Massage is one of the most natural methods of health care and has been used by ancient cultures for thousands of years. Evidence of massage dates back to prehistoric times and is depicted in European cave paintings done about 15000 BC. Massage in its basic form has been around as long as man. From these basic techniques massage gradually developed into a healing therapy comprised of specialised forms of treatment. Therapeutic massage first evolved in the Eastern World and gradually migrated to Western societies. A blending of old and modern techniques today provides the massage therapist and clients with a vast variety of healing tools.
Massage as a healing method was in use in China around 3000BC. The Chinese style of massage, called 'amma' (meaning “push-pull”), is regarded as the precursor to all current manual and energetic therapies (Salvo, 2007). Amma massage aims to balance the energy flow in a client's body and to address specific medical conditions. Nutritional advice, herbal therapies and other suggestions for healthy living forms part of an 'amma' massage. The massage is given over clothing and consists of deep tissue manipulation on specific pressure points of the body (Smith, 2009).
Knowledge of massage spread from China to India and became a part of the Hindu healing practices. The practice of healing touch, Ayervedic medicine, used by the Hindus is regarded as the basis of holistic medicine and focuses not only on healing the body, but also the mind and spirit (Salvo, 2007).
By the 6th century, the practice of massage had spread to Japan, where shiatsu (finger pressure) a component of 'amma' was commonly practiced. The Japanese used the Chinese concept of energy points and massaged these to bring balance between the mind and body (Salvo, 2007).
The ancient Egyptians also practiced foot massage (the modern reflexology) as depicted in archeological evidence.
In the Western world, the concepts of health and medicine started to evolve around 700 – 600 BC. The Greeks and Romans adopted massage and other healing practices from Egypt and the East. The Greek physician, Hippocrates (460 – 377 BC) was a great believer in massage and wrote “the physician must be skilled in many things and particularly friction” (Salvo, 2007, pg 6). He called his art 'anatripsis', which means 'to rub up' (Fritz, 2007, p 14). Hippocrates also changed the direction and technique of massage - his strokes were directed towards the heart to encourage the elimination of waste products, whereas the Eastern shamans and priests massaged their patients from the core of the body towards the limbs (Salvo, 2007).
The medical knowledge of the Greeks spread to the Roman world. Galen, (AD 130 – 200), a Roman physician, also promoted the use of massage and linked touch to human anatomy and physiology (Salvo, 2007). He described many massage techniques, and their application to health and well-being. Galen studied the effect of massage by looking at the influence of massage on athletes, both pre- and post-event, thereby associating massage with sports, as well as health (Elluminate, 2009).
During the Middle Ages, midwives and folk healers, kept the art of massage alive and it was passed on as a healing art form. When William Harvey proved that blood circulated through the body, it gave massage as a therapy more credibility and massage gradually became a popular treatment option in Europe (Salvo, 2007).
The modern massage era started in the early nineteenth century. During this time, Pehr Henrik Ling (1776 – 1839), a Swedish physiologist, developed the Swedish movement cure which used active and passive movements and massage. Ling's therapeutic movements were designed to improve circulation, ease muscle pain, increase flexibility and encourage relaxation.
Johann Mezger (1817 – 1893), a Dutch physician, also practiced the Swedish movement cure and made massage an integral part of physical rehabilitation. He used the French massage terms such as effleurage, petrissage and tapotement. Having a medical and scientific background, he was successful in getting massage accepted by physicians as a form of medical treatment (Salvo, 2007).
Massage spread to the United States by European immigrants. Dr John Harvey Kellog (1852 – 1943) wrote articles and textbooks on massage and also published a magazine, 'Good Health' (Fritz, 2004).
Then followed the massage scandals of the late 1800s. Fritz correctly states that massage was 'a victim of its own success' (Fritz, 2004, p16). Inconsistent quality, unsubstantiated and unethical claims and high fees, a lack of standards and unregulated training institutions eroded physicians' confidence in massage. In an article in the British Medical Journal (1894) the advertising of some massage treatments in the local papers were called 'sufficiently suggestive' and were seen as 'lures and touts of places of execrable character'.
Criticism by the medical profession eroded the public's confidence in massage. This lead to the formation of a British Society of Trained Masseuses which was later called the Chartered Society of Massage and Medical Gymnastics. This Society issued certificates of competence to massage practitioners to help raise the profile of the profession.
Modern times have seen the development of different facets of massage. One of the leading pioneers in the diagnosis and treatment of myofascial pain, was Janet G. Travell, MD (1901-1997). She single-handedly created this branch of medicine. Trigger point massage still is the most effective treatment option for massage therapists for relief of pain (Janet G. Travell, M.D. The Mother of Myofascial-Trigger Point Knowledge, n.d.)
Dr Emil Vodder (1896 – 1986) and his wife, developed a gentle massage technique called Manual Lymphatic Drainage, which encourages the natural circulation of lymph throughout the body. They introduced this technique in 1936 in Paris and it is now the main form of management of lymhoedaemia.
Cross friction massage (CFM) was developed by James Cyriax (1904 – 1985), also called the 'Father of Orthopaedic Medicine'. According to Junkill (2005), Cyriax developed comprehensive range of motion assessments. His techniques involved deep tissue massage using no lubricant and is still one of the best rehabilitation techniques for some sport injuries.
Massage in New Zealand has seen many changes. To ensure adequate training, a massage department was formed at the Dunedin Hospital 1913. In 1947 the massage school became the School of Physiotherapy. Those wanting to practice massage had to adhere to the Physiotherapy Act which required them to do 600 hours of training. Physiotherapy superseded massage therapy for many years, but in recent years the massage therapy field has undergone a resurgence.
The Massage Institution of New Zealand (MINZI) was founded in 1985 in Auckland with the focus on the education and standard of massage therapists. In 1989, Jim Sandford established the New Zealand Association of Therapeutic Massage Practitioners. Their focus was on educational standards, the professional image of practitioners and the distribution of information. In 2007 this Association merged with MINZI to become Massage New Zealand. This organisation supports registered members and act as a voice for the profession.
Maori healers in New Zealand are not bound by an association. The Maori do 'miri miri', a healing practice that takes the physical, spiritual and mental health of a person into account, as well as the health of the client's family. They use three forms of massage, namely romiromi (where squeezing and pinching strokes are performed with the elbows, hands, feet, knees and sticks), toto (infant massage) and takahi (walking on body parts to relieve muscle stiffness or other injuries). (Tuchtan et al, 2004). Massage is part of the Maori way of life and is passed down the generations. It is a holistic form of treatment - the whole person is treated (body, mind and spirit) with herbal medicine, massage, counselling etc.).
Western massage is still mainly based on symptoms and the cause of these are mainly related back to anatomical structure, posture or injury. There is a lot of emphasis on bodywork and movement in the Western world – these are reflected in the Reiki, Feldenkrais and Pilates modalities. However, with the 'body-spirit-mind” movement growing stronger, a more holistic approach is being promoted that hopefully will lead to a more comprehensive approach.
In the Eastern world, massage is based around the flow of energy (chi) in the body-mind-spirit concept. The aim is to restore balance to the client's life force. These methods are for example, reflexology, shiatsu and traditional Chinese massage.
In conclusion then, the history of massage is ancient, clearly intricate and full of variety. The East and West have met on many fronts and blended to some extent. However, in order to provide clients with the best possible options, I need to see them as comprised of a body, soul and spirit and focus on all their needs, not only the physical symptoms. For complete healing, it is imperative to not only treat the body but the whole person. I need to ensure that my clients' needs are fully met and be willing to refer them to other health practitioners for assistance in areas which are outside my scope of practice.
Reference List
British Medical Journal. 1894 November 3: 2 (1766): 1003-1004. Retrieved on 29 August, 2009, from http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=2405274&pageindex=1
Calvert, R. N. (2002). The History of Massage. Vermont: Healing Arts Press
Fritz, S. (2004). Mosby’s Fundamentals of Therapeutic Massage (3rd Ed). St. Louis: Mosby.
Janet G. Travell, M.D. The Mother of Myofascial-Trigger Point Knowledge.Retrieved on August 28, 2009, from http://www.pain-education.com
Junkill, J. (2005). Friction Massage. Retrieved on August 27, 2009, from http://www.everything2.com/index.pl?node_id=1717584
McQuillan, D. (2008). A History of Massage in New Zealand. Retrieved on September 1, 2009, from http://www.wikieducator.org/A_History_of_Massage_in_New_Zealand
Salvo, S. (2007). Massage Therapy: Principles and Practice (3rd Ed). Saunders: Mosby.
Smith, S.E. (2009). What is Amma massage? Retrieved on August 27, 2009, from http://www.wisegeek.com/what-is-amma-massage.htm
Tuchtan, C., Tuchtan, V., & Stelfox, D. (2004). Foundations of Massage. Australia: Churchill Livingstone/Elsevier.
