Archive for the ‘Registered Massage Therapy’ Category
- of, or relating to, the viscera
- relating to deep inward feelings rather than to the intellect
synonyms: instinctive, instinctual, gut, deep-down, deep-seated, deep-rooted, inward
I found this definition online and it perfectly encapsulates the nature of the course I went on this weekend. The course was called Visceral Manipulation I and both of the definition options above speak clearly to the nature of the work we did this weekend.
The course reviewed the anatomy and physiology of the internal organs – and reminded me that the lungs, heart and brain – with all their accessory bit are a part of that viscera. Our focus though was on the gut organs this time. The other definition is very appropriate to as the work requires that you use your knowledge of the structure of the body and then release it to simply feel the body. I knew going in that for myself the need to be patient and quiet my mind in favour of listening to my body would be my greatest challenge.
I am very aware, with a kind of chagrined pride, that I tend to over-think things at times. I often have said that I am more comfortable in my mind than in my body – but I have also said that my education and practice as a massage therapist has balance that to some degree. This weekend was, for me, another step toward embracing that balance. I do not think that I will ever be someone who first speaks to how they FEEL, I suspect I will always first go to the place of THINKING, but I do believe my life is richer for the fact that I strive to improve the balance between the two.
What is all this work for anyway? What will it help and might you be one of the people that experiences this work when next you are on my table. There are many indications for this work, some are emotional or life related (stress, depression, anxiety), many more physical – including digestive issues, disease process or history in the body – especially those where organs have been damaged or altered – right through to pain patterns in the body, especially those that are persistent and respond to, but do not resolve, with direct massage. Quite a few of you might just be finding yourself experiencing something a bit different in the near future. If you are interested in this work specifically feel free to ask more when you are in next time or to drop me an email or call.
For myself, I had an interesting time on the receiving end of all of this work and will be bringing some of treatments into my own self-care regime. I am interested to see the way this subtle and progressive work unfolds within me over the next weeks.
Modalities Massage Therapy
Dear clients, This Thursday, August 23rd, is the deadline for aromatherapy orders. Check out the webpage on direct orders for the short list of products and pricing. Contact me by phone or email to place your order. As always, orders should be in within a week and I will contact you regarding pick-up. Beginning in September there will be some small changes in my work schedule. I will be teaching infant massage at Mothering Touch again but on Wednesday mornings and I will no longer be working at Achieve Health Monday and Wednesday mornings. In terms of hours here at Modalities there will be only small changes and a continuation of the ‘temporary’ addition of Tuesday mornings. New hours as of September 1/2012 will be:
Monday: 10am to 6pm Tuesdays: 10am to 4:30pm; one 7 pm appointment Wednesdays: 12:30pm to 4:30pm Thursdays: 9am to 4:30pm; one 7 pm appointment Friday: 10am to 6pm
As we move into the fall I hope that we all have the opportunity to enjoy some more warm weather and sunshine. For those of you coming under the influence of school I hope your return to classes goes smoothly.
Sheila Hobbs, RMT
Today began with a keynote speech by Carla Stecco who spoke on the nature of fascial anatomy. One of the most amazing pieces of information I took from this was the fact that the sheaths of the limbs and trunk (aponeurosis of the deep fascia) that are traditionally classified as “disorganized” can actually be dissected into 2-3 layers of highly organized, aligned collagen fibers that are each oriented in discrete directions in each layers whose fibers are shifted 78 degrees from each other throughout the body and are capable of gliding on each other. The other aspect, which actually came up several times over the last days is that there are penetrating collagen fibers that bind across various levels of fascia to affect sensory organs and allow force transmission across nested fascial layers.
I chose not to attend the discussion of imaging techniques and devices that followed, but from the tweets that I have seen there is a huge desire for a 4D sonograph now. I have no idea what that is nor why it is so lusted after but I am glad that those that stayed had a good time. I was not alone in missing some of the events of the day, I think overload was being reached by many of us and I know I enjoyed the time to be quiet with my thoughts and organize myself for the trip home.
