reduces risk of preterm delivery for women in high-risk pregnancies, my sample should include women in high-risk pregnancies. The control group would receive no massage, and the experimental group would receive massage.
First, I need to define "high risk" and determine how I will operationalize my variables. To ensure that women in my sample are more or less equivalent, I will limit my sample to patients in a high risk hospital ward. The experiemental group will receive an hour-long relaxation massage three times a week, to include the same massage techniques. The control group will sit with a massage therapist with the same frequency, but will not receive massage.
This design raises some questions. High-risk pregnancies are not identical and any number of confounding variables might affect my results, affecting the study's internal validity. The experiment is not double blind, meaning the massage therapist knows which subjects are control and what are the experimental group. This many not even be single blind, as subjects are likely to deduce they are the control group when they receive no massage whatsoever (and ethics in research requires human subjects are aware of the nature of the experiment). A small sample size will compromise the study's external validity. How will I measure "reduced risk" of preterm delivery? Length of hospital stay before delivery? Total number of week's gestation before delivery? Finally, once my study makes its way through the peer review process and is published, what will it mean if researchers fail to replicate my findings?
Astute massage therapists will have these questions in mind when analyzing the latest research. They will also be mindful of the source: is the study published in a peer-reviewed scholarly journal? And another layer to the onion; is this journal ranked and what is its impact factor? A case study or an experiment where n=1 may raise some interesting questions, but we should proceed with caution in terms of drawing any conclusions. Questions in science are seldom cut and dry. Meta-analyses or literature reviews can help clarify the latest consensus in a particular field of inquiry. Admittedly, staying current on the research can seem daunting. But how else can we know if our therapies produce any results? Evidence-based practices separate the professionals from the quacks. Massage is not a science, but that doesn't mean it can't be studied. Any inquiry that furthers our understanding of the natural world (of which massage is very much a part) is fundamentally beneficial, even to massage therapists who are not clinically minded--and their clients. Knowledge is power.
II. The question
With that in mind, I have undertaken a review of an unrelated research question: Can fascia be stretched to release adhesions?
Fascia is the web of connective tissues throughout the body. It is, according to Jean-Claude Guimberteau, a network "of total tissue continuity" (2016), linking the entirety of our physical being with itself. The theory behind myofascial release is that fascia can become adhered to surrounding structures as a result of trauma, injury or misuse (Osborn, 2016). Only in recent decades, however, have scientists come to consider this tissue's importance and an emerging body of research aims to understand it.
A number of studies concern self-myofascial release (SMR) as foam rollers are widely used among athletes to aid in recovery, improve performance and increase range of motion (ROM). SMR is not shown to improve performance (Healy et al, 2011; Schroeder and Best, 2015), although as Healy et al. also find that SMR reduces fatigue, they theorize SMR could indirectly improve performance as athletes are able to train longer and/or with more intensity. Foam rollers have been shown in multiple studies to improve ROM (MacDOnald et al, 2013; Schroeder and Best; Grieve et al, 2015) and, Schroeder and Best, in their exhaustive literature review, find that SMR improves soreness.
Studies consider myofascial release at the hands of trained therapists, as well. Anne Walton (2008), in a single case study, found MR lessened the severity and length of symptoms in a woman with Raynaud's disease. In a randomized, controlled study of plantar fasciitis (Suman et al, 2007), a control group received traditional treatments (including plantar fascia stretching exercises). The test group received the traditional treatments in addition to the MR. MR decreased pain and increased foot function.
Tozzi et al (2011) looked at cervical and lumbar pain using dynamic ultrasound. Two blinded experts rated cervical sliding for the cervical group, reno-diaphragmatic distance and neck bladder mobility for the lumbar group. Surveys were administered to participants on the day of treatment and the third day following treatment. Myofascial treatments were found to release areas of "impaired sliding fascial mobility" and decreased pain.
But are these findings unique to myofascial techniques? Could a therapist achieve the same results with, say, Swedish massage? In a study of 12 fibromyalgia patients, both Swedish massage and MR improved symptoms, although MR showed "consistent focal improvement" in the body while Swedish massage did not (Lipton et al, 2013). More study is needed, as the mechanism of MR is not understood (Schroeder and Best).
In summary, MR and SMR have been shown to lessen symptoms and aid recovery. Findings support the claim that fascia can stretch to release adhesions, but questions remain. I found no paper directly showing that results are attributed to releasing fascial adhesions (although Tozzi et al were closest)--it is possible that we're not testing what we think we're testing. I am curious what technology can identify an adhesion, and how that might further research. I would also like to see more long-term studies and larger sample sizes.
Certainly our understanding of this integrated web within the human body lends a more holistic perspective on movement, illness and trauma. Myofascial release isn't the only game in town, either. More research is necessary across fascial techniques and also with other modalities--I would like to see a follow-up to Liptan et al's provocative pilot study. And finally, for this massage student, greater understanding of statistical methods is also a must. I will be interested to deepen my hands-on undeerstanding as my education progresses; ultimately I would like to apply this knwoeldge in my proactice.
Works Cited
Guimberteau, Jean-Claude. "The living fascia." Massage & Bodywork, 2016
Grieve et al. "The immediate effect of bilateral self-myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility; a pilot randomized controlled trial." Journal of Bodywork and Movement Therapies, 2015.