Tuesday, September 1, 2009
Tuesday, August 25, 2009
The Story of Stuff - do Ethics count?
The presenter on the Story of Stuff has obviously done a lot of research on the topic of how things are produced and the effect it has on the planet. However, I found that all the evidence given were very one-sided, with emphasis only on the negative aspects of production.
Globally, people are becoming very aware of the effect we have on the environment and are becoming much more responsible. This is reflected even locally in the newly introduced recycling system of the Christchurch City Council. Each household now has three bins, of different colours and sizes. One bin is for greens (food and plant material), one for glass and paper and one for general rubbish. Most of the rubbish lands in one of the first two bins, leaving very little for the unrecyclable rubbish. The Council is very proactive and invites the public to come and see for themselves how their recycling process works.
In countries like South Africa, people are discouraged to use plastic bags by charging them for it. This has had a noticable, positive effect - no more plastic bags floating around, lying on street corners and blown agains fences. This practice has now also started in New Zealand, with recyclable shopping bags being sold and charges made for plastic bags in chain supermarkets.
It is good to be made aware of the negative effects we have on our environment. However, when people are made aware of the effect of even some small effort, e.g. recycling of cans, and how it has contributed to a clean green environment, it serves as a motivating factor. I think most people,in New Zealand anyway, would like to be environmentally responsible and caring. Once they have been made aware of consequences, and given a choice, they will respond favourably.
Globally, people are becoming very aware of the effect we have on the environment and are becoming much more responsible. This is reflected even locally in the newly introduced recycling system of the Christchurch City Council. Each household now has three bins, of different colours and sizes. One bin is for greens (food and plant material), one for glass and paper and one for general rubbish. Most of the rubbish lands in one of the first two bins, leaving very little for the unrecyclable rubbish. The Council is very proactive and invites the public to come and see for themselves how their recycling process works.
In countries like South Africa, people are discouraged to use plastic bags by charging them for it. This has had a noticable, positive effect - no more plastic bags floating around, lying on street corners and blown agains fences. This practice has now also started in New Zealand, with recyclable shopping bags being sold and charges made for plastic bags in chain supermarkets.
It is good to be made aware of the negative effects we have on our environment. However, when people are made aware of the effect of even some small effort, e.g. recycling of cans, and how it has contributed to a clean green environment, it serves as a motivating factor. I think most people,in New Zealand anyway, would like to be environmentally responsible and caring. Once they have been made aware of consequences, and given a choice, they will respond favourably.
Saturday, August 22, 2009
ASSESSMENT TASK 7: TIME MANAGEMENT
Time management is about using the time you at your disposal wisely in order to achieve and meet deadlines. In order to create better time management skills, I have looked at what worked for me and what did not, and then formulated a plan that would assist me in better management of this valuable resource, in order to achieve my study goals.
I have a wall planner which is helpful as it shows the dates that we have on-line class and dates for the practical blocks. I also have a diary which I can take with me when away from home. I decide each day which things are priority and try to set a goal for the day. Instead of just a reminder to work on a specific assignment, I have started to list specific small goals, e.g. what exactly about the assignment I wanted to get done that day. This has been very helpful and felt more like an achievement. It has also helped to set more realistic goals as some goals set turned out to take much more time than I anticipated. I have also tried to find little pockets of time that I could use during the day that could help even just to achieve something small, e.g. tea breaks at work. That has been helpful, even just to find a reference on the web.
What I find very difficult to manage is unplanned events, e.g. a friend that takes ill and needs help and funerals! I have also discovered that if I stay and try to study at home, that there are too many distractions. Friends tend to think you are available and can take time off if you are at home. So I have had to look at other venues to study at, e.g. a library.
I find it difficult to say 'no' when asked to help someone. I realised that I need to become more assertive when expectations are set by family members which I am unable to achieve without sacrificing time I set aside for studying. I need to set firm boundaries around the time I set aside to achieve my study goals.
I also find that I tend to spend a lot of time trying to 'finalize' my assignment and that I keep adding to it in an attempt to get it perfect. I have to be more realistic in my expectations and allocate a certain amount of time to the task and then learn to be happy with the outcome.
Distractions will always be part of life. However, learning to adjust to circumstances and planning around it become necessary when study goals become high priority. I have become more time conscious by being made aware of time wasters and other factors that impact on my studies. I am now learning to make adjustments and to set boundaries in place to use my time more effectively.
Reference
Time Management (n.d.). Retrieved on 22 August from http://www.ulc.psu.edu/studyskills/time_management.html
I have a wall planner which is helpful as it shows the dates that we have on-line class and dates for the practical blocks. I also have a diary which I can take with me when away from home. I decide each day which things are priority and try to set a goal for the day. Instead of just a reminder to work on a specific assignment, I have started to list specific small goals, e.g. what exactly about the assignment I wanted to get done that day. This has been very helpful and felt more like an achievement. It has also helped to set more realistic goals as some goals set turned out to take much more time than I anticipated. I have also tried to find little pockets of time that I could use during the day that could help even just to achieve something small, e.g. tea breaks at work. That has been helpful, even just to find a reference on the web.
What I find very difficult to manage is unplanned events, e.g. a friend that takes ill and needs help and funerals! I have also discovered that if I stay and try to study at home, that there are too many distractions. Friends tend to think you are available and can take time off if you are at home. So I have had to look at other venues to study at, e.g. a library.
I find it difficult to say 'no' when asked to help someone. I realised that I need to become more assertive when expectations are set by family members which I am unable to achieve without sacrificing time I set aside for studying. I need to set firm boundaries around the time I set aside to achieve my study goals.
I also find that I tend to spend a lot of time trying to 'finalize' my assignment and that I keep adding to it in an attempt to get it perfect. I have to be more realistic in my expectations and allocate a certain amount of time to the task and then learn to be happy with the outcome.
Distractions will always be part of life. However, learning to adjust to circumstances and planning around it become necessary when study goals become high priority. I have become more time conscious by being made aware of time wasters and other factors that impact on my studies. I am now learning to make adjustments and to set boundaries in place to use my time more effectively.
Reference
Time Management (n.d.). Retrieved on 22 August from http://www.ulc.psu.edu/studyskills/time_management.html
Thursday, August 20, 2009
Task 5: Sustainable Massage Practice
The operational strategies in a massage clinic setting is a reflection of the values and attributes of the massage therapist. Running a sustainable practice is possible and within reach of every therapist. It may require making changes and adjustments, but the outcome is sure to be rewarding.
The focus in a massage clinic setting is on the client and to help facilitate the healing process. However, when sustainability is an integral part of therapist's business practice, it has a flow-on effect. As Spehar (n.d.) aptly puts it: “helping the environment goes hand in hand with basic massage principles—healthy, happy people help keep the planet healthy and happy.”
In maintaining a holistic view of health, the therapist keeps in mind that a healthy body also needs a healthy mind and spirit to encompasses the full spectrum of health. This applies to the client and therapist alike. Therapists wanting to offer clients a well rounded service need to have strategies in place to sustain their own health in all its facets.
Then they also need to implement strategies to keep their clinic sustainable. An innate care to sustain the environment and contribute positively to the economy is evidence of the therapist's social conscience and will reflect positively in the care they provide to clients.
A sustainable massage practice starts with the therapist. A balanced outlook and healthy habits increases the chance of a long, happy career. Burnout is the major cause of therapists leaving the profession but can be avoided by adapting sustainable practices. The therapist has to ensure that the efforts and time put into running a clinic are sustainable over time. This can be done by planning how many massages can be done a day without overextending oneself and also by establishing hours and days of operation that will leave enough time for relaxation and social interaction. Leaving some time between massage sessions will help the therapist to relax, do stretches and re-focus. Focussing on correct body mechanics will help prevent aches and pains. A big mirror on the clinic room wall can help to periodically check for postural anomalies. Having a height adjustable massage table is essential to help ensure the optimum working environment. Constant use of just the hands and fingers may not be sustainable over time, so other massage techniques like using knuckles, elbow and even hot stones, can be explored (Salvo, 2007).
Between sessions and/or after a day's work, the therapist can do stretches or selfmassage. Massaging the arms with ice may also be helpful. It is also helpful to exchange massages with another therapist on a regular practice. Some form of exercise also need to be part of the life of a therapist. This will help them to remain supple and fit and adds balance to their life. Other hobbies that are mentally stimulating or relaxing are also beneficial.
If the therapist experience any personal issues or issues with clients, it is advisable to talk these through with a trusted friend, colleague or counsellor. Taking clients' problems on board is not a healthy practice and is not sustainable in the long run. Therapists need to maintain not only their physical, but also their emotional health. The therapist is not a counsellor and can listen to clients but need to have a network of resources to refer clients to e.g. counsellors, a psychologist and other health care professionals, if needed. It is also good practice to have regular contact with other massage therapists to exchange ideas and to get support and fresh inspiration.