In the afternoon I returned to congress-land and heard some very interesting presentations, one on plantar fasciitis, one on immobilization of rats (which requires metal harnessing and ankle cuffs, those rats are apparently very much not keen on bondage), one on trigger point release using myofascial techniques and finally a study designed to demonstrate the actual force generate with different applications of Swedish massage. This last one was an amazing demonstration of several important facts. One, that the Fascial Research Congress model is generating clinically relevant research (the study was conceived after the presenter attended the second congress in Amsterdam. Two, that there is a lot of very basic research to do on clinical application of manual therapy – after all, we cannot actually say with any scientific certainty the amount of force that we are generating on the tissue of our clients. Three, that research is a rough go. The presenter, brave soul that she was, led us through an elegantly designed trial to determine the compressive force generated by Swedish massage technique. She covered the various challenges she faced and how she managed to overcome many of them. She showed us some lovely, very tidy printouts of force generation waves generated by the strokes, and then she had to tell us she had no data to share. All of her data was invalid due to faulty calibration of the testing equipment. Oh my. Despite this I would say she did in fact share quite a lot of data, just no outcomes. I was relieved to hear she hasn’t given up and she may be able to salvage some of the data she had acquired through the magic of algorithms (okay, I think they are magic, some people think of what I do as magic, I think of algorithms as magic, we each have our own perspective).
After the bittersweet conclusion of the parallel panel presentations we concluded the afternoon with a panel entitled “Art & Science/ Research & Practice”. Here was our opportunity to hear the thoughts and hopes of a few that I think reflected the hopes and dreams of many of us.
Maureen Simmonds and Paul Standley both spoke about the importance of clearer, more standardized language and communication between clinicians and researchers to aid in the development of a greater understanding of whether what we do in the clinic is actually doing what we think and if it can create the kinds of impacts in the real world that simulated work in the lab does in petri dishes and research animals.
Robert Schleip likened himself to Alice in Wonderland as he as a clinician who has entered the world of the scientist and continues to find both worlds “curiouser and curiouser” (I think I have applied the analogy a bit differently than he did, but I think the idea is the same). He also pointed out the fact that he is not the only person to have shifted their position on the continum of clinician and scientist, nor is there only one direction to go on that voyage. the rabbit hole goes both way and it is the both the people that switch burrows and those that simply reach a hand into the other hole to give or receive, or perhaps to join with a hand reaching back, that enrich and invigorate the worlds of fascial research and manual therapy.
Geoffrey Bove concluded the panel with an case study of his experience in reaching hands across the divide, and switching rabbit holes both. Initially a clinical practitioner, he is now the researcher stretching his hand out to the clinician, in the person of Susan Chapelle, to bridge the gap and create new and fascinating (fascia-nating?!?!) discoveries regarding the outcomes of rubbing rat adhesions. He presented with an interesting combination of practicality and emotionalism as he discussed the challenges of research and collaboration clearly demonstrating the passion that is brought to the work.
I departed prior to the final remarks to catch a ferry but I left feeling full of knowledge and enthusiasm and hopeful for the future of my profession.
Tonight I watched a prophet perform. Not what I expected to see at a Fascial Congress but I am not sure what other words to use. Gil Hedley was the final act in our multimedia night. After three amazing, room-stilling videos that were highly anticipated, onto the stage came a wiry, kinetically unstable bundle of poetry reading anatomist.
Perhaps I have had too much coffee, not enough sleep or entirely too much mental stimulation but Gil Hedley’s presentation on his new thinking around fascia makes me what to sign up to join whatever cult he’s leading or drink whatever kool-aid he’s pouring. He brings an inspiring combination of respect, enthusiasm, joy and intellect into the world of fascial dissection.
I am someone who loves my words and concepts and rather resent having to give up a perfectly good story for a new idea. Even though Hedley’s whole presentation was a debunking of his own, infamous “fascial fuzz” speech that has become an easy, u-tube click away, introduction to fascia for the uniformed, I loved it. I now have to discover a new story to tell myself about the development of adhesions and what I am doing in my work. Daunting. I am inspired though by the enthusiasm, dance, poetry and joy that was displayed on the stage of the grand ballroom of the Sheraton Wall Centre tonight in Vancouver, BC
Today is a new day of learning and the overload is starting to set in. Not in a bad way, but you can see the shiny eagerness beginning to fade, there is more movement during presentations and alternate seating is becoming more popular and the familiar seats begin to feel entirely too familiar to our posteriors.
A great day none the less with some wonderful clinical information and tonight a multimedia presentation of fascial videos that I, along with several others from the look of the bar and cafe here at the hotel, will be late for. I admit that I have stepped away from a few presentations seeking some quiet retreat time to process some of the information. After some dinner though I look forward to watching some highly visual presentations that I am betting won’t stress my lack of chemistry knowledge as several of the presentations today did.
The flip side of the restlessness is an increase in casual interaction between attendees and lots of chatter. As I sit and type several tables of congress attendees sit together chatting, eating and drinking. I suspect many a new research project will be hatched over the next several days.
