Raising Awareness for Prenatal and Postnatal Care in NYC

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Raising Awareness for Prenatal and Postnatal Care in NYC

 

Miles for Midwives helps raise awareness for prenatal and postnatal care in New York. 

Raising awareness for prenatal and postnatal care in NYC

Every year we are fortunate enough to participate in some great events through some of our amazing friends. This year we ran the Miles for Midwives 2018 5k run in Prospect Park, a fantastic event that is also child friendly. Miles for Midwives is a professional organization that supports midwifery and midwives in New York. Their mission is to help raise awareness to important issues surrounding birth, prenatal and postnatal care. Last year Miles for Midwives raised $35,000 for their organization through their fundraising.

What is a midwife you ask? Midwives are independent practitioners that provide healthcare — maternity, gynecologic, reproductive, contraceptive and primary healthcare — to women from adolescence through post menopause, and to infants up to 28 days of age”.  Midwives can help you make healthy choices for birth and after-care, working with your health care team. 

Why focus on women’s health and Prenatal/Postnatal Care?

The United States has the unfortunate position of being one of the worst countries for infant and mother mortality, especially for minorities, despite the United States being one of the wealthiest countries in the world. If you would like more information on that subject, check out this NPR article that is fully linked to research. 

Female complaints, such as chronic fatigue often often go untreated due to not being taken seriously, and women are often subject to longer wait times than men, therefore medical professions that focus on women’s health are incredibly important. That is not to say women are not getting great care because there are a number of resources women can use throughout their lives to improve their chances of getting what they need when they need it. Midwives are just one of the resources. It is, however, important to always remember that a mother may not be getting great care, and that keeping alert for signs of both mental and physical distress are essential as part of a health care team. 

Our care-team often work with pregnant women and women in their fourth trimester (what is the fourth trimester?)  One of the most important jobs a massage therapist can fill is to spot potential problems and refer people to the right kind of health care. Consequently, we thought we would take some time to provide a little reader information on some of the potential problems and health care concerns that our care-team often intercepts. 

Pre-baby we often focus on pain and stress management in our office but during intake we ask for a full health history. Headaches, swollen limbs, faintness, over-fatigue, and numbness and tingling can all be signs that you need a referral out, and your massage therapist should be happy to give you one. Over the course of my career I have referred a number of patients out for similar reasons, only to learn later that we were able to intervene early in an issue, which avoided a more serious problem later.

Beret Kirkeby Massage TherapistI am currently pregnant, so I understand how confusing some of the symptoms can be! Many of the warning signs are also symptoms of pregnancy!

Additionally, given pregnant woman sometimes have changed their lifestyle, it is extremely important that mothers know there are resource available to them. Letting a mum to be know there is help available to them can be invaluable; they just need to know to look in the right place.

As massage therapists, when we sit down with someone and spend an hour with them facilitating a restful state, we have the luxury of time that medical professionals often don’t have so we can often direct women to resources that they need, such as lactation consultants, doulas, midwifes, and pelvic PT’s. Additionally, we can help a woman understand that it is okay to take an hour a day to seek help with us or another practitioner to help with their stress management.

After the baby is born, it is especially important to continue with self-care. Many women simply do not know help is available for them, mostly because women do not talk about the problems they are having. In fact, after birth 1 in 10 mothers continue to experience pelvic pain after the 3 month mark and after their first vaginal birth, 21% of women may experience incontinence.

Massage therapists who do a quality intake and know the statistics can help steer women to great referrals when they come in for unresolved pain issues or complications. 

What can you do to help? 

Continue the conversation on women’s health and participate in great events like the Midwives for Miles next year!

 

Body Mechanics Orthopedic Massage, Prenatal and Postnatal Care

1 W. 34th St, #204

NY, NY, 10001

646-709-2280

 

 

 

 

 

Does your Massage Consent Pass the Peanut Butter and Jelly Test?

Consent, Massage &Peanut Butter & Jelly

*Full disclosure, I believe I learned this exercise in grade school creative writing.

