Winter Break - Time to Catch My Breath....

WOW, busy semester; but I'm done for the winter break. My internship is in place and is called CAM Reach. We will be investigating the practice patterns and health care approaches of local CAM health influencers (MT'S, LAc's and DC's) in order to develop an office system smoking cessation intervention tailored to their needs. Close as I could get so far to research in MT. It seems I must have a doctorate before I can do research in the area of my interest. So, I have applied to the DrPH program in Public Health here at the University of Arizona. I am also applying for a pre-doc fellowship, in the spring, that will allow me to do research in other areas of CAM study at the U of A. Never thought I'd go this far but I REALLY want to research MT, and so here I go. I better live a long time as I've gotten a late start in research; better late than never, don't you think?

Changing Gears

Ok, PTSD MT intervention on the back burner, CAM Reach to the forefront. CAM Reach is part of a 10 year study of tobacco cessation and the public. I have joined a research team, at the University of Arizona, who is investigating getting the word out about tobacco education through CAM practitioners; ie MT's, Acupuncturists, and Chiropractors. We will be doing key informant interviews with 60 practitioners, here in Tucson, in a needs assessment effort. Then, based on what we learn from these interviews, we will develop a training tool for CAM practitioners about smoking and tobacco cessation. In other words, we hope to give them successful, evidence based methods of engaging smokers in a discussion around not smoking. That's as much as I know so far, and will post more later. Suffice it to say, the principle investigator on this project is a doc who recognizes the value of CAM, respects alternative practitioners, and thinks providers have failed in their attempts to educate their patients about smoking and tobacco use. She is reaching out to our industry for help in educating the public about smoking cessation. What are your thoughts about this plan?

Plodding along....

The fall semester is back in session and I'm adjusting to a new schedule once again. I'm trying to get through my internship prep class ASAP in order to have IRB approval for next semester. This is an internal review board that has to approve any project working with human subjects. Still waiting for my professor and his VA contacts to come through as well. In the mean time I have anthropology and public health, and a research methods class that look quite promising for content and student discussion potential. One more semester to go; I can see the light.

Internship progress

My meeting with the president of Cortiva, here in Tucson, went better than expected. She has offered up her students and clinic for my research design. Do I hear a hallelujah? My advisor has been out of town, but we were able to talk briefly twice while he was away, and he's still in. Next step, connecting with his UA contacts regarding our target population for our volunteer participants. I'm chomping at the bit here as I have a few contacts myself, but Pete says the VA has their own way of doing things and we have to play ball. I played volley ball for the army while serving years ago, does that count?

The Client Prospective

One thing that has made me a better massage therapist (MT) is receiving regular massage treatment. It's like taking a class. Not only am I caring for myself and learning new techniques, I also experience the clients prospective. How comfortable is the table and face cradle, for example? If my sinuses are acting up I can only lay prone for a half hour. The bolster under my knees, when supine, affects my circulation and my legs fall asleep. I'm very healthy, so this may really affect someone who is less so. Is it time for new sheets, have I been too chatty lately with my regular clients, and have I really heard my clients response when asked how they're feeling or what needs focus this session? How does another MT handle client issues like no shows, tardiness, or raising rates? What CEU's are they taking and what has worked lately to gain new clients? Their room decor, office design, and location are always interesting to see in comparison as well. Having a massage session from another MT helps me to review and fine tune my own procedures, professionalism, and prospective.

As the world turns....

Just back from a week's vacation and ready to go. This week I'm meeting with my advisers again at the University to discuss my internship plans. Next week I'm meeting with the president of Cortiva to see what their interest in collaboration with the U might be. Wish me luck everyone, as the process of creating a participation opportunity in MT research, completing my internship requirement for the MPH, and maintaining my business has been challenging (not to mention my family life). I feel like I'm stumbling around blindly while trying to get the right people interested. I'm determined to get my needs met while in this program and fighting frustration with the process. I keep telling myself that's always how it is when attempting to initiate something worthwhile; right?

Ergonomics

Ergonomics, as I define it, is the science of making improvements to your work space and daily tasks, to more efficiently fit your body and routine. Its goal is to prevent pain and injury. The warning signs your body is communicating to you that can occur in the hands, wrists, arms, shoulders, neck, head, hips, back, legs, or feet include:

• numbness
• burning or tingling
• soreness, aching, or tenderness
• pain - throbbing or dull
• swelling
• tightness or stiffness
• weakness or cold

Most of us these days, in the US, have computers and therein lie a lot of these issues. The computer is such a great resource, but what a time stealer. We become so involved we lose complete track of time. One should get up every half hour, while at the computer, to do something else; for example, stretch, do another task, or simply stand. Vary your position and tasks often; set a timer to make sure you do. I work from home, so when not with clients, I'm on the computer reading, typing, or networking. I'll start a load of wash, which takes about half an hour, and when the buzzer goes off, I get up and put it in the dryer. Unload the dish washer, make the bed, clean something (ugh), go for a walk, do your exercises, study; break up your tasks throughout the day so you are not in a static position. Those of you at an office, move your phone away from the desk, if sitting all day is an issue, then get up to answer it. Stand up to print documents, file, or even to read your computer screen for a while if you can get the monitor up higher (stack up books underneath). For more information (by HP) on setting up your computer work area ergonomically, click here. For an excellent free download, of stretch breaks you can do at your desk, with periodic pop up reminders, click here.