The next component of a sustainable practice is looking at the service clients receive and/or expect. What is given to clients need to be sustainable. The therapist's scope of practice has to be clearly explained to clients. Boundaries have to be clearly set. According to Fritz (2004), professionals need to find the client's comfort zone and can do so by discovering their own personal and professional comfort zones. This will help prevent clients from becoming demanding, expecting more take more time, expecting treatment which the therapist is not qualified to give or expecting to be 'healed'. This is especially helpful if the client is a friend or relative.
Sufficient client information needs to be taken to establish that there are no contraindications to massage. This information needs to be checked and updated with each visit. The treatment plan and outcome of each session need to be recorded.
Clients feel valued and respected if they are encouraged to give feedback and to ask questions. Reporting back on progress, on any postmassage sensations and experiences helps to adjust the massage. Client may need to be educated to give feedback, especially if they do not have much body awareness. The therapist has to develop a professional trust relationship with the client that will allow the client to feel safe enough to give positive as well as negative feedback. If there has been not the expected outcome, the treatment plan has to be revisited. This will ensure that the client gets the best possible treatment and will help to sustain a trust relationship between the therapist and the client (Fritz, 2004).
Client records need to be treated as confidential. Client comfort and safety always have to be ensured.The massage table has to be able to take the weight of heavy clients and has to be checked regularly. Adequate draping during the session, checking that the client is warm and comfortable and that the pressure used is within a comfort range, all contribute to a client feeling valued and heard. Making the client feel valued will contribute to a positive experience and will also encourage them to refer their friends and family. Word of mouth referrals are very valuable and contributes hugely to sustaining a client base.
Client education is very important. Telling the client what the massage entailed, but also why it was done helps them understand the value of the service given. When stretches are given to perform at home, the client is more likely to oblige if they are told why and how the exercises will benefit them. This will hugely contributing to sustaining the positive benefits gained with the massage.
The next area to establish sustainability is the economic sense of the business. Can the business be run at a reasonable profit or not? The main expense of running a business could be the premises. The therapist need to establish where to work from, home or a clinic, privately or as part of an established clinic. It could be worth renting premises if the therapist finds it difficult to keep home life and business separated. However, the cost of this has to be considered as the business must be profitable and competitive. Information on what other therapists in similar settings charge can be helpful in deciding on a fee structure. However, a business cannot be sustained by undercutting other therapists. It is imperative to establish the total running costs of the business before setting a fee. Then a cost analysis has to be made to see if the business will be competitive and therefore sustainable. The bottom line is that the service must be, according to the client, value for money.
A business plan needs to be part of planning and assessing the running costs of the business. Items that have to be included and considered are things like electricity costs, rates, insurance, consumables like oils, laundry, replacement of items such as light bulbs, towels, sheets etc. as well as possible repairs that may need to be done, e.g. painting. According to a business executive (T.Walker, personal communication, 6 August 2009), the business plan needs to be SMART (specific, measurable, achievable, realistic and timed). All the costs needed to be added, divided by the hourly rate charged and then the therapist can decide if the required hours needed to work is realistic and sustainable. If not, the situation has to be reassessed and re-calculated.
Taking all of the above into account, business objective have to be set, e.g. what does the therapist want to offer, e.g. massage, reflexology, etc. , to what extent (hours, days), to what standard (e.g. relaxation only, therapeutic, deep tissue, neuromuscular, hot stones, etc.), and what training/qualifications are deemed necessary to achieve this or to upskill, where the service is to be rendered (at home, in own clinic or as part of another clinic setting) and lastly the therapist has to be clear on the reason for doing this (hobby, part-time income, full-time occupation).
Taken all of the above into account and having created a sustainable practice, it then remains for the therapist to consider the impact of their practice on the environment. What rubbish does the therapist create that will contribute to landfills and what equipment and consumables are used that come from non-sustainable resources? It is good to ensure that the table has not been made from an endangered wood species or from polluting plastics. If possible, ascertain that the cushioning does not contain chlorofluorocarbons and is ozone safe. To help sustain the local economy it will be good practice to buy a table, other equipment and consumables like oils and balms from a local supplier. This also ensures that the quality and contents can be verified.
Another consideration is the lighting used. Natural lighting is obviously the first choice. Getting the maximum of natural light through thin curtains will still give the necessary privacy. Double glazing will help prevent heat loss. Insulated inner walls will help maintain an even temperature. Both curtains/blinds and insulation will help reduce sounds and thus contribute to the ambiance of the massage room. The décor of the room also contributes to this as well as soft, soothing background music.
Heating is important and needs to be given consideration too. On a sunny day, the curtains can be opened to allow the sun to heat the room between appointments. Solar heating may be an option, or otherwise just an oil column heater set on low or a heat pump will ensure that there are no sharp fluctuations in temperature. Spehar gives tips to contribute to sustainable practices, e.g. using long life light bulbs and to unplug appliances when they are not in use to reduce energy consumption and electromagnetic field exposure. This would be applicable to dryers, washing machines, heaters, electric blankets, computers, etc.
The types of oils used in a clinic is another important consideration. Are they organic and are they from sustainable resources? Are the containers they come in biodegradable or can they be recycled? One option is jojoba oil which is close to human sebum in composition and is therefore non allergenic, and makes a great massage oil.
Client records generate paper work. To help 'save the trees', these can be kept to a minimum. The consultation form can be printed double sided and scrap paper can be cut up to reuse where needed for making notes. Business cards can be printed on re-cycled paper. Printer cartridges can be refilled and reused.
There are clearly many considerations when looking at the sustainablity of a massage practice. According to Wright (n.d.) it's about “combining economy with ecology”. He encourages businesses to honour the cyclic principle of ecology and to recycle, reuse, reduce and redesign.
Sustainable business practice involves consumer-centered thinking, approaches that view customers as people with needs beyond material consumption and temporary gratifications. It also includes issues that affect customers' fundamental quality of life, access to air, water, health, markets, and so on. Careful planning will ensure that therapists serve the needs of their client in the broadest sense possible while minimising the impact on the environment and making a positive contribution to society.
Since I have been made aware of the concept of sustainability, I have looked at changes that I can make, personally and in my own practice both now and in the future.
A life coach has given me tips on how to be empathetic to client without taking their stress on board (F. Walmsley, personal communication, 12 July, 2009). One of the ways to do this is to imagine having a big raincoat on while talking to the client, and then 'shedding' the coat after the session. I have also incorporated the habit of washing my arms right to the elbows after a massage. I have also learned to listen but not encourage too much talking from clients while they are on the massage table. This has so far helped me to not become so emotionally involved in clients' personal issues and will help me sustain an emotional balance. I have also given more time and thought to grounding and re-energizing myself between sessions, and have found that very beneficial.
I have consulted with a business manager (T Walker, personal communication, 6 August, 2009) who has given me advice on how to work out whether my future clinic will be sustainable at the number of hours I envisage working. We have discussed where I will have my business, how to work out a business plan and he has offered to assist in setting up a business plan.
I would have to ensure that the business not only runs profitably but that I also get personal satisfaction from it. If not, I will not be able to sustain a practice for long as it will become only a mechanical exercise. I have put my name on a mailing list and now receive information on courses and upskilling opportunities in Christchurch. I have already done a course in Manual Lymphatic Drainage which has added to my scope of practice and have given me another area of interest. This means that I can offer another modality to clients. This adds to the sustainability of the practice.
To ensure that clients get the best value for their money, I now take a more detailed medical history and also ensure that they know what my scope of practice is. A few clients have had longstanding issues which I felt was not responding to relaxation therapy. I consequently made it clear to them that they would benefit from seeing a therapeutic massage therapist. I have made an arrangement with a previous tutor and attend the massage session with the client if they give their consent and also learn from the experience.
Fritz, S. (2004) Mosby’s Fundamentals of Therapeutic Massage (3rd Ed). St. Louis: Mosby.
Salvo, S. (2007) Massage Therapy: Principles and Practice (3rd Ed). Saunders: Mosby.
Spehar, C. (n.d.). Making Your Massage Practice Earth Friendly. Retrieved August 18, 2009, from http://www.abmp.com/massagemarketplace/downloads/TenForToday_JA08.pdf
Wright, T. (n.d.). Sustainable Business Practices. Retrieved August 15, 2009, from http://www.sustainablebizness.com/WhySustBiz.htm\
The focus in a massage clinic setting is on the client and to help facilitate the healing process. However, when sustainability is an integral part of therapist's business practice, it has a flow-on effect. As Spehar (n.d.) aptly puts it: “helping the environment goes hand in hand with basic massage principles—healthy, happy people help keep the planet healthy and happy.”
