Posts Tagged ‘RMT’

August newsletter

| August 20th, 2012 | No Comments »

Modalities Massage Therapy

August Newsletter

 

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

I have been doing some blogging lately and wanted to share those thoughts with you. The following links will take you to them: food and drug efficacy and DNR and final wishes.

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.

Best wishes,

Sheila Hobbs, RMT

250-361-5246

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Aromatherapy and a change in hours….

| May 30th, 2012 | No Comments »

Happy spring to you all,

I have decided to place an unscheduled aromatherapy order this Friday so if there are any essential oils, base oils, skin care products or the like you wish to buy from my supplier for the usual 20% mark up please let me know by Thursday night.  To see a selection you can go to the website.  Please note that the listed prices include the 20% mark up, but will have HST added.

As you all know I have been teaching baby massage classes at the Mothering Touch since September.  I have found it to be a lovely addition to my practice.  Due to lower numbers in the nice weather though we have decided to call off classes for the summer and resume in the fall on a new day.  What this means to you is that I will be adding Tuesday morning hours for the summer.  As of this coming week Tuesday hours will be from 10 to 5.  I will still be offering the Tuesday night time at 7pm.

I hope the spring is finding you and that you are enjoying the long, light evenings.

Cheers,
Sheila Hobbs, RMT
Modalities Wellness
250-361-5246

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International Fascia Research Congress, Vancouver, BC – Day 3

| March 30th, 2012 | No Comments »

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.

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International Fascia Research Congress, Vancouver, BC – Day 2, the night

| March 29th, 2012 | No Comments »

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

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International Fascia Research Congress, Vancouver, BC, Day 2

| March 29th, 2012 | No Comments »

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.

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International Fascia Research Congress 3 – Vancouver, BC, Day 1

| March 28th, 2012 | No Comments »

***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….

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Integration, hooray!

| November 23rd, 2011 | No Comments »

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.

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A new gig for me…

| September 13th, 2011 | No Comments »

My baby...back when he was...

(more…)

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Insured Visits

| June 6th, 2011 | No Comments »

Registered Massage Therapy can be a costly affair and the provincial health plan does not offer a great deal of coverage, however various extended insurers and third party groups do offer some support.  When you go looking though it is often a very confusing process and can come with some time restraints.  Each plan offers its own type of coverage and decrees how its members and their care providers may claim that coverage.   Do not assume that one Blue Cross plan is like all Blue Cross plans – the variety is actually endless.  MSP, Worksafe and ICBC also each have their own type of coverage and ways of submitting claims.  It is always wise to inquire with them if you believe you may be eligible.

What follows is what I am willing to take on in terms of types of coverage, direct and indirect billing.  This is my set of choices, other RMTs make different choices.  This information will remain on my website and as current as I can keep it, but this is where I stand now….

Worksafe BC: As part of the Worksafe BC Massage Therapy Network  I provide service to WorkSafe claimants in accordance with the agreement between the Massage Therapists Association of BC (MTABC) and Worksafe BC.  Given the fee schedule set by this agreement I have specific appointment lengths for Worksafe BC patients.  Initial Visits are 35 mins in duration and include history taking and assessment.  Subsequent treatments are of 20 min duration and have a small re-assessment component included.  I am not able to treat anything other than the injured area that is in the claim.  Worksafe BC does allow me to address areas excluding the injured area for a Injured Worker if a separate appointment is booked.  The separate appointments may be booked consecutively with the covered appointment.  If an Injured Worker is receiving care from another practitioner (ie. physio) I may not bill Worksafe BC without permission from Worksafe BC

MSP: I am opted out from MSP, which means I take privately paying clients and submit a claim to MSP for their visit.  Patients receive a re-imbursement of $23.00 per appointment within 2-4 weeks.  Only those on subsidy from MSP are eligible for any coverage and they have a limit of 10 visits from a pool of 5 practitioner types (massage, chiropractic, physiotherapy, podiatry and acupuncture).  Additional visits are sometimes available but require your GP to authorize them (this is the last I heard, it may have changed)

ICBC: At this time I am not accepting clients for direct billing to ICBC.  Inquire with your adjustor if they will cover your privately paid appointments. ICBC has a quite strict 8 week time frame for coverage, so do not delay!

