Historical, Cultural and Philosopical approaches to Massage

Massage has been round for thousands of years. Although there are many different forms of massage, they all have the same end goal. “Massage therapy has been in existence for one purpose and one purpose only: to aid human beings in their pursuit of pain management and take away their stress. From the paintings in ancient caves depicting one person rubbing another's foot to ancient Egyptian artwork often found in temples and pyramids showing foot, hand, and head massages, all have one thing in common, the universal language of therapeutic touch.” (Fernandez, E. 2005). There has been many influences from various cultures throughout history. There has been a lot of research into the benefits of massage and surprisingly knowledge that has been pasted down through the generations still in use today.

Asian bodywork therapy which we see today is based on traditional Chinese medicine and Ayurvedic medicine (India), which is 2500-4000 years old. “Traditional Asian techniques and treatment strategies to affect and balance primarily the energetic system for the purpose of treating the human body, emotions, mind, energyfield, and spirit for the promotion, maintenance, and restoration of health.” (Salvo, 2007, p755-756). These Eastern traditions developed to maintain a persons health looking at the overall picture of their health. Concentrating on their energy and correcting stagnation in energy. The body maps for energy involving meridians or chakras. In these traditions is where the five element theory was developed. These elements, fire, water, wood, earth and metal relating to different body organs. Acupuncture and use of hot stones and various herbs was also developed in eastern tradition. Eastern tradition is very natural and spiritual. The western traditions however have a little more tunnel vision to them. They have taken a very medical approach usually with scientific evidence to support their theories. Many great names of history in the western traditions are responsible for the medical knowledge that we have developed.

Some of the great names in western history are as follows:
Hippocrates of Cos (460-375 BC) is considered to be the 'father of modern western medicine'. He was the founder of a Hippocratic Medical School. Numerous books were published about medial techniques and practices from the school.
Galen of Pergamon (A 130-200) was a Roman physician who studied medicine in Egypt. He became the personal physician to the Roman Empire Marcus Aurelius. Galen combined the Greek knowledge of anatomy and medicine.
After the collapse of the Roman Empire the western medical knowledge that had been previously advancing stopped. It is only thanks to some western physicians who recorded the medial knowledge of the Greeks and Romans that it was not lost.
Pehr Henrik Ling (1776-1839) was a Swedish physiologist and gymnastics instructor. He is regarded the 'father of swedish massage'. Ling developed his own system of medical gymnastics and exercise. His main focus was to treat disease and injury. Sadly because Ling was not a physician it took a long time before his work was appreciated.
However, Johann Mezger (1817-1893) was a physician. Because of this he had the medical and scientific knowledge to promote massage. He is thought to have introduced the French terminology such as effleurage.
John Harvey Kellogg (1852- 1943) published a 'Good Health' magazine in the United States. This helped make massage popular to the public.
James Cyriax (1907-1947) influenced the range of motion assessment and deep transverse friction.
Janet Travell published many papers regarding the understanding of trigger points.
Emil and Estrid Vodder developed the manual lymph drainage in the 1930's. Otherwise recognised as the Vodder technique.

A part of history in New Zealand is the influence of Maori techniques on massage. Traditional Maori healing takes a mind-body-spirit approach. There are four cornerstones of Mirimiri. These are family health, physical health, mental health and spiritual health. The focus is on physical growth and development, faith, belonging, caring and communicating. Health in ones entire being. Romiromi is the use of the therapists elbows, hands, knees and feet as well as wood, stones and seawater. Traditional Maori healing is similar to the eastern traditions with the use of nature and spiritual well being. The western tradition being different in that it has more the body approach with a lack of spiritual treatment.

Massage Therapy is still a growing industry in New Zealand. In the early 1900's there was over 300 massage therapists. In 1985 Bill Wareham helped form Massage Institute of New Zealand (MINZI) with a focus on education for therapists, standards for teachers and conferences for skill development. In 1989 Jim Sanford established the New Zealand Association of Therapeutic Massage Practitioners (NZATMP). His focus was not only on education but also promoting a professional image and increasing public awareness of massage therapy. In the late 1990's NZATMP changed its name to the Therapeutic Massage Association (TMA). Its new focus was to be a voice for the massage industry and to support and represent those who were qualified therapists. In 2007 MINZI and TMA joined together to form Massage New Zealand (MNZ). Although this seems to be a positive step for the professional development of massage in New Zealand, MNZ has been struggling ever since the merger. MINZI and TMA have disagreed over some issues but also there has been a lack of new members joining. Its the same old story with voluntary organizations. Always the same few people doing all the work. Some people can be selfish and if they can't see immediate benefit to themselves and their career they are not prepared to put the work in. Hopefully MNZ will become better supported as it provides a good professional base by providing such things as code of ethics and scope of practise on which to base our practises. Unfortunately it would have much more of a voice if it was compulsory to join. But with all the past stigma regarding prostitution it is important to support professionalism.