This week was a busy client week and I had to finish the remodeling work started in the client bathroom as well. So, I did extra repetitive motion tasks realizing it would probably compromise my wrists. The median nerve pain told me it was time to stop. I chose to finish up knowing it would hurt for a day but that I would not abuse it further for the rest of the week, and worked as efficiently as possible in the mean time to get the work done. This included using my other hand, as often as possible, to paint the walls and seal the floors. I then was extra careful of my body mechanics while with clients that day. In between, I dry skin brushed my forearms from wrist to elbow, front and back, until the circulation was greatly increased. Afterwards I did muscle releases, massaged my forearm, and rested my hands for the evening. The way to avoid carpal tunnel pain is prevention and that means prioritizing tasks. Usually when I have a busy client day, I will not use my hands for other tasks that include pulling weeds, carrying buckets, typing, writing, food prep, playing the piano, cross stitching, knitting, or in this case, painting. Those of us who use our hands to make a living know this is not always possible, so are sensible and cautious in situations like I had this week. My wrists feel much better today, the bathroom is done, and I'm receiving a massage tomorrow; ahhhhh...

Communication with Your Massage Therapist

I had a couple new clients this week. Most of my clients are regulars (monthly or bi-weekly) so a new client keeps me on my toes as I want them to return too. We have to get to know each other, so good communication is essential. After the intake and evaluation she asked me to spend time on specific areas of tension. I asked what kind of pressure she preferred and to let me know if more was needed at times, or (conversely) when to back off.

Of course, the body communicates as well, with areas of sensitivity, misalignment, and tight muscles that aren't quite ready to let go. Gradual pressure to the clients level of comfort is my working process. This client had regular massage treatments in the past and knew to speak up and give feedback. Never lay quietly on the table, uncomfortable with techniques you aren't enjoying. Let the massage therapist (MT) know and they can change it up as MTs are trained in a lot of different modalities. A first session with a new MT might have this dialog: "I prefer medium pressure" to start, and then, "you can go deeper here" or "that's a little too much."

Don't think only deep techniques are required to work out those knots either; it's an individual preference. There are many light touch therapies that are just as beneficial as deep tissue in releasing the muscles. A skilled and experienced professional will mix it up to get the desired effect depending on your response.

It's normal to feel a little sore in the heavily worked areas for a day or two. Any soreness after that usually means it was too much too soon, so let the therapist know next time you see them and they'll adjust. Communicating effectively with your MT can make all the difference to whether you receive a good massage or not.

The Future of Massage Therapy

Here's an exciting, well balanced, recent document, I came across yesterday, that suggests the direction MT research should take next; by a group of our industry proponents: Click here to read. It discusses evidence based MT effects, as well as, limitations in our research that need further attention. For example, we can say, based on our current research evidence, a well established effect of MT is its reduction in anxiety. Effects reported in other studies, such as pain reduction, are not yet as well understood and need more scientific analysis. Our profession is young, from a research point of view, and is subject to the same scrutiny every other established profession has endured. It's important to me, as a MT, we define and control our industry to the extent that some outside profession does not. To that end, we need to develop more rigorous study that can hold its own when compared to other health care professions. In any case, this article addresses all these points and more, in an easy to read, well organized and thought out manner, with the most up to date information I've seen summarizing the future in MT.

Innovations in Networking & Research Literacy

Blogging, discussion boards, Linked In, Face book, Twitter; unbelievable how we network these days. Check out this wonderfully creative YouTube Video that has put it all to music and dance in an updated version of West Side Story called Web Site Story: http://www.collegehumor.com/video:1913584

I'm also reading a book my advisor suggested, when I was whining recently about massage therapy not being accepted by the medical community, called The Diffusion of Innovation by Everett M. Rogers; great book! When Pete first suggested it I thought, how can this apply to a practice that's been around for thousands of years? Lot's of reasons, it turns out, and there's a whole discipline of study around this subject that is subdivided into at least ten different major research traditions, including public health (which is my college at the university). The reasons behind MT's slow diffusion into current mainstream health practise include social and cultural explanations. That leads back to an oft debated discussion in our industry to evidence based practise. I'm only going to go there briefly as MT's debate this quite thoroughly through our associations discussion board: http://www.massageprofessionals.com/group/EBMT. It's just time for more and better research, plain and simple.

