Issue link: https://www.massageandbodyworkdigital.com/i/1299745
This combination of therapies could occur because the scope of practice for the various fields of manual and movement therapy in Singapore (and many other countries where I taught) have not yet been sharply defined. This lack of definition allows for various methods of bodywork to be integrated together. In Singapore, less regulation seemed to allow for fewer turf battles over who could and—more to the point—who could not perform certain techniques. This lack of regulation allowed for a greater expression of assessment and treatment techniques being performed by these professionals. Creating a More Cohesive Approach What at first seemed discordant to me was actually much more cohesive and inclusive. Instead of dividing the world into many separate fields of manual and movement therapies—with each field denying the others the right to perform what they feel is their proprietary technique—why not combine them together in one inclusive world? Yin and Yang One reason for combining the worlds of manual and movement therapies is that each individual therapy addresses a fundamental component of musculoskeletal health, but by itself also misses another fundamental component. The strength of one field fills in the weakness of the other field. So, like yin and yang, manual therapy and movement therapy are two pieces that complement each other and create a greater whole that serves to benefit the client. If we compare and contrast massage therapy and fitness training, we see that massage therapy primarily works to loosen taut/tight myofascial tissues but does little to increase the strength of these tissues. In effect, massage therapy's principal aim is to increase flexibility but does little for strength and stability. On the other hand, fitness training primarily works to strengthen myofascial tissues but does little to loosen tautness in these tissues. In fact, the more we focus on resistance in strength training, the tighter our baseline tone of musculature tends to become. Let's look at an example of when this might matter. Example: Upper-Crossed Syndrome We have a client with upper-crossed syndrome, meaning they have a postural distortion pattern that involves hyperkyphosis of the thoracic spine with protracted shoulder girdles and forward-head posture (Image 1). The massage therapist knows that a major focus of their session would be to massage and stretch the locked-short pectoral shoulder girdle protraction muscles. Loosening the pecs would allow the client to open their shoulder girdles back into retraction. But if this is all that is done, and if the retractor muscles of the shoulder girdles (rhomboids and trapezius, especially middle trapezius) are weak, the client would not be able to maintain 58 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 2 0 1 Upper-crossed syndrome involves hyperkyphosis of the thoracic spine, protracted shoulder girdles, and forward-head carriage. Permission Dr. Joe Muscolino (www.learnmuscles.com). Intersection of Stretching Truth be told, there is already an intersection between the worlds of manual and movement therapy. That intersection is stretching. Stretching can be simply a movement technique that clients perform by themselves, such as during a fitness, Pilates, or yoga session, but stretching can also be performed by a manual therapist with hands on the client to facilitate and augment the stretch. But beyond this intersection of stretching, most manual therapy techniques are denied to movement professionals, and strength-training techniques are out of scope for most manual therapists. Scope of practice set by licensure varies from state to state in the US, but the foregoing is generally true. Therapist-assisted and client self-care stretch for the posterior deltoid. Permission Dr. Joe Muscolino. The Muscle and Bone Palpation Manual: with Trigger Points, Referral Patterns, and Stretching, 2nd edition ( Elsevier, 2016).