In the 1890's is where the massage scandals took place. Massage had become well recognised and with the increased numbers of therapists some had resorted to prostitution. Massage parlours were sometimes just another place for prostitution. This is a terrible stigma. People can be conservative at the best of times. It is a big deal to be unclothed on a table for a massage. No wonder people that are uneducated about massage would think it is still linked to prostitution. Even now, 2009, when I have told some people about what I am studying they are associating it with prostitution. That is why education standards need to be in place so massage therapists have some sort of uniform. So the public is aware what will be expected when going to see one. I know if I was unaware of what a massage therapist did and my partner wanted to go, I would be a little hesitate about him going to see a practitioner where he was going to take his clothes off!

Today contemporary massage is a growing industry beginning to get recognition from other healthcare professionals. With research supporting lymphatic drainage, injury rehabilitation, myofascial release, stress management etc. It is becoming very complimentary to use massage in association with other healthcare providers. There is developing education opportunities for massage ranging from certificates to degrees. Also membership, as previously mentioned, is not compulsory in massage organizations such as MNZ, massage has more of a professional voice now. There is still a lot of educating to be done as there is a lot of untouched clientèle out there. But hopefully with this continuing education to the public, and the acceptance and recognition of the benefits massage provides the stigmas associated with massage will soon be a thing of the past.

There are different approaches to massage. The western tradition has focused mostly on the body-mind approach, the direct effects massage has on the body and the mind. The western tradition although very effective can be a little clinical in that everything needs to be proved or measured. This is effective for many people who are 'closed book', who are in pain in an area of their body but are not ready to open up emotionally or spiritually. For a treatment to be effective you have to believe in it. For example it is easy to believe that massage has a positive effect on your injured hamstring as your range of motion begins to increase. It is harder to believe that you have stagnant energy because there is nothing to measure. The eastern tradition has a focus on the body, mind and spirit. These could be viewed as the unexplained health benefits. Although science can not yet explain it doesn't mean it doesn't have an effect. You hear of stories of somebody being diagnosed with an incurable disease, yet by some sort of alternate treatment they get better. The mind is very powerful tool and maybe diseases are just an unbalance in our body-mind-spiritual health. As a massage therapist we can then chose if we would like to be a therapist or a facilitator. Therapists have a massive role in society, but their primary focus is on the body. They can alleviate pain and stress. A more holistic approach however would look at the whole picture, body, mind, spirit. This is the facilitator.

So it is no surprise that massage has been going on for thousands of years. “It is a natural response to rub our aches and pains, whether or not we are familiar with the medical knowledge behind these actions.” (Salvo, S. 2007 p4). Massage is getting more and more proven and recognised thanks to the research of people going back hundreds of years. There has been many historical and cultural influences to give us the different variations of massage therapy. Different styles will suit different people but at the end of the day if it feels good to you, keep doing it! There will always be varying types of therapists, with different specialities in different areas but hopefully massage will keep pushing forward to give that professionalism as a healthcare provider.


References:

Fernandez, E. (2005) Massage Therapy Licensing: An In-Depth Look retrieved June 6, 2009 from www.massagetoday.com/mpacms/mt/article.php?id=13608

McQuillan, D. (2009) Energetic Approaches. Dunedin, New Zealand: Otago Polytechnic

McQuillan, D. (2009) Recent Advances. Dunedin, New Zealand: Otago Polytechnic

McQuillan, D. (2009) The roots of massage therapy. Dunedin, New Zealand: Otago Polytechnic

Salvo, S. (2007) Massage Therapy Principles and Practice (3rd Edition) Missouri: Saunders Elsevier

Sustainable Massage Practice

To run a massage business, or in fact any business it has to be sustainable for it to last. “Sustainability, in general terms, is the ability to maintain balance of a certain process or state in any system.” (sustainability, 2009). When making your business plan you should look at different aspects of sustainability: economic, social, environmental, to see how you can make each area more sustainable.