I don't want to change the fact that we get to spend an hour or more with our clients, we touch them in healthy ways, we listen to them, and encourage healthy behaviors. I do want to be able to answer their questions, to the best of my knowledge, and explore the mechanisms behind what we see works, with illness and injury, on the table each session. I also want to be able to look it up, when I have questions, to see what other MT's have tried and found successful; their outcomes. I want to be able to trust that their research has been reviewed by my knowledgeable peers and critiqued for bias, confounders, and limitations. I want to be able to review those studies with my well trained critical eye, and make up my own mind as I filter all the information that's out there. I want the research to include MT's because we know muscles best! Yes, our work is intuitive, and that's best mixed with experience and education.

Great Resources

Yesterday morning I connected with Laura Key of Lotus Massage and Wellness Center. She has a beautiful place off of Grant and Country Club for any one needing MT's more central; check them out: http://www.lotustucson.com/. I've had a few other MT's express interest in support of research here at the U of A, so check here for updates to my progression with initiating this endeavor. I'm also spending a great deal of time reviewing the research that has been done actively since the '80's, some as early as the '30's. Here are the sources I use in finding MT research articles, or studies, in scientific journals that have been peer reviewed:

1. http://www.pubmed.com/
2. http://www.massagetherapyfoundation.org/index.html
3. http://www6.miami.edu/touch-research/research.htm
4. crisp.cit.nih.gov/crisp/crisp_query.generate_screen
5. http://mtabc.wordpress.com/2009/04/17/the-cochrane

If you find something that interests you and can't get access to the free text, copy and paste the title of the article in your web browser, do a search and it will usually lead you to a free copy. If anyone needs help, let me know.

Local MT Resources

So, I spent a good deal of yesterday following up on leads regarding a MT research collaboration between the MT schools and the U of A for my internship requirement. Mostly dead ends so far, from several well meaning interested parties. I did, however, enjoy tea with a new friend, Jan Schwartz, who's also in the MT industry and shares my belief in the need for evidence based practise. Jan's slaving away on her masters thesis this summer and hopes to be done by the end of this year. In the meantime her online business has taken off; you can check it out at: http://www.educationtrainingsolutions.com/. She also shared with me her contacts in the field and I joined a new local group, at her invitation, called Holistic Tucson Online. Thanks Jan.

Did I mention I received a massage on Monday? Thank you Donna, it was wonderful. If you are in need of a massage in the Marana Twin Peaks area, or have insurance that covers massage, Donna is an approved provider: donnabishop.massagetherapy.com. I receive at least two massages a month from different MT's, and they are so well worth it. Not only do I get to receive the benefits of relaxation, muscle work, and self-care, it's like taking a class. You get to experience another MT's techniques and are reminded of how a client feels and what they experience on the table. The benefit of self-care in receiving a massage refers to the notion you are doing something healthy towards illness and injury prevention. It also gives you a feeling of control knowing you have a tool you can rely on for maintaining optimum health. Exercise, good nutrition, and massage keeps me out of the doctors office and at my best.

Grinding My Wheels

It's so nice in the desert early morning. Went for my 6:30 walk and saw several assorted sizes of lizards scurrying around; they are so interesting and we don't see them when it's cooler. The quail are scooting around as well, tooting like they do. All the critters are pretty active in the cool of the morning. Now to bring my temp down. Ever try freezing grapes for a quick cool down? Also, frozen bananas cut in half with peanut butter in the middle, on a stick? I have to be creative, in my household, to get my fellows to eat enough fruit.

I've been gathering info as I call it, in preparation for my internship prep class in the fall at the U of A; preparing to prepare. I'd like to do my internship on research in massage therapy (MT). So far, I have one professor who's showing some interest and a few contacts locally in the MT industry. I have lots of ideas and hope the MT schools are interested in collaborating; much begging to do. I've spent the past several weeks reviewing the completed studies in MT research. There have been over 9000 studies since the '60's. I'd say the U of A is behind the times here. A few CAM studies going on, but no MT specific research. These three women have contributed a great deal to MT studies over the years nationwide: Tiffany Field, Janet Kahn, and Patricia Sharpe. All three are PhD's and LMT's; I'm impressed.

The Who, Why, & What For

Welcome,

I am a licensed and nationally certified massage therapist with about 20 years experience. I specialize in stress and pain management, as well as, ergonomic intervention as a way to prevent illness and injury. For the past three years I have also been working part-time on a masters in public health at the University of Arizona here in Tucson. Why, many people ask? To gain further skills in promoting massage therapy to the public and changing our health model from one of disease focus to a model of wellness; it's all about prevention folks. I'm also very interested in massage therapy research because I like to get to the root of things and understand the outcomes and mechanisms of therapeutic massage.

I thought I'd share with you what I'm learning and my thoughts about health. A natural approach, that avoids medication and surgery, should be your first call to action when your body gets out of balance. Therapeutic massage increases your awareness while working out tight muscles and reduces your stress through relaxation; a valuable tool in your arsenal of defense. Pain should be your guide in making physical choices, not your enemy. Listening to pain helps you avoid injury by pacing yourself and knowing your limitations. We can still be active and listen to our bodies; that's awareness.