Healy et al. "The effects of foam rolling on myofascial release and performance." Journal of Strength and Conditioning Research, 2011
Liptan et al. "A pilot study of myofascial release therapy compared to Swedish massage in fibromyalgia." Journal of Bodywork and Movement Therapies, 2013.
Macdonald, Penney et al. "An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force." Journal of Strength and Conditoning Research, 2013.
Osborn, Karrie. "Addressing fascia with myofascial release." Massage & Bodywork, 2016
Schroeder and Best. "Is self-myofascial release an effective pre-exercise and recovery strategy? A literature review." Current Sports Medicine Reports, 2015.
Suman et al. "Effectiveness of myofascial release in treatment of plantar fasciitis-a RCT." Indian Journal of Physiotherapy and Occupational Therapy, 2007.
Tozzi, Bongiorno, et al. "Fascial release effects on patients with non-specific cervical or lumbar pain." Journal of Bodywork and Movement Therapies, 2011.
Walton, Anne. "Efficacy of myofascial release techniques in the treatment of primary reynaud's phenomenon." Journal of Bodywork and Movement Therapies, July 2008.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
The article "The Painful Truth, Helping Clients Manage Chronic Pain," by Mark Liskey, in the November 2015 issue of Massage & Bodywork, addresses the ethical dilemma in dealing with clients whose problems cannot be resolved by manual therapies alone nor by any other means as well. These are cases that can really only be managed and/or co-managed, not "cured."
Liskey discusses the various pain models that people may employ to cope with chronic pain and how to recognize them in your clients. He discusses then how to deal specifically with each psychological coping mechanism so as to ensure the most refine and effective treatment plan.
It was enlightening to learn that there were different perceptions of pain and responses that people utilize/embrace to deal with their chronic problems. And in order to be successful, the therapist's approach when interceding needs to be tailored more specifically to the pain model in which the client is operating.
In most of these cases only pain relief, not a "cure," can be the aim of treatment and it is unethical to promise a goal that is unrealistic or unattainable. It is our responsibility to help direct the client to the most positive outcome and not to inadvertently impede or interfere with improving their quality of life. Not recognizing a pain model can have negative biopsychosocial effects.
Depending on the pain model, the therapist may need to support massage with strategies ranging from self-massage instruction, ergonomic advice, encouraging functional activities that don't trigger/exacerbate symptoms, to referring to vetted healthcare professionals within the area (diagnosticians, counselors, psychologists, pain-control specialists, etc.) when a case progresses outside their scope of practice.
In my practice, I hope to be more cognizant of the above factors in dealing with people who have been diagnosed with chronic conditions. It brings home the importance of establishing a network of health care professionals that I can feel comfortable referring to and with which I can co-manage cases. It also actually reduces the pressure of attempting to manage these difficult cases alone. Treatment outcomes are more likely to be positive if the physical, psychological and behavioral components are all considered.
Acknowledging, recognizing, and understanding the various chronic pain models and their varying behavioral impacts can help guide the therapist in how best to direct treatment and help improve the client's overall quality of life, even if he/she can not completely eliminate the pain.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
As a person who always tries to have several hands in many baskets, and places enormous value on my free time, I was immediately drawn to the title of this article: Passive Income: 3 Ways to Set Yourself Up for Success, by Coach Cary Bayer from Massage Magazine, December 2015. Entering my 30's last November was a bit of a "wake-up call" for me, in terms of thinking of my financial future, and exploring ways to ensure my financial stability through retirement.
Though massage is typically thought of as a strictly hands-on, in-person profession, Bayer explores 3 models in which massage therapists can apply their skills to receive income without having to do any physical work. The first strategy the author offers is entitled Sessions other Massage Therapist Perform. This business strategy appears to work best once a therapist has established their own booming practice, to the point where there is a long waiting list for new clients to be accepted. Bayer suggests that instead of simply referring these "wanna-be" clients out, that the therapist instead hires other therapists to work for them, and splits the price of the session 60/40. The hired therapist would receive 60 percent, while the primary therapist would receive the remaining 40 percent for the providing the overhead and client.
The second suggestion for passive income Bayer shares with the reader is product sales. By establishing a relationship with a wholesale company selling wellness products, you can often receive a 40% discount from buying in bulk, and thus earn profits from sales. You are also helping your clients by providing them with a "one-stop shopping" experience. Of course, they recommend that you only buy and sell products that you already believe in or are recommending. Baylor concludes by encouraging the therapist to use a gentle marketing strategy, instead of pushing products on their clients.
The last possibility offered is entitled Affiliate Marketing. Baylor explains that this is an arrangement made between individuals and businesses loosely affiliating them to each other in some way. For example, a friend in a non-competitive, but relevant business, such as a yoga instructor or concierge can refer clients to you, while you simultaneously refer your clients to them. This can also include percentage fees for the referral, which are kept by the referring party. Personally, I think it would be more advantageous to work on a system of barter, unless of course, one party is getting more referrals than the other, which I suppose is possible and potentially complicated.
After reading this article, it seems like human capital and connections are at the root of passive income sourcing. The second two business options, which Baylor describes, seem most appealing to me. I have always enjoyed networking, and like the idea of bartering referrals to friends in supplemental lines of work for a win-win outcome. I plan to explore cross advertising with other service providers I meet.