In my opinion economic sustainability is the most important. If you aren't making any money you aren't going to last. A business plan is important. Setting realistic goals to keep yourself focused. “The most important thing to consider is the minimum amount of business you need to maintain – that way, you will know on a daily basis if you are swimming or sinking.” (Fanuzzi, J. 2002). Early in your business you need to identify what are the daily costs of running the business. For example, electricity for heating and washing linen, lubricants in your massage and also your time. There is also the set up costs of purchasing your table, linen and getting your room respectable for clients. Once identifying these costs, you need to make sure they are covered in the price you are charging for a massage.

Keeping business costs down also helps increase your overall income. You can't spare things that are going to lessen the massage experience you are going to provide, but you can be sensible when it comes to saving costs. For example advertising can be expensive. I am lucky as where I live in Ranfurly there are means of advertising for free. There is the local radio station and a local flyer where you can advertise your business. I also plan on putting a few flyers around the town in places like the hairdresser and the play centre. These forms of advertising are only going to cost me the cost of the piece of paper! Also in a small town I can rely heavily on word of mouth.

Social sustainability largely comes down to being an effective communicator. From the first instance you meet a new client and through all the sessions you have with them, they need to be assured that you are listening to them and that you respect them. You want to build a strong therapeutic relationship to keep them coming back to you. Often people don't remember what you did but how you made them feel. Giving them compassion and respect is just as important as actually giving the massage. Social sustainability also refers to the relationships you have with other health care professionals including other massage therapists. You want to make sure that you always come across as a professional. If you a working with another professional that you are referring a client too, you want make sure your notes are well documented and clear. Gaining respect from other professionals is important for future referrals. Once you have proven your professional capabilities they will be much more happier to work with you.

Environment sustainability has become increasingly important as research has discovered we are consuming at such as alarming rate which is having a negative effect on the environment. We all need to do our part to reduce the effect. Although there is not a lot of material used in a massage. Linen often needs replaced as if it starts looking old and worn it stops looking professional. One way to combat this waste is to donate your old linen to salvation army or some such thing. At least it is not being thrown away as waste. Recycling where possible also helps you be environmentally friendly. Minimising waste and maximising the use of our materials anywhere possible will at least do your part for the environment. Although we also use electricity and water we can only really try to minimise what we are using as we still need it.

One way I intend to make my massage practice more sustainable is by reducing business costs. The biggest cost I can see at this stage is electricity. I have moved my massage room to the east side of the house for it to get the morning sun. This way I am saving on heating the room. Even though there is not a lot of drying weather at the moment I am trying to dry my linen in front of the fire for a while and just finish it in the dryer to decrease the time I am using the dryer.

As already mentioned I plan to have absolute minimal advertising costs. When I find business a little slack I will also advertise 'monthly specials' to get some more people through the door. And if you can make someone's first experience a good one you will increase you chances of seeing them again. Specials are also a way on getting back some old clients who have become less frequent in their visits. Lastly I intend to continue my training to increase my scope of practice. Continuing my education keeps my brain active and keeps my skills fresh. I think it is important for clients to see you are always trying to better yourself.

So overall, sustainability is important to keeping my massage practice going. Keeping up relationships, good business practice and caring for the environment are all important to the sustainability for massage practice. These are things that can always be reviewed to make sure that we are doing everything possible to run the best massage practise that we can.


References:


Fanuzzi, J. (2002) Step 12: Sustainability retrieved May 24 2009 from www.massagetoday.com/mpacms/mt/article.php?id:10618

McQuillan, D. (2009) Elluminate retrieved on May 18 2009 from http://elluminate.tekotago.ac.nz/join_meeting.html?meetingId=1242557934762

Sustainability (2009) retreived on May 24 2009 from
www.wikipedia.org/wiki/sustainability

Time Management

Time is one of those great things because unlike almost everything else, everybody has the same amount of hours in a day. How to manage these hours however can be a bit of a challenge! It wasn't until I started studying again that I realised that my time management needed a bit of work. There is just too much stuff going on for me to remember so I needed to make some changes to make sure I was going to fit everything in.

It started with getting a diary. I think out of everything this is my number one tool. I have gone through my diary and put EVERYTHING I need to remember in it. And as I am such a visual person or maybe just because I like colouring in, I colour coded it. As far as course goes I have assessment due dates highlighted in pink. The weeks before assessments I have what's coming up, so I can make a start, highlighted in yellow. Birthdays are in orange, elluminate in blue and everything else relevant such as days I am at work and massage appointments I put in pen. From there I have all the important, unchangeable things noted.

As well as my diary every week on a separate piece of paper I put all the work I need to do each week with regards to my course. This is everything posted on the blogs and the assessment work. I try put these in order of priority such as something that is due in on Wednesday I will definitely make time for on Monday or Tuesday. I don't like having things specifically programmed in at a certain time I just make sure that everything I need to do is on my 'to do' list and then just cross it off when I am done.

