Issue link: https://www.massageandbodyworkdigital.com/i/68175
reader forum WHAT YOU ARE SAYING Talk About Spinal Manipulation In May/June 2010's Talk About Touch column ("Intention of Practice," page 24), I was surprised to read the following interaction: "How is massage defi ned?" "It is generally defi ned as a manipulation of soft tissues using a range of conventional massage strokes and techniques. The laws are also remarkably consistent in describing what massage practice excludes: medical diagnosis and treatment, spinal manipulations, and sexually related touch." This reads as though all specifi c and general manipulations of the joints of the spine are outside of the scope of practice of massage therapists, though perhaps what was meant was "chiropractic style" or high-velocity, low-amplitude thrust adjustments of the vertebra are prohibited. While I realize there may be differing laws in some parts of the country, it would seem unusually restrictive to prohibit all spinal manipulations, as even moderate paraspinal effl eurage can involve manipulation of the joints of the spine. Furthermore, it would seem unreasonable to restrict specifi c manipulations of the spine through normal range of motion when it most decidedly is within our scope of practice for every other joint in the body. Throughout my education and licensure process in Oregon, we were taught not only broad, general manipulations of the spine such as unilateral compressive effl eurage of the erector spinae group, but also more precise manipulations of individual rotators, multifi di, and intertransversarii muscles with the intent of affecting movement and position of individual vertebrae through normal range of motion. In other words, we were trained to perform by manipulation of the soft tissue and without thrust, similar vertebral manipulations to what chiropractors accomplish by means of high-velocity, low-amplitude thrusts, which may exceed range of motion. In my limited experience as a licensed massage therapist, I have personally witnessed the benefi t of these techniques for many clients who are uncomfortable with, or have remained unhelped by chiropractic style adjustments. As well, while working in the chiropractic setting, I have been talk about touch with Mary kathleen rose and Mary ann Foster INTENTION OF PRACTICE Understanding the legal scope of practice and working with a clear intention makes it easier to work with confidence in meeting the needs of our clients. Mary ann Foster: Students often ask me why they have to learn orthopedic tests as part of their massage practice. They are not sure what they are supposed to know, wondering how to run muscle and joint tests, while still leaving time for a full-body massage. They also get confused about where evaluation fits into the legal scope of massage. Mary Kathleen rose: This is part of a much bigger question regarding the overall range of the massage and bodywork profession. In late 2008, a number of key stakeholders from professional organizations convened to begin a process of defining massage therapy and entry-level competencies. The draft of their work is compiled in a document called the "Massage Therapy Body of Knowledge" (www.mtbok.org). MaF: The students' persistent questions sent me on a search for answers. I found the most helpful information about the scope of massage and bodywork by reading state laws. They each define massage in two or three categories: the range of techniques and methods that massage includes; the intention and purpose of massage; and what massage does not include. MKr: How is massage defined? MaF: It is generally defined as a manipulation of soft tissues using a range of conventional massage strokes and techniques. The laws are also remarkably consistent in describing what massage practice excludes: medical diagnosis and treatment, spinal manipulations, and sexually related touch. Mary Kathleen Rose, left, and Mary Ann Foster. Rick Giase Photography. MKr: How do they define the intention or purpose of the massage? 24 massage & bodywork may/june 2010 MaF: This was the most interesting part of the statutes. I was surprised that 25 percent of the state laws do not even mention the intention and purpose of massage. But in the remaining statutes, there is a definite theme. Most of them describe massage therapy as a wellness practice for the purpose of "providing muscle relaxation," "alleviating general stress and pain," and "enhancing and restoring physical and mental health and well-being." MKr: How did your study of the laws help you guide your students? MaF: First of all, I tell students there is no right or wrong answer to the question about orthopedic testing. It's all a matter of context. If they are using the test within the wellness paradigm defined by the statues, then they are working within our scope of practice. A massage therapist is expected to make general assessments to develop a course of action for the session that meets the client's goals. Also, general joint and muscle tests can be helpful in identifying contraindications and developing an overall treatment plan. But running specific tests to evaluate a specific condition for treatment is questionable. MKr: While working in a medical setting, and with other health-care professionals, it has been my practice to work to address the needs of the given medical diagnosis of the patient. MaF: Combining conventional medicine and complementary therapies is what the National Center for Alternative and Complementary Medicine classifies as integrative medicine. The benefit of this collaboration is that massage therapists can draw on the diagnostic and evaluative expertise of medical practitioners, and the medical client can receive the general healing effects of therapeutic massage, such as relaxation and the release of muscle tension. MKr: These benefits are what we provide the best. And that endears us to our clients and the other health-care professionals. With this intention of the profession in mind, I am able to define the intention in my own work. MaF: In the classroom, we practice resisted muscle tests and joint range- of-motion tests as a way to learn more about the human body and to make general assessments about what would improve the condition of the client. When I tell my students that they are not responsible for testing to figure out clients' orthopedic problems, they sigh with relief. MKr: Understanding the legal scope of practice and working with a clear intention makes it easier to work with confidence and meet our clients' needs. MaF: Perhaps we can challenge our readers to check their own state laws and write their own definitions of massage therapy, its intention and purpose, and what it excludes. Our clarity of intention in practice will help us build bridges with other health- care professions, fostering mutual respect and understanding. been practicing shiatsu and integrative massage since 1985. She is the author of Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams & Wilkins, 2009). www.comforttouch.com. Mary Kathleen Rose, BA, CMT, has in movement education for massage and is the author of Somatic Patterning: How to Improve Posture and Movement and Ease Pain (Educational Movement Systems Press, 2004). www.emspress.com. Mary Ann Foster, BA, CMT, specializes connect with your colleagues on massageprofessionals.com 25 able to aid in clients' assimilation of the chiropractic treatment by providing joint specifi c, muscle specifi c soft-tissue therapies that reinforce the chiropractic adjustments. For anyone interested in learning more about this subject, I recommend Spinal Manipulation Made Simple: A Manual of Soft Tissue Techniques by Jeffrey Maitland. AARON ALLEN PORTLAND, OREGON AUTHOR RESPONSE We appreciate your detailed response to our last column. Like you, we, too, were surprised to read that spinal manipulation was promoted as within the scope of massage practices in Oregon. Regardless of how you use the term, this is a well- defi ned term in the chiropractic fi eld. If we, as massage therapists, are going to use medical terms, we must use them how they are defi ned in their respective fi elds. Regardless of what techniques you are using and your good intentions, if the state connect with your colleagues on massageprofessionals.com 13