Frequently when talking to clients you may think that you are communicating effectively and giving a great consent when you actually are not. This failing actually massage consenthappens with everyone at some time. People are full of funny little quirks. If you ask them if they understand, they may say yes when they mean no, or you yourself may unintentionally overcomplicate the matter in order to show you understand when you don’t understand. To make things even murkier, lurking below our psychology, the actual words we choose may have a totally different meaning to another person based on the context, their past experience, and the desired outcome.So how do you know if you’re really making sense and connecting on any legitimate level?

I would always advocate for clarity and simplicity of speech, but sometimes even when you think you are being clear you are not.

This recently happened between a staff member and a client. As the mediator, I listened to both sides of the event, and both thought they had clearly communicated their thoughts but both walked away completely at odds with the outcome. So what happened?


 

-The client had expressed that her shoulders were tight and her neck needed work

-After a full intake, the therapist confirmed that she agreed and that she also wanted to work on those areas and described “We have 30 minutes. I would like to spend about 15 min on each area. How does that sound?”

-At the end of the massage the client was unhappy and stated, “Although I thought the massage was quite good, I asked for my neck to be done”

-In talking to the therapist, I learned she had performed a 30 minute massage, with 15 minutes on the shoulders and 15 minutes on the neck, but she had performed the majority of the cervical massage prone, rather than supine because she felt the client was very relaxed and did not wish to ruin that therapeutically. As the client was use to the neck treatment having been performed face up, she assumed it had not been done and left unhappy. 


 

Even though both parties sat down to communicate formally, because of the personal histories they brought to the table, they failed to reach clarity. For reasons like this, and many others, I really recommend putting your consent through the peanut butter and jelly test. It goes like this:

Write instructions for making a peanut butter and jelly sandwich to an alien, who does not know anything about this planet. 

While the task seems simple enough, you will soon find you are going to run into problems when you start critically thinking about things such as:

 

  • What is jelly?
  • What is a plate? What does that look like?
  • What is a knife?
  • How do you determine amounts?
  • What are descriptive terms? What do they mean?

Through this practice, you begin to understand there is a LOT we take for granted in our communication, even when relating to other professionals. Words like ‘massage, trigger point, therapeutic, deep, strong, sports, etc’ may have lots of meaning, some meaning, no meaning, or a different meaning, depending on who you are talking to. So if you think you are communicating clearly or if you suspect that you’re not, try running through the peanut butter and jelly test and see what you are taking for granted.

 

 

Plain Jane Consent for Massage

Being Simple For Your Consent For Massage Is A Best Practice That Will Take You Far…

One of the things I believe is really important in health care, for a number of reasons, is that consent not only must be given, but given in a way that clients understand what they are agreeing to. All too often in health care, especially in manual therapy, there is the tendency towards a professional chatter that is trendy , but to the patient really has no meaning. This is one of the places where a patient/client differential might lurk unseen even by someone with the best of intentions.

Frequently in my space we will hear from reception that a client is looking for “fascia work, trigger point or ART”. We have an extensive intake at our location where we actually sit down with patients beforehand, and generally what we find is that MOST people do not actually know what those things are, they are seeking those things based on research, advice, trend or referral.   Typically people do not feel comfortable admitting what they do not know to another person such as in an intake.  Therefore, health care workers must try to provide a safe environment to guide people through letting go of choices that may not fit and making choices that make sense for them.

I always advocate for using medical terms whenever possible when referring to anatomy and professional conduct. However in talking to clients, we have to let go of that vernacular.  Patients are not just there for a massage–they want to understand what is happening to them.   Consent is not consent unless the patient fully understands what they are agreeing to.  When proposing a verbal contract to a client on a path of treatment, we need to speak in plain descriptive language that the person can understand.

With that in mind, I have put together a list of common “modalities and terms” that we use frequently which have virtually no meaning to a client (and sometimes not even to us) along with some suggested substitutions. Remember, I am not trying to describe what is  happening in the body during the modality (some of that is up for grabs anyway), but what the client would anticipate or feel.

Here is a quick example of what I am suggesting.