In terms of the learning there was a shift from the mechanical to the fluid as our keynote speakers focused on the issue of fluid dynamics in the interstitium and the wonderous fourth state of water – bound water. The water talk, given by Gerald Pollack from the University of Seattle, was my third exposure to his theories and seems to have been a bit of a charm as several of the concepts seemed to sink right into my brain rather than flying inches or feet over my head. Dr. Pollack’s research has focused around the behaviour of water at it’s edges, where it contacts hydrophilic (water lovings) substances and air, and there is the creation of an exclusion zone where the water enters the bound, or fourth state. In this zone the water is denser, negatively charged, has a viscosity similar to honey and just generally is really different from what he calls bulk water. Beyond the interesting implications for us manual therapy practitioners whose clients are all largely composed of water there are real world implications.
In the real world the exclusion zone offers explanations for cloud to cloud electric activity (= lightning), why the basilisk lizard really can walk on water, why heavy objects float and offers interesting possibilities for water decontamination, perhaps even desalination, and the ability to harvest electricity from water – all using only the radiant energy of light to accomplish the task.
There is the report for today, stay tuned for the final day’s report where imaging and more anatomy and clinical discussion look to be the highlight.
***Beware – this post is a total fascia geekfest, if you are not prepared to deal with that, read a different post! Also, any factual errors are my faulty memory, not faulty presentations.***
Today I had the absolute pleasure of beginning my time at the 3rd gathering on scientists and clinicians who have an abiding interest in fascia in all its varied and wonderous forms. I began the day with a flight to Vancouver and a slightly late arrival – but I got before the real geek-out stuff began, so it is all good.
After some general introductory speeches we dove right into the first keynote speaker. A anatomist from Temple University, Mary Barbe spoke to us about her research in duplicating repetitive stress injuries (RSI’s) in rats and the tissue changes that occurred in response to various types (high, low and negligable intensities) of work. How could this possibly relate to massage therapy you ask? Well the road hasn’t fully been built, but knowing that rest doesn’t always fix the problem and that inflammatory processes have likely come and gone prior to anyone presenting at my office (they peak between week 4 and 8 of performing the task) after months or years of a repetitive task, provides me with insight into what interventions and homecare might best benefit my clients. simply knowing that there are significant connective tissue changes that occur within weeks of undertaking an repetitive task shouts loud and clear about the importance of the fascial work that I am a huge advocate for.
After a quick break we moved our second speaker, Michael Kjaer, whose topic was the impact of exercise on tendon tissues. We discovered that exercise (and not a lot, 1x creates 72 hours of increased collagen production which is what builds your tendons) increases the density of tendons. Interestingly, there seems to be little issue with maladaptive changes in the tissue to repetitive exercise as there is to repetitive work activity (there’s a thinker). More surprisingly, it turns out men exhibit greater tendon density increase than women, and that within the female population women taking oral contraceptive exhibit even lower levels of tendon response than the general population. Further interest in gender issues came when it was revealed that in post-menopausal women being on hormone replacement heightened tendon response. Hmmm, that estrogen, funny stuff.
After a break for lunch we broke into three groups for presentations on specific areas of fascial research. I chose the “biomechanics” room and got to learn about different means of trying to empirically measure different types of mechanical interventions. From pressure sensitive pads on fingers to rather medieval looking table devices this part of the afternoon was an interesting insight into the various ways we can try to research the interventions we apply with our hands and their outcomes. I also gained an interesting insight into the world of research. Failure, or rather, not proving your hypothesis fully or at all. Even in those cases it was interesting to see how that research could be used to launch into better studies.
Our next keynote speaker, Albert Banes, was a doozy. I am pretty sure I learned so interesting things, but they went by so fast I think I might be lucky to catch up with them sometime next week – after reading the paper a few times! He seemed to be summarizing quite an extensive array of studies in the field of fascia research and had some very interesting things to say – and showed us pictures of some lab grow tendons, but it was a lot in just a little time
The final event of the afternoon, academically, was a panel of four clinicians presenting of “scars and adhesions”. One of the exciting bits of us BC RMT’s was having one of our own on the panel – Susan Chapelle of Squamish, BC who talked about the benefits of integretive treatment and the need for increased research that included a manual therapy aspect. She was preceeded by a surgeon, Dr. Michael Diamond, who discussed post-surgical adhesions (things sticking together that shouldn’t after surgery) which I was surprised to find has a 65-100% incidence rate in abdominal surgeries (though they are not limited to those surgeries). We were then treated to a new movie by Jean Claude Guimberteau, a French physician, who has now produced several in vivo movies of fascia using endoscopic techniques (his first being “Strolling Under the Skin”, presented at the first fascial congress). We also had a naturopathic doctor, Hal Brown, present some of his case studies of the impact of the injection of aenasthetic under the skin into scars to improve function in both near and far tissues.