In maintaining a holistic view of health, the therapist keeps in mind that a healthy body also needs a healthy mind and spirit to encompasses the full spectrum of health. This applies to the client and therapist alike. Therapists wanting to offer clients a well rounded service need to have strategies in place to sustain their own health in all its facets.
Then they also need to implement strategies to keep their clinic sustainable. An innate care to sustain the environment and contribute positively to the economy is evidence of the therapist's social conscience and will reflect positively in the care they provide to clients.
A sustainable massage practice starts with the therapist. A balanced outlook and healthy habits increases the chance of a long, happy career. Burnout is the major cause of therapists leaving the profession but can be avoided by adapting sustainable practices. The therapist has to ensure that the efforts and time put into running a clinic are sustainable over time. This can be done by planning how many massages can be done a day without overextending oneself and also by establishing hours and days of operation that will leave enough time for relaxation and social interaction. Leaving some time between massage sessions will help the therapist to relax, do stretches and re-focus. Focussing on correct body mechanics will help prevent aches and pains. A big mirror on the clinic room wall can help to periodically check for postural anomalies. Having a height adjustable massage table is essential to help ensure the optimum working environment. Constant use of just the hands and fingers may not be sustainable over time, so other massage techniques like using knuckles, elbow and even hot stones, can be explored (Salvo, 2007).
Between sessions and/or after a day's work, the therapist can do stretches or selfmassage. Massaging the arms with ice may also be helpful. It is also helpful to exchange massages with another therapist on a regular practice. Some form of exercise also need to be part of the life of a therapist. This will help them to remain supple and fit and adds balance to their life. Other hobbies that are mentally stimulating or relaxing are also beneficial.
If the therapist experience any personal issues or issues with clients, it is advisable to talk these through with a trusted friend, colleague or counsellor. Taking clients' problems on board is not a healthy practice and is not sustainable in the long run. Therapists need to maintain not only their physical, but also their emotional health. The therapist is not a counsellor and can listen to clients but need to have a network of resources to refer clients to e.g. counsellors, a psychologist and other health care professionals, if needed. It is also good practice to have regular contact with other massage therapists to exchange ideas and to get support and fresh inspiration.
The next component of a sustainable practice is looking at the service clients receive and/or expect. What is given to clients need to be sustainable. The therapist's scope of practice has to be clearly explained to clients. Boundaries have to be clearly set. According to Fritz (2004), professionals need to find the client's comfort zone and can do so by discovering their own personal and professional comfort zones. This will help prevent clients from becoming demanding, expecting more take more time, expecting treatment which the therapist is not qualified to give or expecting to be 'healed'. This is especially helpful if the client is a friend or relative.
Sufficient client information needs to be taken to establish that there are no contraindications to massage. This information needs to be checked and updated with each visit. The treatment plan and outcome of each session need to be recorded.
Clients feel valued and respected if they are encouraged to give feedback and to ask questions. Reporting back on progress, on any postmassage sensations and experiences helps to adjust the massage. Client may need to be educated to give feedback, especially if they do not have much body awareness. The therapist has to develop a professional trust relationship with the client that will allow the client to feel safe enough to give positive as well as negative feedback. If there has been not the expected outcome, the treatment plan has to be revisited. This will ensure that the client gets the best possible treatment and will help to sustain a trust relationship between the therapist and the client (Fritz, 2004).
Client records need to be treated as confidential. Client comfort and safety always have to be ensured.The massage table has to be able to take the weight of heavy clients and has to be checked regularly. Adequate draping during the session, checking that the client is warm and comfortable and that the pressure used is within a comfort range, all contribute to a client feeling valued and heard. Making the client feel valued will contribute to a positive experience and will also encourage them to refer their friends and family. Word of mouth referrals are very valuable and contributes hugely to sustaining a client base.
Client education is very important. Telling the client what the massage entailed, but also why it was done helps them understand the value of the service given. When stretches are given to perform at home, the client is more likely to oblige if they are told why and how the exercises will benefit them. This will hugely contributing to sustaining the positive benefits gained with the massage.
The next area to establish sustainability is the economic sense of the business. Can the business be run at a reasonable profit or not? The main expense of running a business could be the premises. The therapist need to establish where to work from, home or a clinic, privately or as part of an established clinic. It could be worth renting premises if the therapist finds it difficult to keep home life and business separated. However, the cost of this has to be considered as the business must be profitable and competitive. Information on what other therapists in similar settings charge can be helpful in deciding on a fee structure. However, a business cannot be sustained by undercutting other therapists. It is imperative to establish the total running costs of the business before setting a fee. Then a cost analysis has to be made to see if the business will be competitive and therefore sustainable. The bottom line is that the service must be, according to the client, value for money.
A business plan needs to be part of planning and assessing the running costs of the business. Items that have to be included and considered are things like electricity costs, rates, insurance, consumables like oils, laundry, replacement of items such as light bulbs, towels, sheets etc. as well as possible repairs that may need to be done, e.g. painting. According to a business executive (T.Walker, personal communication, 6 August 2009), the business plan needs to be SMART (specific, measurable, achievable, realistic and timed). All the costs needed to be added, divided by the hourly rate charged and then the therapist can decide if the required hours needed to work is realistic and sustainable. If not, the situation has to be reassessed and re-calculated.
Taking all of the above into account, business objective have to be set, e.g. what does the therapist want to offer, e.g. massage, reflexology, etc. , to what extent (hours, days), to what standard (e.g. relaxation only, therapeutic, deep tissue, neuromuscular, hot stones, etc.), and what training/qualifications are deemed necessary to achieve this or to upskill, where the service is to be rendered (at home, in own clinic or as part of another clinic setting) and lastly the therapist has to be clear on the reason for doing this (hobby, part-time income, full-time occupation).
Taken all of the above into account and having created a sustainable practice, it then remains for the therapist to consider the impact of their practice on the environment. What rubbish does the therapist create that will contribute to landfills and what equipment and consumables are used that come from non-sustainable resources? It is good to ensure that the table has not been made from an endangered wood species or from polluting plastics. If possible, ascertain that the cushioning does not contain chlorofluorocarbons and is ozone safe. To help sustain the local economy it will be good practice to buy a table, other equipment and consumables like oils and balms from a local supplier. This also ensures that the quality and contents can be verified.
Another consideration is the lighting used. Natural lighting is obviously the first choice. Getting the maximum of natural light through thin curtains will still give the necessary privacy. Double glazing will help prevent heat loss. Insulated inner walls will help maintain an even temperature. Both curtains/blinds and insulation will help reduce sounds and thus contribute to the ambiance of the massage room. The décor of the room also contributes to this as well as soft, soothing background music.
Heating is important and needs to be given consideration too. On a sunny day, the curtains can be opened to allow the sun to heat the room between appointments. Solar heating may be an option, or otherwise just an oil column heater set on low or a heat pump will ensure that there are no sharp fluctuations in temperature. Spehar gives tips to contribute to sustainable practices, e.g. using long life light bulbs and to unplug appliances when they are not in use to reduce energy consumption and electromagnetic field exposure. This would be applicable to dryers, washing machines, heaters, electric blankets, computers, etc.
The types of oils used in a clinic is another important consideration. Are they organic and are they from sustainable resources? Are the containers they come in biodegradable or can they be recycled? One option is jojoba oil which is close to human sebum in composition and is therefore non allergenic, and makes a great massage oil.
Client records generate paper work. To help 'save the trees', these can be kept to a minimum. The consultation form can be printed double sided and scrap paper can be cut up to reuse where needed for making notes. Business cards can be printed on re-cycled paper. Printer cartridges can be refilled and reused.
There are clearly many considerations when looking at the sustainablity of a massage practice. According to Wright (n.d.) it's about “combining economy with ecology”. He encourages businesses to honour the cyclic principle of ecology and to recycle, reuse, reduce and redesign.
Sustainable business practice involves consumer-centered thinking, approaches that view customers as people with needs beyond material consumption and temporary gratifications. It also includes issues that affect customers' fundamental quality of life, access to air, water, health, markets, and so on. Careful planning will ensure that therapists serve the needs of their client in the broadest sense possible while minimising the impact on the environment and making a positive contribution to society.
Since I have been made aware of the concept of sustainability, I have looked at changes that I can make, personally and in my own practice both now and in the future.
A life coach has given me tips on how to be empathetic to client without taking their stress on board (F. Walmsley, personal communication, 12 July, 2009). One of the ways to do this is to imagine having a big raincoat on while talking to the client, and then 'shedding' the coat after the session. I have also incorporated the habit of washing my arms right to the elbows after a massage. I have also learned to listen but not encourage too much talking from clients while they are on the massage table. This has so far helped me to not become so emotionally involved in clients' personal issues and will help me sustain an emotional balance. I have also given more time and thought to grounding and re-energizing myself between sessions, and have found that very beneficial.
