Archive for Julie Onofrio

The problems with researching massage

There are many problems that arise when doing research on massage therapy.  You will find many of these are objections from the massage therapists themselves as to why we should have or even use research in massage.  The biggest problem is how do you really measure what happens in a session and recreate a real massage in a controlled environment?  Massage is not done in a controlled environment where a particular type of massage is done on a particular body part for a specified amount of time.  The way most massage works is that the massage therapist will let their hands and ‘gut feelings’ lead the massage.  How do you really measure or recreate that?

How do you measure the amount of pressure or the massage technique that is done?  You can teach a 12 MT a specific technique and it will be done 12 different ways with each persons own unique touch and intention behind the technique. How do you regulate or measure the amount of pressure that is applied and how do you regulate or measure the exact spot in each muscle or muscle group so that you know exactly what it is that is making the difference?

There is also nothing really in massage that could replicate the idea of a placebo or sugar pill.  You can hand someone a pill that they don’t know what is in it, but how do you really do that with massage?

How do you control for all of the other factors in a persons life also – I guess that is a problem with all research – was it the intervention or the change in diet that they made or them getting more sleep or them living their life.

Yet one of the ways we will get the insurance companies and the general public’s attention is with having more research.  The insurance companies especially are moving toward using research to determine where they spend their money for their patients – what works best for the money spent.  It is also just as important to have research for the spa or relaxation division of the massage profession.  Spa massage, heat and special spa therapies are just as important in healing.

Getting massage therapists interested in research is another part of this challenge.  They are taught various techniques in school that are actually not proven scientifically and the research that is done to support various modalities is usually flawed in some way but massage therapists do not really know it because they are not trained in research literacy and more importantly – they see these same things work when they practice it.   When the ‘researchers’ show up and say something doesn’t work to the many massage therapists who are practicing that modality – it is like a slap in the face (even though the researchers that I have interacted with online don’t mean it that way- their approach is very well for lack of a better work -egotistical).   That is not going to get any points for research!  From what I understand so far in this process of learning about research is that it isn’t that it doesn’t work but more of the way that it is explained as to how it does work -(does that make any sense?)  For example – research does not support the practice of Reiki but there are many massage therapists, nurses and even people in hospitals and hospice units who practice it.  It does work but the reason it does work is a mystery really or so it is said to be by science.  Is it the therapeutic presence?  Most likely but we don’t really know.  Supposedly there is no such thing really (scientifically speaking) as Universal Energy according to this article- Reiki Can Not do Harm – or can it? by Christopher Moyer, a well known massage researcher and Assistant Professor of Psychology at University of Wisconsin-Stout

“universal energy” on which it is based cannot possibly exist, for if it did, it would have to do so in contradiction of the conservation of mass-energy principle, and that is as well supported by scientific evidence as practically any principle that we know

 

The problem with researching massage is how do we combine science with the art of massage and preserve the art of massage – of being present, of connecting, of being compassionate care givers, with science?  We (I) just want to do massage!

National Certification for Massage Therapy

National Certification for Massage Therapy is offered by the National Certification Board for Therapeutic Massage and Bodywork.  (NCBTMB).  The problem though is that this does not really mean that you can practice anywhere in the US with just taking one exam.  There is no “National Certification” in massage that will allow you to practice in any state.

Each state has different laws regarding the practice of massage and each has a different number of hours of education requirements.  The number of hours of training needed varies between 500-1000 hours of training and even within that requirement are variations in the number of hours of each specific area of training making it even more confusing.  For example: in WA state the required number of hours of training is 500 hours to take the test and become a licensed massage practitioner in WA. (From the WA State Board of Massage)

  • 130 hours of anatomy, physiology, and kinesiology including palpation, range of motion, and physics of joint function. There must be a minimum of 40 hours of kinesiology.
  • 50 hours of pathology, including indications and contraindications.
  • 265 hours of theory and practice of massage, to include techniques, remedial movements, body mechanics of the practitioner, and the impact of techniques on pathologies. A maximum of 50 of these hours may include time spent in a student clinic. Hydrotherapy is to be included when consistent with the particular area of practice.
  • 55 hours of clinical/business practices, minimally to include hygiene, record keeping, medical terminology, professional ethics, business management, human behavior, client interaction and state and local laws.
  • Certification in American Red Cross first aid and American Heart Association Cardiopulmonary Resuscitation
  • Four contact hours of training in HIV-AIDS in the following six topics: Etiology and epidemiology; Transmission and infection control; Testing and counseling; Clinical manifestations and treatment; Legal and technical issues; and Psychosocial issues. Training can be obtained from local community hospitals and colleges.

The NCBTMB requirements are:

  • A minimum of 500 hours of instruction as follows:
    125 hours of body systems (anatomy, physiology and kinesiology)
    200 hours of massage and bodywork assessment, theory and application, in-class and supervised
    40 hours of pathology
    10 hours of business and ethics (minimum of 6 hours in ethics)
    125 hours of additional instruction in an area or related field that theoretically completes the massage program of study
  • Graduate of a NCBTMB Assigned School Code with a current valid transcript submitted to NCBTMB

So more hours of pathology and anatomy are required by the WA State Board of Massage than for the so called National Certification in Massage meaning that if you want to be licensed in WA State you will need more hours than what the NCBTMB requires.