The day finished with a welcome reception that was very well attended that allowed us all to review and discuss our reactions and thoughts regarding the days flood of knowledge. I can hardly wait for day two….
Many massage therapists in BC will not work with WorkSafeBC injured workers. I was one of the abstainers. The length of appointments, the payments and the reporting and billing processes were all been very limiting and difficult to sort through. In 2011 the Massage Therapists Association of British Columbia signed a new contract with WorkSafeBC which improved the rate of pay and simplify the whole process. Given the huge improvements, I decided to begin treating WorkSafeBC clients. What has changed, and how is the process still unique and challenging? That’s what this blog is all about.
First, the changes and why I like them. The money factor, for better or worse I do this job to support myself and my family and I need to make a certain amount of money to do that, the previous contract just didn’t make fiscal sense for me. The new contract significantly raised the rates and I am now able to offer reasonable appointment lengths balancing treatment effectiveness with fiscal feasibility. The paperwork and hassle factor also decreased. Credit goes to both negotiating parties for many of these improvements, but technology also plays a huge role. The policy change that most helps the quick, effective treatment of WorkSafeBC claimants is the removal of the need for an active claim number. As long as a claimant has a referral from their MD for the treatment and is within 8 weeks of their injury, I can treat them and have a reasonable expectation of payment – even if the claim is later denied. This eliminates a lot of delay and the need to try to get money out of the injured worker later. Policy now allows me up to three treatments a week for 5 weeks with the submission of only one quick form. The technology part of the improvement begins with the form which you can submit by fax – no mailing. Then there is billing submission. Paper billing and the time lags of snail mail made reimbursement ridiculously slow previously and small errors could move the ridiculous into the impossible range. Waiting 30 to 45 days is long enough, but I had heard of 3-6 month waits. The introduction of online billing made the process much simpler. Submission is fast and easy, billing errors are less frequent and caught sooner. All of these factors make being “a part of WorkSafeBC’s Massage Therapy network” a much more appealing.
What are the restrictions that still make the process difficult? Treatment limitations are the big issue for me. The time factor is part of that, though I must say it has been far less bothersome than I had anticipated. The big issue is the, well, let’s call it the geographical restriction. As a Massage Therapist our training emphasizes the idea of the body being a whole. This is not the way WorkSafeBC sees the body. They see the injured part and the non-injured part. When working within the agreement therapists may only deal with the injured area. On the surface this seems reasonable. WorkSafeBC is trying to avoid having undo advantage being taken and limiting their responsibility to the workplace injury. The difficulty, as a therapist, is ignoring the complications of the initial injury that are causing pain and dysfunction for the worker. I need to change my focus from improving the overall well-being of my patient, to restoring function in one part. It seems a subtle difference but it is a difficult shift to make. Reinforcing this shift is another of WorkSafeBC’s policies – get the worker back to work. Again, a reasonable goal for a corporation but sometimes more difficult for a health practitioner.
For all the limitations the thing I like is the challenge. The above mental gymnastics and regional restricts are the less joyful part of the challenge; the injury assessment and restoration of function being the more joyful. WorkSafeBC clients the issues are generally acute, so I get to use types of assessment and treatment rarely called for in my other work. The focused treatment and the newness of the injuries is a more intense and dynamic process, which adds variety to my practice.
Yesterday I got an email from one of my clients asking if “I would be open to communicating” with her chiropractor. I almost swooned with joy – okay, not really, I’m not much for swooning, but I was really excited. This type of request doesn’t come very often but I am always happy to receive them.
Most often we allied health professionals work in a bit of a vacuum. We have only our clients recollections to inform us of what other treatments they are receiving. Client feedback is helpful for understanding their feelings regarding progress and how their bodies experience and respond, but not so helpful in determining what another practitioner actually did, nor what they intended by doing it.
By habit. I always ask about other practitioners my client’s are seeing. When they are receiving concurrent treatment I will often ask when they last saw that practitioner and what they work they did. I have often determined my approach based on this feedback. If I know their chiropractor has gotten a good re-alignment I won’t focus on my own tools for structural alignment, I will focus on soft tissue support. If their physiotherapist has been working on nerve mobilization in the neck and shoulder I may choose supportive back work and joint mobilization to complement. The problem is that some clients recollections don’t provide me with those insights – or I fail to inquire – and a chance to improve the quality of care I give my clients is lost. Even worse, we practitioners may overwork an area by compounding treatments, which is as detrimental as not working the area at all.
I believe strongly in the need for increased communication between practitioners to improve the impact of all of our work and ensure that patients receive the most efficient and effective care. Thanks to that client and I look forward to the collaboration. I will use this reminder to increase my initiative in communication, so that I am walking my walk, not just talking my talk.