I have consulted with a business manager (T Walker, personal communication, 6 August, 2009) who has given me advice on how to work out whether my future clinic will be sustainable at the number of hours I envisage working. We have discussed where I will have my business, how to work out a business plan and he has offered to assist in setting up a business plan.
I would have to ensure that the business not only runs profitably but that I also get personal satisfaction from it. If not, I will not be able to sustain a practice for long as it will become only a mechanical exercise. I have put my name on a mailing list and now receive information on courses and upskilling opportunities in Christchurch. I have already done a course in Manual Lymphatic Drainage which has added to my scope of practice and have given me another area of interest. This means that I can offer another modality to clients. This adds to the sustainability of the practice.
To ensure that clients get the best value for their money, I now take a more detailed medical history and also ensure that they know what my scope of practice is. A few clients have had longstanding issues which I felt was not responding to relaxation therapy. I consequently made it clear to them that they would benefit from seeing a therapeutic massage therapist. I have made an arrangement with a previous tutor and attend the massage session with the client if they give their consent and also learn from the experience.
Fritz, S. (2004) Mosby’s Fundamentals of Therapeutic Massage (3rd Ed). St. Louis: Mosby.
Salvo, S. (2007) Massage Therapy: Principles and Practice (3rd Ed). Saunders: Mosby.
Spehar, C. (n.d.). Making Your Massage Practice Earth Friendly. Retrieved August 18, 2009, from http://www.abmp.com/massagemarketplace/downloads/TenForToday_JA08.pdf
Wright, T. (n.d.). Sustainable Business Practices. Retrieved August 15, 2009, from http://www.sustainablebizness.com/WhySustBiz.htm\
Thursday, August 13, 2009
THE ETHICS OF PROFESSIONAL PRACTICE
Massage is a client focussed therapy and as such a massage therapist needs to 'acknowledge the inherent worth and individuality of each person by not discriminating or behaving in any prejudical manner with clients' (Massage NZ Code of Ethics, nd). There are many ethical considerations when dealing with clients as discussed below. Following these guidelines will help to build a trust relationship with clients and will benefit both them and the practitioner's reputation and practice.
Client centered care
The massage therapist needs to always have the client's best interest at heart. Rapport has to be established with the client at the very first meeting. This is the start of a trust relationship where the focus is on meeting the client's needs. The therapist needs to gain essential information from the client in order to ascertain whether the client's needs can be met and/or if the expectations of the client are realistic. Before formulating a treatment plan, the client's beliefs have to be taken into account, e.g. the client may not be comfortable with some areas of the body being worked on or may have cultural and/or religious beliefs that need to be considered. It is also important to gain information on the client's health to ascertain that there are no contraidications for massage. The ultimate goal of the therapist needs always to be to give the client the best value for their time and money and to do them no harm.
If the client experience an emotional release during the treatment, it has to be handled with empathy and compassion without going beyond the ethical boundaries. The “otherness' of the client always needs to be respected, especially if the client is not of the same culture or gender as the therapist. Having an open mind will help the therapist to remain sensitive to the client's needs.
Informed consent
Before starting a massage, the therapist has to explain the proposed treatment plan to the client and give the client enough time to ask questions. Once the client understands and agrees to what the session is going to entail, informed consent needs to be obtained before proceeding with the massage. According to Salvo (2007), this will demonstrate 'client participation in the therapeutic relationship.'
Scope of Practice
The massage therapist needs to be very clear about her/his own qualifications, training and experience and always work within his/her 'scope of practice'. Salvo (2007) defines the term scope of practice as “the profession's working parameters” which sets 'professional boundaries and limitations.” A relaxation massage therapist, can not offer therapeutic massage to a client or prescribe any medications, as this would be outside their scope of practice. If a client's treatment needs are outside the therapist's scope of practice, the client needs to be referred to another health professional.
Confidentiality
Confidentiality needs to be maintained at all times. The client's details cannot be discussed with any other person without prior consent by the client or unless required by law. Client files need to be kept in a locked cabinet and not left lying around where anyone else can see it.
Boundaries
The massage therapist has to maintain a professional relationship with the client at all times, e..g by conduct, dress and the treatment offered. The client's personal space and privacy has to be considered by maintaining adequate draping and not making any personal comments about their bodies. This helps to keep client/ therapist roles clear so that the client will feel safe and therapist and have confidence in them. It is imperative for a massage therapist to be self-aware and to think clearly at all times. This includes not using drugs, alcohol or other substances that impairs the normal thinking and judgement process (Salvo, 2007).
Power Differentials
The massage therapist needs to be conscious of the client's vulnerability and possible feelings of not being 'in control' as they lie on the massage table. There is a power difference in the fact that the therapist has the specialist knowledge and is giving the treatment, but the client needs to be able to decide what they wish the treatment to achieve. It is essential to build rapport with the client from the start so that they will trust that you will not abuse your power but will give them the best possible treatment.
Relationships
The therapist needs to maintain a professional relationship with the client, irrespective of whether the client is a friend or family. A counsellor can advise the massage therapist on strategies that will help to maintain professional boundaries with clients that are related or a friend. Small talk should ideally be kept to a minimum and, while in the session, the therapist needs to keep the conversation on the reason for the consultation.
If a therapist should want become involved in an intimate relationship with a client, the client needs to be referred to another therapist as this would be a violation of professional boundaries.
Transference and Counter-transference
A client may become emotionally attached to the therapist and may start calling the therapist just to talk to them, sgive them gifts, stay longer after a treatment to talk or even making suggestions of social contact and a romantic relationship. This is called transference. The therapist needs to discuss such issues with a counsellor or mentor and then make an appropriate decision to either refer the client on to another therapist or set clear boundaries with the client.
It could also happen that the therapist develops an attachment to a client due to the personal needs of the therapist, e.g. for acceptance or friendship. This could give rise to the therapist giving the client longer sessions and wanting to spend more time, with them, which could develop in an unhealthy client/therapist balance. The therapist could want positive feedback from the client to boost their selfesteem. This can make the client feel obliged to be positive about the outcome of each session. This is a breach of ethical practice and the therapist needs to seek professional guidance if they become aware of this happening.
Conclusion and Reflection
It is imperative that a massage therapist maintains an ethical approach to his/her profession and adhere to standards and boundaries as set in their Code of Practice. Confidentiality and respect for clients' rights need to be an integral part of their treatment plans, whilst keeping within their scope of practice. This will ensure a healthy and balanced relationship with clients and contribute to developing and maintaining an exciting career.
I have become aware of both strengths and weaknesses with regard to ethical considerations in my practice. I have found it relatively easy to treat friends and family without crossing the professional boundaries, by creating a professional environment and keeping to the purpose of the visit. I am aware of the need of confidentiality and also how essential it is that the client can trust me with their details.
What I need to watch out for, is not to overstep my scope of practice and be tempted to do therapeutic massage before I have the knowledge and qualifications to do so. I also find that with my friends (not with other clients) that I do not watch the time closely and tend to give them more time. I need to set the boundaries clearly in this regard. I also feel that I need to concentrate more on the client's goals for the session and then to check that they are happy with the outcomes. I can also improve on my client record keeping by recording more detailed information on the treatment plan and goals set.
I would like to adhere to ethical standards in my practice as I realise it would help ensure that I meet the needs of my clients and enjoy my work.
Reference List
Salvo, S. (2007) Massage therapy: principles and practice (3rd Ed). Saunders: Mosby.
Massage New Zealand Code of Ethics. Retrieve on 13/08/09 from http://massagenewzealand.org.nz/about-us/code-of-ethics/
Notes from Elluminate lecture Felicity Molloy. 6/7/09
Client centered care
The massage therapist needs to always have the client's best interest at heart. Rapport has to be established with the client at the very first meeting. This is the start of a trust relationship where the focus is on meeting the client's needs. The therapist needs to gain essential information from the client in order to ascertain whether the client's needs can be met and/or if the expectations of the client are realistic. Before formulating a treatment plan, the client's beliefs have to be taken into account, e.g. the client may not be comfortable with some areas of the body being worked on or may have cultural and/or religious beliefs that need to be considered. It is also important to gain information on the client's health to ascertain that there are no contraidications for massage. The ultimate goal of the therapist needs always to be to give the client the best value for their time and money and to do them no harm.
If the client experience an emotional release during the treatment, it has to be handled with empathy and compassion without going beyond the ethical boundaries. The “otherness' of the client always needs to be respected, especially if the client is not of the same culture or gender as the therapist. Having an open mind will help the therapist to remain sensitive to the client's needs.