In New Mexico, the basic number of hours required is 650 with a specific number of hours in each of the following (from the New Mexico Board of Massage):

(650) hour program in massage therapy training.  The massage therapy training must meet the following minimum curriculum requirements:

  1. 165 hours minimum of anatomy and physiology, to include:
    1. physiology;
    2. anatomy;
    3. kinesiology; and
    4. forty (40) hours minimum of pathology.
  2. 150 hours minimum of training in massage therapy as defined in 16.7.1.7 NMAC.
    1. The massage therapy training shall include contraindications of massage therapy.
    2. A minimum of 100 hours of hands on training must be completed before the student is allowed to begin a clinical practicum as defined in 16.7.1.7 NMAC.
  3. 75 hours minimum of general instruction to include.
    1. business;
    2. hydrotherapy;
    3. thirty (30) hours minimum of professional ethics;
    4. four hours of first aid; and
    5. four hours of cardiopulmonary resuscitation.
  4. Electives may include:
    1. additional massage therapy;
    2. related hands-on modalities;
    3. additional anatomy and physiology;
    4. clinical practicum (not to exceed 150 hours);
    5. counseling;
    6. herbology;
    7. homeopathy;
    8. nutrition;
    9. breathing and stretching techniques;
    10. theory; and
    11. other courses with prior board approval.  See 16.7.4.14 NMAC for instructions.

So with such variations in the number of hours required by each state, to have a true “National Certification” would mean that each state would need to change the number of hours of training required.

Currently, if you want to practice massage in another state than the one that you were originally licensed in, you need to fulfill the requirements of that state.  Some states do have reciprocity already set up because they know the requirements of other states will meet their requirements.

There are also three different licensing tests being used by the states.  The NCBTMB offers two different tests and the Federation of Massage State Boards offers another. You will have to find out what your state excepts and fulfill those requirements for massage licensing.

Find out more about becoming a massage therapist.

Careers in Massage

National Certification in Massage Therapy

History of National Certification in Massage

Massage Therapy Licensing Issues

There are many massage therapy licensing issues that are challenging a massage therapists right to practice and how they practice in the US right now.

Florida State’s Bill SB 1860 (PDF)is threatening to stop massage therapists from being able to bill Personal Injury Protection insurance for people who are injured in a motor vehicle collision.  The Consumer Advocates Report states that “Average charges by massage therapists saw the greatest increase, increasing from $2,887 in 2005 to $4,350 in 2010.” which is up much more than orthopedic physicians and acupuncturists.  I think the bill is showing a big problem in the massage profession which is overbilling for massage services for car accidents.  While I do believe we need to fight this bill, the next step would be to look into the problem that brought this bill up and see what can be done to find out if there are many massage therapists who are overbilling or is it needed in the care of injuries sustained in car accidents.

The Florida State Massage Therapy Association has a call to action and you can find out more by asking on their Facebook group page.

Tennessee is also faced with HB 2387 that is trying to move massage therapy from the health related boards to that of the commerce and insurance division–the division that regulates “trades.” The biggest thing would be that massage therapy would then be considered a “trade,” not a “profession,” and insurance companies don’t pay tradespeople. They pay professional health care workers. It would also be a step down for the profession of massage overall moving to that of a trade division.

There is a petition for the TN bill “Stop the deregulation of Massage in TN”

Each state needs to keep up to date with the laws and legislative actions that are constantly  happening.  The current economy is challenging the budgets of many states and they are always looking for a way to lower expenses and make more too.

 

Massage Therapy Schools

Massage Therapy Schools are faced with the challenge of filling their schools with massage students.  There are so many massage schools to choose from and it can be very confusing.

You have to really do your research to find the best massage school for you.  It is often difficult to really know which career path is best for you since you are just starting out.  There are many different paths that careers in massage can take.  In general, they are as follows:

  • Relaxation or Spa Massage Therapy – which is doing massage on people in spa settings mainly.  You can start your own spa or work for someone else.
  • Medical Massage which is not a discipline in itself but a way to assess people’s conditions and diseases and apply a massage treatment to them.  It can be most any type of massage that works to show improvement.  Many massage schools may offer you a medical massage training course when there is no one technique that is ‘medical massage’.  Orthopedic massage, deep tissue massage, structural integration bodywork, cranio -sacral massage and many other types of massage are considered to be ‘medical’ in nature as in – they are able to address many medical conditions.
  • Sports Massage is massage that focuses on athletes from every caliber from the weekend athlete playing soccer or tennis or something like that to a masters athlete who are serious amateurs to Olympic athletes and professional athletes.

So you also need a general idea of what area of training that you really want to start with.  You will be able to change at anytime or take one aspect of training and learn more as you go.  In fact, most massage therapists are continually taking continuing education classes partly because it is required to renew your massage license and partly because it is such a fascinating field with many things to learn.

The best way to get an idea of what areas you are interested is to get massage at various places like a spa, health clinic or other environment and talk to the massage therapists there to find out more and to actually experience the different types of massage for your self.

My Book – A Career in Massage – Is It For You?: The truth about becoming a massage therapist…what massage schools and associations don’t tell you about becoming a massage therapist. (Link goes to www.amazon.com)
will tell you more! It covers every thing you need to know about becoming a massage therapist and also covers how to choose the massage school that is best for you.

You can also start looking for massage therapy schools and learn more on my other website at www.massage-career-guides.com

Massage and Sleep Disorders

Initial search for research on Massage and Sleep Disorders:

Int J Neurosci. 2001;106(3-4):131-45.

Lower back pain is reduced and range of motion increased after massage therapy. Hernandez-Reif M, Field T, Krasnegor J, Theakston H.

Palliat Med. 2004 Mar;18(2):87-92.

A randomized controlled trial of aromatherapy massage in a hospice setting. Soden K, Vincent K, Craske S, Lucas C, Ashley S.

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.

Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study

Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese postpartum women.

See more on massage and sleep disorders