Rather than saying: ‘So for this treatment, after warm up,  I think we should do about 30 minutes of fascia work and trigger point to the hamstrings’

The practitioner could instead say ‘ What I am suggesting for this treatment is about 10 minutes of warming the tissue, using stroking motions with lotion.   Then what I would like to do is start working the skin by pulling it gently, moving it around and torquing it.  Finally we will progress to some deeper longer holds using firm finger or elbow contact where I am going to focus on the area just above the knee and below the hip

Here are my suggested possible substitutions for industry fluff

Fascia work I am going to preform skin stretching, pulling or traction of surface tissue, torquing of the skin

ART / Pin and Stretch I am going to be holding the muscle and resisting slightly (or pinning it down) while moving it through a range of motion.  Alternatively:  Holding a muscle and pinning it down while you move it thorough a range of motion.

Stretching  I will extend the muscle until you feel tension and hold

PNF stretching / contract relax etc Take you into a position of stretch for the (effected) muscle and then ask you to contract, resist, or pull against me possibly in a sequence

Trigger point I will use sustained pressure into the muscle using fingers, thumbs or elbows.

Lymphatic Drainage Using very gentle pressure, I am going to try to simulate the natural movement of the tissue that would occur with muscle pumping when the body is relaxed.

Deep tissue We can work deep specific. I will listen to your verbal feedback and from what I feel physically, and make adjustments to my pressure as needed.  If there is an area where you feel that you need more pressure, we can specifically target that area.

Distraction- I will gently hold the joint or tissue to create space between the surfaces inside the joint that we cannot see.

And so on, and so forth. If you are a science based practitioner, this  jargon that we use daily  helps keep the waters murky as to what we are actually doing. It’s a best practice to be simple and clear. Plain Jane never had it so good.

 

Massage in NYC, My journey – Part One

I love NYC

Massage In NYC

Part One- My story

This blog likely will not win me any friends, but it’s time to discuss what’s wrong with massage in NYC.
Before we can do that, however, we need to discuss my journey and why I feel comfortable saying New York, with one of the highest standards of practice for massage in the U.S., is doing a terrible job, how I ended up practicing in NYC and what a horrible struggle it was to be able to practice here.

In 2011 I moved back to NY from Canada to be closer to my family. I sold my house in Canada and quit my job where I had been working as an RMT (Registered Massage Therapist) in a pain clinic for insurance claims for four years. The plan was to take a brief two month trip to Thailand, where I could take a vacation, and practice teaching Thai massage while I waited for my New York State massage therapy license to be approved. Knowing that these things take time, I applied for my license well in advance of leaving for my trip. It was a wait that extended my trip to nearly a year, totally unacceptable based on what I learned about New York State licensing requirements. What a waste of taxpayer dollars.

The Ontario Massage Program

First I guess I should explain what massage is in Canada, because it is not the same as it is here in New York. Massage in Ontario is a full medical profession that requires a science prerequisite to even apply. Most candidates are already college graduates by the time they enter the program, and the field is attracting the kind of student that would want to be a nurse practitioner or physical therapist. The program itself is science based, and has a scope of practice similar to that of a physical therapist state-side. We, as massage therapists in Ontario, took blood pressure, temperature and special tests for physical problems on a daily basis. Our place is firmly set as the gateway to the health care continuum. Patients with physical problems are assessed and checked for red flags, and if it is something that can be triaged on-site within the therapist’s scope, we treat. If not, they are referred out to the appropriate professional.

The value in the Canadian program lies specifically not just in the treatment, but in the ability to act as medical professionals who can prevent those with physical problems that do not require a doctors attention from actually going to the doctor, while at the same time recognizing those folks with symptoms such as high blood pressure, early signs of disease, or pre-stroke symptoms and getting them attention right away. In Canada, treatments are designed to fit the problem. We do not specialize in modalities. If you had to give the style a name the best description would likely be classical rehabilitative manual therapy and movement.

When I applied to the Ontario RMT program, which is 2300 hrs of education, I had already been to college and taken pre-med classes, but even for me the school was challenging. It’s not just the content that is difficult, but the methodology of the structure, which forces you into critical thinking patterns. Once you have learned a skill, or piece of information, it is free game to show up anywhere as questions on the test, while about facts, are also about the application of information given outside forces. You must constantly compare what you know to “what if this happens”; always looking at a thousand-and-one possible outcomes….because it might show up on a test.