Informed consent
Before starting a massage, the therapist has to explain the proposed treatment plan to the client and give the client enough time to ask questions. Once the client understands and agrees to what the session is going to entail, informed consent needs to be obtained before proceeding with the massage. According to Salvo (2007), this will demonstrate 'client participation in the therapeutic relationship.'
Scope of Practice
The massage therapist needs to be very clear about her/his own qualifications, training and experience and always work within his/her 'scope of practice'. Salvo (2007) defines the term scope of practice as “the profession's working parameters” which sets 'professional boundaries and limitations.” A relaxation massage therapist, can not offer therapeutic massage to a client or prescribe any medications, as this would be outside their scope of practice. If a client's treatment needs are outside the therapist's scope of practice, the client needs to be referred to another health professional.
Confidentiality
Confidentiality needs to be maintained at all times. The client's details cannot be discussed with any other person without prior consent by the client or unless required by law. Client files need to be kept in a locked cabinet and not left lying around where anyone else can see it.
Boundaries
The massage therapist has to maintain a professional relationship with the client at all times, e..g by conduct, dress and the treatment offered. The client's personal space and privacy has to be considered by maintaining adequate draping and not making any personal comments about their bodies. This helps to keep client/ therapist roles clear so that the client will feel safe and therapist and have confidence in them. It is imperative for a massage therapist to be self-aware and to think clearly at all times. This includes not using drugs, alcohol or other substances that impairs the normal thinking and judgement process (Salvo, 2007).
Power Differentials
The massage therapist needs to be conscious of the client's vulnerability and possible feelings of not being 'in control' as they lie on the massage table. There is a power difference in the fact that the therapist has the specialist knowledge and is giving the treatment, but the client needs to be able to decide what they wish the treatment to achieve. It is essential to build rapport with the client from the start so that they will trust that you will not abuse your power but will give them the best possible treatment.
Relationships
The therapist needs to maintain a professional relationship with the client, irrespective of whether the client is a friend or family. A counsellor can advise the massage therapist on strategies that will help to maintain professional boundaries with clients that are related or a friend. Small talk should ideally be kept to a minimum and, while in the session, the therapist needs to keep the conversation on the reason for the consultation.
If a therapist should want become involved in an intimate relationship with a client, the client needs to be referred to another therapist as this would be a violation of professional boundaries.
Transference and Counter-transference
A client may become emotionally attached to the therapist and may start calling the therapist just to talk to them, sgive them gifts, stay longer after a treatment to talk or even making suggestions of social contact and a romantic relationship. This is called transference. The therapist needs to discuss such issues with a counsellor or mentor and then make an appropriate decision to either refer the client on to another therapist or set clear boundaries with the client.
It could also happen that the therapist develops an attachment to a client due to the personal needs of the therapist, e.g. for acceptance or friendship. This could give rise to the therapist giving the client longer sessions and wanting to spend more time, with them, which could develop in an unhealthy client/therapist balance. The therapist could want positive feedback from the client to boost their selfesteem. This can make the client feel obliged to be positive about the outcome of each session. This is a breach of ethical practice and the therapist needs to seek professional guidance if they become aware of this happening.
Conclusion and Reflection
It is imperative that a massage therapist maintains an ethical approach to his/her profession and adhere to standards and boundaries as set in their Code of Practice. Confidentiality and respect for clients' rights need to be an integral part of their treatment plans, whilst keeping within their scope of practice. This will ensure a healthy and balanced relationship with clients and contribute to developing and maintaining an exciting career.
I have become aware of both strengths and weaknesses with regard to ethical considerations in my practice. I have found it relatively easy to treat friends and family without crossing the professional boundaries, by creating a professional environment and keeping to the purpose of the visit. I am aware of the need of confidentiality and also how essential it is that the client can trust me with their details.
What I need to watch out for, is not to overstep my scope of practice and be tempted to do therapeutic massage before I have the knowledge and qualifications to do so. I also find that with my friends (not with other clients) that I do not watch the time closely and tend to give them more time. I need to set the boundaries clearly in this regard. I also feel that I need to concentrate more on the client's goals for the session and then to check that they are happy with the outcomes. I can also improve on my client record keeping by recording more detailed information on the treatment plan and goals set.
I would like to adhere to ethical standards in my practice as I realise it would help ensure that I meet the needs of my clients and enjoy my work.
Reference List
Salvo, S. (2007) Massage therapy: principles and practice (3rd Ed). Saunders: Mosby.
Massage New Zealand Code of Ethics. Retrieve on 13/08/09 from http://massagenewzealand.org.nz/about-us/code-of-ethics/
Notes from Elluminate lecture Felicity Molloy. 6/7/09
Friday, July 31, 2009
FM Task 2: The Effects of Massage
THE EFFECTS OF MASSAGE ON THE AUTONOMIC NERVOUS SYSTEM
The autonomic nervous system (ANS) controls the involuntary activities in the body through stimulation of smooth muscle, cardiac muscle and glands. The ANS consists of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These two systems generally affect the same organs but causes opposite effects(Marieb, 2004).
The role of the sympathetic division is to prepare the body to cope with situations that threaten survival. It is also called the “fight-or-flight” system. The parasympathetic division, in contrast, can be called the “resting and digesting” system. Both systems work together to maintain homeostasis in the body (Marieb, 2004).
Massage can stimulate the function of either of the sympathetic or parasympathetic subdivisions, depending on the techniques and strokes applied. The massage therapist can adapt a massage to the needs of a client, by knowing the effect of different massage strokes on the nervous system.
When starting a massage, the first effect of touch, even on a fully clothed client, is involuntarily arousal of the sympathetic functions of the body. This response can be maintained by doing a fast-paced massage and compression techniques as is typically used in sports massage. This can also be used to lift depression temporarily (Fritz, 2004).
If a parasympathetic response is required, using holding techniques and breathing with the client will help to connect the practitioner to the client and to diminish the initial sympathetic response. This gives the client’s body time to integrate the sensory input. Massage strokes then need to be applied slowly, rhythmically and with pleasurable but not painful pressure (Fritz, 2004).
THE EFFECTS OF MASSAGE STROKES
Touch and holding serves to reassure the client at the start of a massage and helps them to adjust to the sensory stimulation.
Effleurage, a gliding stroke, assists in lymphatic drainage when applied lightly It also warms up the tissues by increasing blood circulation and makes the tissues more extensible. Effleurage helps to flush metabolic waste out of the tissues after the use of other deeper strokes like pétrissage and tapotement. If applied in the direction of the muscle fibres, effleurage also helps to increase muscle length (Salvo, 2007).
According to Salvo (2007), effleurage calms the nervous system when done slowly and rhythmically, but stimulates the nervous system when done quickly. Fritz (2007) also states that slow superficial strokes are very soothing, whereas fast superficial strokes are stimulating. If a deeper stroke pressure with a slower rate of application is used, the effect is more mechanical and stimulates parasympathetic dominance.
Petrissage, a kneading stroke, is effective in releasing muscle tension. According to Fritz (2004), petrissage has the mechanical effect of softening and creating space around the muscle fibers, making the tendons more pliable. When lifted, the tendons are stretched, which creates tension in the Golgi tendon receptors. The muscle then reflexively relaxes to keep it from harm. Fritz states that petrissage is a method of ‘tricking’ the muscle into relaxation. The increased blood flow achieved with petrissage brings more oxygenated blood to the tissues, helps to rid the body of metabolic wastes and reduces local swelling, muscle soreness and stiffness.
Compression effectively increases blood circulation in the body. The pressure change in the capillary beds encourages fluid exchange. Compression on arteries causes back pressure to build up. On release, arterial flow is increased, bringing fresh, oxygenated blood into the area. This has a stimulating effect on muscles and tissues and is not generally used for a relaxation massage. However, when used repetitively, the muscles eventually gets fatigued and starts to relax in response (Fritz, 2004).
Fritz says that tapotement has a stimulating effect and enhances sympathetic activity. When tapotement is applied to a tendon it causes the tendon to stretch and the reflexive action is to contract. This causes the antagonist muscle to relax. When used mainly on the skin, percussion initially causes the blood vessels of the skin to contract. Heavy or prolonged light tapotement again dilates the blood vessels due to the release of histamine, is a vasodilator.
Vibration stimulates nerve activity and can be used to ‘wake up’ nerves. Muscle pain and joint pain are often confused and with vibration this perception can be changed (Fritz, 2004).
OTHER EFFECTS OF MASSAGE
One of the major effects of massage is increased blood circulation, which increases the supply of nutrients and oxygen to the muscles. The increase in blood supply enables the body to get rid of metabolic waste faster, and that helps to relieve muscle soreness, fatigue and spasms. Deep strokes serves to mechanically assist venous return (Salvo, 2007 ).