Tasks that I find difficult I will look at once and then go back to at a later date. Seems easier the second time you look at it. I also have identified the subjects that need complete concentration, these I do in the morning when I work best and have little distraction. Other subjects I leave until when Fergus is home from work. Especially anatomy, I make flashcards and then most nights in the ad breaks at some stage Fergus will test me on them. This is a good way to include him in my study as well.

One thing I have found as a distraction is visitors. On many occasions someone will just pop in because they know I am at home. The way I have overcome this is multi-tasking. In the morning after walking the dog I start my study. When someone else calls in this is when I do the dishes, fold the washing etc I have found there is no point wasting my quite time on housework. The other thing that has been effective is always having an arrangement of books on the dining room table. If people call in and see course stuff everywhere they realise I am busy and don't stay long. I don't mind them coming for a short time though, always good to have a break!

So now overall my time management isn't looking to bad. At least I'm not forgetting to do anything. I think time management is always going to be a 'work in progress'. You just have to be able to identify areas of time that you can't change and make the best use of the rest of the time that you can.

The Ethics of Professional Practice

As a massage therapist we work with our clients at a very personal level. So because of the nature of our work laws and code of ethics have been put in place to help avoid conflicts of interest. As a profession we want to be giving the best service to our clients in a safe environment. To help us do this we need to establish boundaries with our clients, define our scope of practice and always have clear communication so there is no confusion about our work. “In general, ethics in somatic therapies involve behaving honourably; adhering to prevailing laws; upholding the dignity of the profession; respecting each client; staying committed to high-quality care; working within the appropriate scope of practice; being client-centred; and remaining service-oriented.” (Benjamin, 2002).

It all comes down to giving client-centred care. Taking into consideration client goals and treating the client with respect and compassion. The client is coming to us for a service, although we will develop a relationship with our client it is that of a therapeutic relationship rather than a friendship. This means that the relationship is unequal and it needs to stay that way in order for us to maintain our professionalism. We give the treatment and although we get money in return it is the client that needs to be getting all the attention. We only do what is in the best interest of the client.

There is a power differential in the relationship because the therapist has education and training in massage over what the client has. We can therefore be treated as almost a teacher figure so being aware that some clients may take everything we say as gospel we need to make sure we don't abuse this power. “Self-accountability is the cornerstone of ethics: it is who you are and what you do when no one is watching. When you have a well-developed sense of self-accountability, you are honest with yourself, and are answerable and responsible for what you say and do. You have the ability to look beyond the immediate moment to consider the consequences and know if you are willing to pay them. You have personal ethics. Personal ethics is the precursor to professional ethics, since we are not likely to be more ethical in our professional life than our personal life.”(Benjamin, 2003).

As well as it being in the clients best interest it is also in the Health and Disability Act 1994, that we receive informed consent from our clients before being treatment. This means not just getting consent to give a massage but also explaining what areas you will be working and why you may want to work in these areas. There are many areas of the body that a client may not feel comfortable with being massaged eg gluts, abdomen, feet. Although we can educate our clients to help them understand why it may be beneficial to work in these areas we can only work there if we get consent. Educating our clients helps our client still feel in control. Make the plan of treatment together. Its a good idea to inform our clients of our qualifications, training and policies of our practice. This will help to eliminate surprises and misconceptions in our treatment.

Clients also need to be informed of our scope of practice. We know ourselves what our limits are. Sometimes we may be perceived to have more qualifications or experience than we do. We cant afford to get caught in the trap of doing things out of our league otherwise we could end up harming the client. Its important that we work within our scope of practice and that we have communicated to our clients what are limitations are.

Confidentiality is always important. This is part of the Privacy Act 1993, that client records are kept confidential but records may be given to authorised people. It also could be a good idea not to greet a client in public. We may acknowledge them with a smile but it should only be the client that initiates contact as they may wish to avoid us so nobody realises they are a client and we must respect that decision.

Boundaries are in place to clarify our roles and responsibilities. We need to be clear what our boundaries are, sticking to our scope of practice. This is where communication is also important. It is a common mistake to start giving advice in areas such as psychology in which we are not trained. “Healthy relationships always involve healthy boundaries.” (Salvo, 2007).

