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Science-Based Educators for Massage Therapy

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Science-Based Educators for Massage Therapy

Body Mechanics’ own Beret Loncar was recently featured in an article in Massage & Fitness Magazine, which highlighted some of the top educators in the field of massage therapy for those in the United States and Canada. One of the key points author Nick Ng makes is that reliable and current information can be difficult to come by for massage therapists. That’s not to say that many teachers and providers don’t have valuable things to say or techniques to teach, but many massage therapy educators are also teaching outdated or incomplete ideas as well.

All medical fields go through growing pains where tradition will sometimes clash with science. The physician Ignaz Semmelweis was derided by his peers when he proposed that washing his hands was the reason his patients had a drastically lower incidence of death during childbirth when compared to the patients of his colleagues. Semmelweis’s peers resisted hand washing because it was not something they (or the people who had come before them) had ever done, so they saw no reason to change. It was not until years after Semmelweis’s death that the rest of the medical community eventually accepted hand washing as a standard practice.

Within the past 10-15 years, much of the research in physical medicine and pain management began to point to the need for some major paradigm shifts in how we understand many things including the effects and implementation of massage therapy. We are keen to give credit and homage to those who have come before us for doing the best that they could with the information available at the time, but in order for our field to advance, massage therapists must be willing to embrace evidence over eminence.

Ultimately by growing with and adapting to new research, massage therapists are able to provide better massage treatments and improved outcomes for those who they serve. That’s why the environment at Body Mechanics cultivates continual growth and encourages therapists to challenge what they do and don’t know. Even if it’s uncomfortable to change, at the end of the day our primary focus is on getting the best results that we can with the knowledge that’s available.

One of our favorite resources for keeping up with current research and trends is Massage & Fitness Magazine. Most massage industry magazines usually include a few authors who appreciate the ever-changing nature of research in related fields, while the rest of the authors will mostly share opinions on ideas they’ve had passed down to them by others. In contrast, Massage & Fitness Magazine features articles that always include perspectives that are deeply informed by recent research and authors who will even go back to revise what has changed on certain topics based on newly available information. Check out some of our favorite recent articles below that take aim at keeping massage therapy on the science track.

Massage therapy and patella-femoral pain syndrome

Massage therapy and trigger points

Massage therapy and lactic acid

If you are a massage therapist looking to up your game, we encorage checking their content out.

By Matt Danziger

Body Mechanics Orthopedic Massage

1 W 34th St
#204,
New York, NY 10001
Phone: 212-600-4808
Email: info@bodymechanicsnyc.com

Read the next blog….

Why Getting a Massage In New York Could be Dangerous-Part Two

Massage in New York: Doors open to a Dangerous Act

Getting a massage in New York might be one of the more dangerous things you do with your life. Coming out of the Ontario massage program where massage is firmly entrenched as a full health care position that requires 2200 hours of schooling, I was, and continue to be, horrified with massage in New York. I want to stress that this is not ALL massage in New York, but the problem is it is such a mixed bag that you can’t really trust any massage in New York. Before we enumerate why there are issues, I want to share some of my experiences working and hiring in New York City.

I have worked in some of New York City’s best spas and medical massage locations and now I own my own clinic. Along the way I have met and worked with many therapists in the city. While a good many of them are competent at what they do, a large majority of them do not know the muscles of the body, do not know general red flags, treat beyond scope, treat dangerously within scope, diagnose, pathologize, and in general have some really weird ideas about what massage does and does not do.  I have had therapist do high grade mobilizations in interviews, had them confess no one explained referral pain to them, that they did not know what muscle group the adductors was, that they are cleansing me, that they don’t know how to tell if something is acute or chronic, and a host of other nasties. In general, even those who are competent still have some strange thoughts on treatment, assessment, and scope of practice. Strange since New York has 1000 hrs of education. So where is it going? And what is happening?

First lets start of with what a scope of practice is:

The Scope of Practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license.

New York State defines massage therapy as:

The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.

A huge problem they have is their scope of practice. In looking at the above, it would be hard to stay in scope at all since the information provided makes no mention of movement, tendons, ligaments, and the nervous system, to which all of the muscles are connected. It makes no mention of stretching or movement, or home care. The scope also mentions that it is the ‘scientific’ application of massage, however a large portion of any of the New York schools curriculum might actually be made up of Eastern studies, energy work, and quackery. To further complicate things, while it outlines that massage might use stroking, kneading, tapping and vibrating (all well and good) it says that those techniques should be used to improve muscle tone and circulation, which is fairly impossible. I can no more improve muscle tone and circulation(with a few localized exceptions) with massage than I can levitate. If you want improved muscle tone and circulation you should get some exercise. This leaves New York massage in a state where massage therapists are being taught essentially whatever the person teaching them was taught…and that is one giant game of telephone and degraded science, or non-science as the case may be.