Salvo (2007) also states that massage improves lymph circulation and reduces oedema. It also relieves muscle tension. Massage furthermore assist in connective tissue healing by reducing keloid and excessive scar tissue formation, decreasing the formation of adhesions. Salvo states that with deep tissue massage, fibroblasts were actived. These cells form CT matrix which promotes tissue healing as it increases collagen production.
Massage helps to lower blood pressure (both systolic and diastolic). By inducing relaxation, massage also helps to alleviate insomnia. According to Salvo (p 95, 2007) patients said that massage made them feel “cared for, happy, physically relaxed, less anxious, calm, and restful and gave them a feeling of closeness with the individuals who gave massages.” Anxiety and depression also respond well to massage, as is common in patients with anorexia nervosa and bulimia.
Massage stimulates digestion and relieves constipation as it induces relaxtion and supports the function of the PNS (Salvo, 2007).
The increased circulatory effect of massage helps to relieve local and referred pain. Massage stimulates the release of endorphins, enkephalins and other pain-reducing neurochemicals. The general relaxation effect of massage also contributes to lower pain levels as it interrupts the pain cycle by relieving muscle spasm and increased blood circulation.
Massage increases mental alertness by its relaxation effect and helping the body to cope with stress. Academic performance was also seen to improve in massage studies (Fritz, 2004).
My personal experience with massage is that clients always commented on feeling as if they are 'floating', 'lighter' and some have called it a 'nurturing experience'. With follow-up, most commented on having a great sleep after a massage. I have found that a bonding occurs between a postive experience with a client and that they enter into a trust relationship and share their experiences readily.
CONCLUSION AND REFLECTION
The effects of massage are vast and are gaining popularity as more people are utilising it as a tool to aid health and well being. Massage therapists are privileged to know that the strokes and intensity and their intent can all contribute to create a relaxing and therapeutic experience for their clients.
Gaining insight into the general effects of massage and the specific effect of strokes, has proved to be very valuable in my dealings with clients. I have now incorporated the different holds, especially at the start of the session, and have noticed the calming effect on clients. It also helped to connect to the client on a different level.
In the past, I concentrated mainly on the muscles and the warming and softening effect of the strokes used. I am now much more aware of the effect of these strokes on the nervous system and consciously use the strokes to cause the wanted effect, which in relaxation massage is to stimulate the parasympathetic nervous system.
I enjoy using the variety of strokes learned and have included them in my treatment plans. I have also asked clients for feedback on their experience when I use different strokes so that I could adjust the treatment given to best suit the client's needs.
REFERENCE LIST
Fritz, S. (2004) Mosby’s fundamentals of therapeutic massage (3rd Ed). St. Louis: Mosby.
Marieb, E.N. (2004) Human Anatomy & Physiology (6th ed). Pearson Benjamin Cummings: San Francisco.
Salvo, S. (2007) Massage therapy: principles and practice (3rd Ed). Saunders: Mosby.
The autonomic nervous system (ANS) controls the involuntary activities in the body through stimulation of smooth muscle, cardiac muscle and glands. The ANS consists of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These two systems generally affect the same organs but causes opposite effects(Marieb, 2004).
The role of the sympathetic division is to prepare the body to cope with situations that threaten survival. It is also called the “fight-or-flight” system. The parasympathetic division, in contrast, can be called the “resting and digesting” system. Both systems work together to maintain homeostasis in the body (Marieb, 2004).
Massage can stimulate the function of either of the sympathetic or parasympathetic subdivisions, depending on the techniques and strokes applied. The massage therapist can adapt a massage to the needs of a client, by knowing the effect of different massage strokes on the nervous system.
When starting a massage, the first effect of touch, even on a fully clothed client, is involuntarily arousal of the sympathetic functions of the body. This response can be maintained by doing a fast-paced massage and compression techniques as is typically used in sports massage. This can also be used to lift depression temporarily (Fritz, 2004).
If a parasympathetic response is required, using holding techniques and breathing with the client will help to connect the practitioner to the client and to diminish the initial sympathetic response. This gives the client’s body time to integrate the sensory input. Massage strokes then need to be applied slowly, rhythmically and with pleasurable but not painful pressure (Fritz, 2004).
THE EFFECTS OF MASSAGE STROKES
Touch and holding serves to reassure the client at the start of a massage and helps them to adjust to the sensory stimulation.
Effleurage, a gliding stroke, assists in lymphatic drainage when applied lightly It also warms up the tissues by increasing blood circulation and makes the tissues more extensible. Effleurage helps to flush metabolic waste out of the tissues after the use of other deeper strokes like pétrissage and tapotement. If applied in the direction of the muscle fibres, effleurage also helps to increase muscle length (Salvo, 2007).
According to Salvo (2007), effleurage calms the nervous system when done slowly and rhythmically, but stimulates the nervous system when done quickly. Fritz (2007) also states that slow superficial strokes are very soothing, whereas fast superficial strokes are stimulating. If a deeper stroke pressure with a slower rate of application is used, the effect is more mechanical and stimulates parasympathetic dominance.
Petrissage, a kneading stroke, is effective in releasing muscle tension. According to Fritz (2004), petrissage has the mechanical effect of softening and creating space around the muscle fibers, making the tendons more pliable. When lifted, the tendons are stretched, which creates tension in the Golgi tendon receptors. The muscle then reflexively relaxes to keep it from harm. Fritz states that petrissage is a method of ‘tricking’ the muscle into relaxation. The increased blood flow achieved with petrissage brings more oxygenated blood to the tissues, helps to rid the body of metabolic wastes and reduces local swelling, muscle soreness and stiffness.
Compression effectively increases blood circulation in the body. The pressure change in the capillary beds encourages fluid exchange. Compression on arteries causes back pressure to build up. On release, arterial flow is increased, bringing fresh, oxygenated blood into the area. This has a stimulating effect on muscles and tissues and is not generally used for a relaxation massage. However, when used repetitively, the muscles eventually gets fatigued and starts to relax in response (Fritz, 2004).
Fritz says that tapotement has a stimulating effect and enhances sympathetic activity. When tapotement is applied to a tendon it causes the tendon to stretch and the reflexive action is to contract. This causes the antagonist muscle to relax. When used mainly on the skin, percussion initially causes the blood vessels of the skin to contract. Heavy or prolonged light tapotement again dilates the blood vessels due to the release of histamine, is a vasodilator.
Vibration stimulates nerve activity and can be used to ‘wake up’ nerves. Muscle pain and joint pain are often confused and with vibration this perception can be changed (Fritz, 2004).
OTHER EFFECTS OF MASSAGE
One of the major effects of massage is increased blood circulation, which increases the supply of nutrients and oxygen to the muscles. The increase in blood supply enables the body to get rid of metabolic waste faster, and that helps to relieve muscle soreness, fatigue and spasms. Deep strokes serves to mechanically assist venous return (Salvo, 2007 ).
Salvo (2007) also states that massage improves lymph circulation and reduces oedema. It also relieves muscle tension. Massage furthermore assist in connective tissue healing by reducing keloid and excessive scar tissue formation, decreasing the formation of adhesions. Salvo states that with deep tissue massage, fibroblasts were actived. These cells form CT matrix which promotes tissue healing as it increases collagen production.
Massage helps to lower blood pressure (both systolic and diastolic). By inducing relaxation, massage also helps to alleviate insomnia. According to Salvo (p 95, 2007) patients said that massage made them feel “cared for, happy, physically relaxed, less anxious, calm, and restful and gave them a feeling of closeness with the individuals who gave massages.” Anxiety and depression also respond well to massage, as is common in patients with anorexia nervosa and bulimia.
Massage stimulates digestion and relieves constipation as it induces relaxtion and supports the function of the PNS (Salvo, 2007).
The increased circulatory effect of massage helps to relieve local and referred pain. Massage stimulates the release of endorphins, enkephalins and other pain-reducing neurochemicals. The general relaxation effect of massage also contributes to lower pain levels as it interrupts the pain cycle by relieving muscle spasm and increased blood circulation.
Massage increases mental alertness by its relaxation effect and helping the body to cope with stress. Academic performance was also seen to improve in massage studies (Fritz, 2004).
My personal experience with massage is that clients always commented on feeling as if they are 'floating', 'lighter' and some have called it a 'nurturing experience'. With follow-up, most commented on having a great sleep after a massage. I have found that a bonding occurs between a postive experience with a client and that they enter into a trust relationship and share their experiences readily.
CONCLUSION AND REFLECTION
The effects of massage are vast and are gaining popularity as more people are utilising it as a tool to aid health and well being. Massage therapists are privileged to know that the strokes and intensity and their intent can all contribute to create a relaxing and therapeutic experience for their clients.
Gaining insight into the general effects of massage and the specific effect of strokes, has proved to be very valuable in my dealings with clients. I have now incorporated the different holds, especially at the start of the session, and have noticed the calming effect on clients. It also helped to connect to the client on a different level.