To give you an idea of the educational environment I can share with you this example: I remember clearly going to my teacher after another girl and I had done poorly on a practical test where we were asked to perform a fifteen-minute treatment for rehabbing an iliotibial band syndrome in a sub acute stage of healing. In such tests we would be asked to show a treatment with massage, exercise on the table, stretching, and also home care broken down into carefully timed segments, always obtaining the appropriate medical consent highlighting the risks and benefits of treatment. We were furious as our school was highly competitive for grades. Our complaint was that we had never learned the particular condition we had been tested on. Our teacher was completely unsympathetic to our issue and let us know that ‘given that we knew the anatomy and friction syndromes in general we should be able to figure it out and that we could not always expect things to go as planned in treatment so we had best get used to thinking about things and doing our best’. So lesson learned in RMT School; you can get tested on things you do not know—and pass—as long as you can critical-think your way out of them. Critical thinking is the passing grade.

The Canadian RMT program teaches college level anatomy, pathology, and clinical skills such as range of motion, charting, medical shorthand, and strong communications skills. It teaches assessment of conditions, and the ability to accurately define an injury into acute, sub acute and chronic. It runs over two years, with multiple internships in clinical settings. The program ends in a 2-day extensive government test (OSCE). Day One is a written exam and the second day is a manual exam designed to test your safety and critical thinking for real world application in a medical setting. It’s the kind of test that makes you weak in the knees. It is a program that prepares you to be able work with stroke patients in hospitals, breast cancer patients, hip replacements and general therapeutic care from day one.

Now: The New York Massage program

The New York Massage program to which I applied for my license requires 1000 hours of education and requires no prerequisite. The classes are not college level (although some might be depending on where you go), and ends in a written exam of 140 questions during which you must stay in the room at least 30 min to complete. It is also a non-scientific program. It includes Eastern massage as well as a number of theories and techniques not backed by science or the medical profession. The New York massage requirements prepare students to work at the entry level of spa work, or in other words, to be able to give a good relaxation massage.
Because I had been practicing for four years in Ontario, rather than five, I fell just shy of being grandfathered in to the New York state system. That process would have simply taken into account my experience as part of my education. Instead of that process, I had to go through a process of ‘educational evaluation’. In my naïveté, I believed that coming from such a high standard of treatment into one that, by comparison, was so much lower that the process would be easy. My point in sharing this is not that I think I should have been allowed to practice without evaluation (remember, I am coming out of a background of high evaluation and heavy government control and regulation), it’s that the standard in New York is meaningless, the process is arbitrary, and does not evaluate in ANY way competency or your ability to practice safely. Getting a massage in NY could be one of the riskiest actives you do…and we will go on to that in another blog.

 

The licensing process, more or less (a lot less because it was way more ridiculous than I will write) and the bureaucracy was absolutely astonishing.

Before I left for Thailand I had submitted all of my credentials and paperwork I needed to get the ball rolling. The first thing “Maureen, my adviser ” from New York state did was request my transcripts….but not just the normal transcripts from school, they want to see a syllabus on every class I have attended for every day of school, for every class I have ever taken, including continuing education. I call my Canadian school and request them and there is extensive paper work and money shuffled back and forth. The registrar of the Canadian school is horrified and angry. She refuses the initial request from me and calls New York to tell them that the classes are college level classes and there is no need to request a daily transcript of the education because the education reads like “anatomy level 1, anatomy level 2, pathology level 1 and pathology level 2 and that the information on what is included can be found on any of the guidelines for education and that those classes would be accepted for transfer to any college”. For a while I am stuck in the middle calling back and forth long distance from Thailand between Maureen and the registrar in Canada. The registrar in Canada finally tells me she has had it, “New York State is unbelievable and, honestly I don’t want to answer the phone when they call”.