In 2010, after sitting the board test here in New York and realizing how different the US and Canadian programs were I wrote this letter to New York State:

“I am not sure if you remember me but I contacted you some two years ago while trying to bring my Ontario, Canada, credentials to NY. …
The reason I am writing, however, is that after working here for some time, I have really had the ability to compare the two standards and see the difference. I wanted to know if there is not some way to get involved with decision making processes about where massage as an industry is going in New York. Healthcare, especially alternative health care, looks to be a booming future industry. After working here, though, I have some concerns about where things are headed. I have met new grads, at very prominent spas who don’t know their anatomy. It concerns me that a therapist can make a decision to work on the arm rather than the JT sprain (that the client complained about) that clearly needs ice or mobilization because it “feels” energetically right’. I find the whole thing dangerous.”

Since then I have become increasingly concerned that the situation is far worse than it seemed at the time.

Even if we ignore the glaring problems with the scope, the inclusion of the eastern education in the standard has opened the doors to a variety of very dangerous problems. For those of you who do not know how eastern or shiatsu massage works, the actual techniques themselves are simple, it’s a combination of touching and stretching. The way the massage is directed is through an assessment just as a science-based massage would have. The difference being that a shiatsu assessment uses the five element theory to figure out where you have an energy imbalance. The five elements are:METAL (lung, large intestine)  WATER (kidney, bladder) WOOD (liver, gallbladder)  FIRE (heart, small intestine, pericardium, small intestine) and  EARTH (spleen, stomach).

It would take into consideration things such as: when you woke from sleep at night , if your eyes are dry, and your emotional state, and then the practitioner would decide based on the element theory and intuition from that information where your imbalance is and treat the energy line that is associated with it. The problem is, however, that is essentially diagnosing someone.  It is completely out of the scope of a massage therapist to diagnose anything. Additionally, because the elements represent internal organs, it leads therapists into believing it’s within their scope to treat them. It is not. A therapist has no business commenting, suggesting or working with your kidney, bladder or heart. (unless it’s to say get thee to a doctor)

All of those elements also have emotional states. Wood is anger, Fire is joy, metal is grief and Earth is worry.  As a theory perhaps it is fine alone, but it opens therapists up to the idea that they should be asking you about your emotions. Massage therapists are not psychologists. They have no business talking to you about your emotional state in any way, shape or form as part of an assessment, or as part of a treatment, other than to refer you out or if a client offers it voluntarily.

It also encourages massage therapists to overlook red flags for treatment because in the context of an Eastern massage, red flags could easily be ignored as its part of the symptoms picture of a specific ‘energy line’ imbalance. As an example someone waking at night in pain (possible sign of cancer) might be looked over as a significant problem because the therapist is so interested to find out ‘what time’ they woke and diagnose it as an imbalance. Or a patient might express grief over a loss of a family member, but rather than get referred out, the therapist might treat it as an imbalance. 

To make matters worse, you, as a consumer really have no choice in the matter. While you, the patient, should have a choice in how you are treated, because this is part of the core education, for most therapists it’s hard for them to separate the science from the fiction. You may only want medical massage but in the context of New York State it would be just as valid for the therapist to work your meridians to treat your knee pain rather than treat, as requested, your knee where the pain is located. As a consumer do you really know what they are doing? Probably not…but it’s all connected, right? Technically you should be taken through a consent process so you know exactly what you’re getting. (but that is a matter for another day)

So whats it all mean? From my point of view its completely unsafe and permissive. New York State is producing healers, not medical professionals. A huge number of the massage population does not know their scope, and does not care, because it was part of their education to be outside of it, provided they were performing in a specific way.  I realize this blog is not going to win me any popularity contests, so in conclusion, I would like to add that there are therapists out there doing great work every day (in all kinds of modalities not just mine- and that includes energy, eastern and what every you offer ), but as a consumer, you can’t tell which ones are which….and that is a problem. The actual system has set the practitioners up to fail, not the educators or the practitioners themselves.

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.