Blue Cross: I have a billing number with Blue Cross that allows me to bill directly for RCMP, military and DVA patients in accordance with their plans.  Re-imbursement is available to University of Victoria grad students who are covered by the UVIC grad student health.  Others covered under Blue Cross should inquire with their plan contact as to how their plan deals with massage therapy billing.

Greenshields: I am registered with Greenshields and can provide direct billing to some plans (UVIC undergrads and staff).  Please inquire with your provider as to their policies regarding massage therapy

Great West Life: Some GWL plans allow for direct billing by RMTs.  Shaw Cable is one employer whose plan allows for direct billing. Others covered under GWL should inquire with their plan contact as to how their plan deals with massage therapy billing.

Other providers: Please inquire with your carrier to find out how they deal with Registered Massage Therapists.


 

 

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Healing Series #4 – Sprains

| February 14th, 2011 | No Comments »

I was trying to stop my toddler from running about the parking lot while coaxing my slightly lame dog into the back of the minivan. In frustration, I bent forward, wrapped my arms around the dog’s middle and lifted him into the back of the vehicle. I felt a funny twinge in your back but nothing seems to come of it – until later. Stiffness and pain began in my low back and radiated down into my butt.  I had sprained my ilio-lumbar ligament (it is right at the base of the spine and goes from the ilium to the 5th lumbar vertebrae). It was a mild injury, a moderate grade one. The grading for sprains is similar to strains, which were roughly outlined in the my muscle strains post.

As with all the other healing processes we have looked at there will be the clearing out of damage and the repairing of the tissue. In a ligament we see scar tissue fill in the ruptured area, restoring the continuity of the ligament. The differences comes from the fact that this is the first avascular, poorly innervated structure we will be looking at.

First, let’s look at what a ligament is and what it is supposed to do. Ligaments are sheets of tightly packed, closely aligned collagen cells.  Structures with little elasticity or extensibility, they are the brakes on the engine of muscular motion.

Without direct circulation, ligaments will be slower to send out the chemicals that signal the need for healing. The exchange of healing materials for waste products will be slow and inefficient. This slow fluid exchange will create and prolong irritation and inflammation. The lack of innervation will further slow healing.  The body’s ability to know when it is being re-injured is be limited. Most of the pain will come when surrounding tissues become over-taxed, irritated and inflamed.  The ankle and low back, two of the most frequently sprained regions, also have the highest rates of re-injury and chronic acute conditions (basically when the area is so regularly being injured it never truly heals and is always painful).

the ligament fibers end up looking as messy as these twigs

How long is slow? A year. It takes a year for a ligament to fully restore itself. If there is no intervention you will be lucky to get 50% functional integrity at the injury site.

For the first three months you are especially vulnerable to re-damaging the healing ligament. After three months most of the basic repair is done and the new scar is in place. We are entering that retraining period I talked about in the muscle strains blog. This is one of the most tricky times, you need to be active, you are generally pain free, but your ligament is just not capable of what it once was. Directional stress tells scar tissue fibres what direction they need to line up and be strong in. To be functional, ligaments need proper structure, something that can only be achieved through safe movement. By six months or so you might be okay in most activity but be aware that you are still at risk. The wrong move at the wrong time can spell a reversal back to the beginning.

 

How much of a difference can proper care make? Immensely, think 98% integrity vs the aforementioned 50%. What is proper care? In

with good healing the fibers flow together smoothly in line

the early stages RICE is the answer. If an activity brings on pain, stop it. Get help or modify for safety activities you need to do. Once you are moving without pain through normal activity, return to more vigorous pursuits. If the activity creates similar risks to the injury, tape the injured area. Tape creates some small physical stability, and, more importantly, it brings your brain’s attention to the area.

The other aspect of proper care is some professional assistance. Help to keep compensating structures healthy and ensure optimal circulation using massage therapy, physiotherapy, or acupuncture. The first two, along with a kinesiologist can help with rehabilitation exercises. The kinesiologist can help with bad movement patterns too, as can Alexander technique instructors or Feldenkrais practitioners. You do not have to use the whole spectrum of care, but think about what you need help with and what you have to invest in your health and match that to the practitioner best suited to assist you.

Finally – be patient. This is a long haul situation, if you try to shortcut it you will make it worse.

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