 

For a very long time I hear nothing from New York…we are talking months here. Occasionally I email Maureen from Thailand and ask how the process is going and am rewarded with statements like “New York has very high standards, honestly the likelihood that you will be approved is slim, you will probably have to go back to school”. On one of my emails a man named Chad responds and tells me that even IF they decide my 2300++ of medical education meet up with New York States 1000 hour requirements they would still need to see my board exam from Canada to let me practice, a minor detail Maureen has omitted telling me. Again, they do not just want the results of the exam, or what is legally on it, they want to see the ACTUAL exam I took.
Now I start calling the Canadian College of Massage Therapists trying to find someone who will help me. I am referred to someone high up on the chain who basically tells me that I am crazy, and that Canada would never ever let any test be seen by anyone for security reasons. She says that New York State can find out what’s on the test by looking at their guidelines and that is suitable for every other country. I try to arrange a call between the two boards and neither will talk to the other. I keep calling Canada, because I am growing increasingly desperate. It has now been 6 months (not counting the initial set up before I left) with no results. New York will not talk to Canada, Canada will not talk to New York; both say it’s my problem. This goes on for another month or so until Canada officially tells me if I call the office again they will suspend my license. I have not yelled at them or anything like that, although I have cried, but I am desperate to make them understand that if New York does not see the test answers they are not going to let me practice.
After seven months overseas I come home to New York for Christmas and my mom finds someone named Harrison at the New York State office who will talk to her about my case. He pulls my file and says that they do not have all the forms they need, which is what the hold-up is…um no one mentioned this. I had been emailing asking what is going on for months. So we go about getting Form 2b submitted, which shows I had been practicing for 4 years. He also says they still need to see my test…at this point I genuinely become hysterical, because I cannot get that test. I tell him if I call Canada again they will take my license. At this point I guess he feels bad for me and explains to me that NEW YORK STATE WOULD NEVER RELEASE THEIR STATE TEST EITHER. And with a chuckle, he says something like “I know it’s a bit unfair, and it’s a catch 22 but that’s the way it is”. I am dumbfounded, but in my month home they announce that they will at least let me sit for the test, the next round of which is of course not for 6 months since all their stonewalling caused me to miss the test in January. The entire process only took about a year and a few months….

So now I started preparing for the New York State test. I knew I was coming from a higher education to a lower one, but at the time I did not know how much lower it was. I, like many of you, assumed massage was massage no matter where it was taught. So I pulled out all of my books and started to study. The Canadian test covers a huge bulk of information; pretty much anything in human biology is fair game, plus laws and clinical studies. It’s overwhelming, so that is what I studied. The New York test was an unknown quantity, and not having gone to school here I had no idea what to expect. I hired a girl who was a tutor to meet with me and talk about it. She gave me a practice test to look over. New York’s laws and regulations took up one online page, so that was not too hard compared to Canada’s entire book on regulation, but what concerned me was there were 20 questions on the test pertaining to Eastern massage and meridian work. While I have taught Thai massage, I can tell you point blank I have 0 experience with any sort of non-medical massage theory. She drew up a chart for me outlining ‘wood, fire, air and whatever the last one is’, the hours their symptoms appear and all related material. This is what I used to study from for the test.

The test was held downtown at a city college. I remember standing outside. It was pouring rain. I was next to a girl who told me she had failed 3 times…which made me nervous. They divided us into groups eventually and we filed into small school rooms. There was zero security, you could go the bathroom anytime you wanted and I remember thinking, ‘My god, anyone could cheat on this test’, a total opposite from the high security of Canada. At last it began and the proctor told us we had to stay in the room for at least 30 min. It took me about 20 to finish the test. As I read through the questions, I have to tell you, I was downright embarrassed for New York. How low was the educational requirement that this was the test? None of the information I had studied from Canada was necessary. The questions were general and broad.  My impression was that the test was cursory, and that anyone, with ANY training could pass the test.  The only question marks on it were of course the meridian questions…which I had learned by memorizing a chart without ever attending a class…which in turn begs the question, what the hell are they teaching if I can memorize a chart and pass? I left utterly stunned. What on earth is wrong with New York massage? This is what they were keeping me from, what they were SO concerned I would not qualify for? Little did I know that this was just the beginning of a journey that would highlight just how different massage therapy can be.

*I completely realize some people in NY will be upset by this. My stance is not that you did not work hard, its that New York State has failed to do an adequate job. In the next section I will go over what I have seen here that I find disturbing and dangerous by health care standards.