In the past, I concentrated mainly on the muscles and the warming and softening effect of the strokes used. I am now much more aware of the effect of these strokes on the nervous system and consciously use the strokes to cause the wanted effect, which in relaxation massage is to stimulate the parasympathetic nervous system.
I enjoy using the variety of strokes learned and have included them in my treatment plans. I have also asked clients for feedback on their experience when I use different strokes so that I could adjust the treatment given to best suit the client's needs.
REFERENCE LIST
Fritz, S. (2004) Mosby’s fundamentals of therapeutic massage (3rd Ed). St. Louis: Mosby.
Marieb, E.N. (2004) Human Anatomy & Physiology (6th ed). Pearson Benjamin Cummings: San Francisco.
Salvo, S. (2007) Massage therapy: principles and practice (3rd Ed). Saunders: Mosby.
Tuesday, July 7, 2009
The Story of Stuff - who is ignorant?
The question that comes to mind is, who is ignorant? The government, the corporations or the people working in dire circumstances to produce all the stuff?
Nobody would work in factories producing toxins and carcinogens if they had any choice. So why are people there? I can only assume that they either
1.have no choice as there are not other jobs available to them,
2.they do not have the qualifications to apply for other jobs that may be available or
3. they do not realise that they are working in a toxic environment.
With regards to the last possibility, it could well be that employers do not WANT their employees to know the risks they are taking. How many of the employers actually spend considerable time 'on the line' themselves?
So education would be the way to go - let the people KNOW what they are handling and breathing at work, THEN and only THEN can they make an informed choice. Then also, they will be much more inclined to join together to make changes to their own destiny.
Nobody would work in factories producing toxins and carcinogens if they had any choice. So why are people there? I can only assume that they either
1.have no choice as there are not other jobs available to them,
2.they do not have the qualifications to apply for other jobs that may be available or
3. they do not realise that they are working in a toxic environment.
With regards to the last possibility, it could well be that employers do not WANT their employees to know the risks they are taking. How many of the employers actually spend considerable time 'on the line' themselves?
So education would be the way to go - let the people KNOW what they are handling and breathing at work, THEN and only THEN can they make an informed choice. Then also, they will be much more inclined to join together to make changes to their own destiny.
The Story of Stuff - who talks the loudest?
It seems reasonable to say after watching the video, that 'money talks' is quite an accurate description of the current production scene. The corporations create a huge revenue for governments and are therefore pandered to.
However, the people (meaning the general populace) have a COLLECTIVE voice, which can only be heard when in big numbers. Governments realise that they need the people's votes, but those are only important collectively. The voice of an individual is not heard, but that of the masses are, and can create a bargaining power with governments and corporations.
It sometimes takes a few individuals to identify causes to stand for, to organise a campaign and then to get the masses on board to put the pressure on the decision makers.
This emphasises the power of UNITY.
However, the people (meaning the general populace) have a COLLECTIVE voice, which can only be heard when in big numbers. Governments realise that they need the people's votes, but those are only important collectively. The voice of an individual is not heard, but that of the masses are, and can create a bargaining power with governments and corporations.
It sometimes takes a few individuals to identify causes to stand for, to organise a campaign and then to get the masses on board to put the pressure on the decision makers.
This emphasises the power of UNITY.
Sunday, June 14, 2009
Re: Blogging
Hi Felicity
I am not sure if this is what I should be doing regarding the Blogging about the feeds received. I have had feeds from you regarding the assessments for both Study Skills and Fundamentals. Have received due dates and handouts and information regarding assessments 1, 2 and 3 for Study Skills. Also power point presentations regarding Basic Massage and Endangerment Sites and your last feed at Fundamentals.\
Is this the feedback you require?
Regards
Erna
I am not sure if this is what I should be doing regarding the Blogging about the feeds received. I have had feeds from you regarding the assessments for both Study Skills and Fundamentals. Have received due dates and handouts and information regarding assessments 1, 2 and 3 for Study Skills. Also power point presentations regarding Basic Massage and Endangerment Sites and your last feed at Fundamentals.\
Is this the feedback you require?
Regards
Erna
Asssessment for Fundamentals
Thanks Felicity for the Power Point (PP) for Endangerment sites and also Irene Hundleby's PP for Basic Massage.
I have emailed some questions regarding the assessment.
Thanks
Erna
I have emailed some questions regarding the assessment.
Thanks
Erna
Tuesday, June 2, 2009
Preparation for massage
When the client arrives for the massage, I greet them by name and introduce myself. I then walk with them to the treatment room, and on the way there, show them where the toilet is. Once inside the room, I ask them to sit down and give them the client information sheet to complete. I tell them that I will give them a few minutes to complete the form and then I leave the room. When I return, I go through the form with the client and ask questions to clarify information given on the form. I ensure that I look at all medical conditions mentioned and ensure that a massage is not contraindicated. If applicable I ask to see the consent form from their health professional. I then ask the client again what they would like from the massage to ensure that I meet their needs.
I now do some musles tests (ROM etc.) and look at their posture. Based on this information, I tell the client the treatment plan I have formulated for them, and which areas of the body I would like to address during the massage. I also ask the client which type of lubricant they would prefer, taking into account any allergies they may have. The client is also given the option of listening to music during the treatment.
I then tell the client:
* to take the clothes off but e.g. keep their underwear on (depending on area being massaged)
* where they can hang their clothes
* the position I would like them on the table (prone or suppine)
* to cover themselves with e.g. sheet or towel provided on table
* that I would leave the room while they undress and that I will knock before I re- enter
* that I am going to wash and warm my hands
I then ask the client if they have any questions, and answer any he/she may have.
I then leave the room and allow the client to undress and position him/herself on the table.
I now do some musles tests (ROM etc.) and look at their posture. Based on this information, I tell the client the treatment plan I have formulated for them, and which areas of the body I would like to address during the massage. I also ask the client which type of lubricant they would prefer, taking into account any allergies they may have. The client is also given the option of listening to music during the treatment.
I then tell the client:
* to take the clothes off but e.g. keep their underwear on (depending on area being massaged)
* where they can hang their clothes
* the position I would like them on the table (prone or suppine)
* to cover themselves with e.g. sheet or towel provided on table
* that I would leave the room while they undress and that I will knock before I re- enter
* that I am going to wash and warm my hands
I then ask the client if they have any questions, and answer any he/she may have.
I then leave the room and allow the client to undress and position him/herself on the table.
Making an appointment
When a client rings for an appointment, I ask them their name and address, telephone number and email address. If it is a new client, I ask if they have any massages before. I briefly ask them if they have any medical conditions that may contraindicate massage, e.g. deep vein thrombosis. If I have any doubt regarding the suitability of massage for the client, I ask them to contact their health professional first and get written consent for a massage.
I ask the client what the reason for wanting a massage is, i.e. just for relaxation or for treatment of a certain condition, e.g. sore neck or a sports injury. Based on the information given, I indicate the length of time that needs to be booked for the appointment (15 minutes longer for a first appointment in order to complete client details form) and proceed to give the client options with regards to times and days available.
Once an appointment has been confirmed, I contact the client either by email or text the day before to remind them of their appointment time.
I ask the client what the reason for wanting a massage is, i.e. just for relaxation or for treatment of a certain condition, e.g. sore neck or a sports injury. Based on the information given, I indicate the length of time that needs to be booked for the appointment (15 minutes longer for a first appointment in order to complete client details form) and proceed to give the client options with regards to times and days available.
Once an appointment has been confirmed, I contact the client either by email or text the day before to remind them of their appointment time.
Monday, May 18, 2009
Wednesday, May 13, 2009
Introduction
Hi!I am Erna van der Merwe doing the Certificate in Relaxation Massage. I am originally from South Africa and imigrated to NZ in 1994 with my husband and two sons. We lived in Christchurch for 2 1/2 years, then Dunedin for 9 years, 1 year in Australia touring around and then back to Christchurch for the last three years.
I trained as a geneticist and worked in the field of human genetics for thirteen years, doing education and training.
I like doing foot reflexology and Indian head massage and am also very interested in doing therapeutic massage. My hobbies are four wheel driving, the rougher the better! Also patchwork, clarinet and piano.
I have always had an interest in massage and it's great to gain skills that enable me to do what I enjoy. I would love to work in a formal multidisciplinary clinic setting with other alternative health care providers.
I trained as a geneticist and worked in the field of human genetics for thirteen years, doing education and training.
I like doing foot reflexology and Indian head massage and am also very interested in doing therapeutic massage. My hobbies are four wheel driving, the rougher the better! Also patchwork, clarinet and piano.
I have always had an interest in massage and it's great to gain skills that enable me to do what I enjoy. I would love to work in a formal multidisciplinary clinic setting with other alternative health care providers.
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