Transference and counter transference can occur in the relationship. Transference is where the client has become dependant on the therapist or are trying to take the professionalism away from the relationship and turn it into a personal one. Warning signs could be when the client extends a dinner invitation or buys you a gift. You need to address the situation without offending the client maybe by having policies about not excepting gifts or spending time with clients outside of work. On the other hand you as the therapist could become over attached to the client. Warning signs could be frustration when client is not advancing in their program as you would have liked. Having a “need to fix” can impair you ability to be client focused. Someone who has always lived in a lot of pain may not be interested in working towards fixing it but rather just having a relaxation massage to feel good. It always comes back to the clients goals. In either instance it is ideal to have some sort of supervision, a confidential outsider that may be able to pick up on these warning signs before anything to serious results from it. They can make us see if there is a need arising on either side and give us advise and support on how to deal with it.

So in conclusion, ethics always come back to acting professionally and making decisions with the clients best interests in mind. Having clear boundaries, scope of practice and communicating with your client can avoid any confusion. Keeping your relationship as a therapeutic one helps you to give the best treatment possible.



References:

Class notes
Internet
Textbook

Benjamin B. (2002), Ethics, Values and Principles, retrieved May 18, 2009 from
http://www.massagetoday.com/mpacms/mt/article.php?id=10521

Benjamin B. (2003), Ethics and Self-Accountability, retrieved May 18, 2009 from
http://www.massagetoday.com/mpacms/mt/article.php?id=10833

Salvo S. (2007), Massage Therapy Principles and Practice (3rd Edition), Missouri, Saunders Elsevier

EFFECTS OF MASSAGE STROKES

The effects of massage on the autonomic system

"The autonomic nervous system innervates smooth muscle, cardiac muscle, and glands. It is divided into the sympathetic and parasympathetic nervous systems which often act in antagonistic ways to regulate blood flow, secretions and organ function." (Gilroy, 2008).
The sympathetic nervous system is often referred to as the 'fight or flight' response. It performs such tasks as speeding up the heartbeat and secreting adrenaline. The parasympathetic nervous system is referred to as the 'rest and digest' response as it slows heart rate and processes like digestion work in this state.

Relaxation massages and strokes like effleurage and petrissage put the body into a parasympathetic state. Sports massages and strokes like tapotment and vibration put the body into a sympathetic state. Although all massages start with the body in a sympathetic state as instinct teaches us to be on guard until we know it is safe. And it is only a short period of time and then the body will change into the parasympathetic state if the purpose and strokes of the massage intend it to do so.

Massage decreases stress and anxiety, help with sleep disorders, relieve pain, improves circulation and improves immunity by decreasing levels of cortisol. Massage can also improve emotional well-being, improving relationships, mood and satiety.

The effects of massage strokes

Different strokes have different effects and different intentions on the body. Touch/holding is used to establish contact. It is used so client is not alarmed by you rushing into movement. It initiates the beginning of the massage. As well as at the end of the massage it can bring the massage to a finish.

Effleurage is used as the opening strokes of a massage. Saying 'hello' to the area and helping to spread lubricant. It warms up the part of the body you are about to work. Effleurage flushes wastes, helps venous and lymphatic return to the heart and helps body to relax.

Petrissage includes strokes such as cross-overs, kneading and wringing. Twisting movements help to break adhesions. Petrissage moves fluids and increases blood flow.

Compression can be used on draped clients. It is described as "rhythmic pumping on the muscle" (Salvo, 2007). It can stimulate or relax the muscles and the nervous system depending on the speed of the compression.

Tapotment strokes include cupping, hacking and pounding. These movements stimulate the sympathetic nervous system so effectively getting the body to wake-up. This is useful when a client is going back to work after their massage. Tapotment also increases blood flow, relieves pain, tone weak muscles and has the ability to contract and relax muscles. It can also help to remove phlegm from the lungs.

Vibration is a little similar to tapotment in respect to the effects. Although in vibration the therapists hands don't leave the client. Vibration wakes up the nerves. It also relieves pain, increases circulation and helps to clear the respiratory tract.

Other effects of massage

Alot of these effects of massage are closely related. Blood flow increases due to massage strokes helping venous return back to the heart. Blood pressure decreases with blood vessel dilation when using Swedish and relaxing type massage. Muscle tension, often caused by stress, and usually leading to pain and stiffness is reduced. With the parasympathetic nervous system activated muscles relax. Because the blood flow is increased more oxygen and nutrients are getting to the muscles and more waste is being taken away. Endorphins are released which reduce pain and also information from pressure receptors being disrupted from getting to the spinal cord helps relieve pain.

Lymph flow increases circulation with the pressure from the massage. Digestion works in the parasympathetic nervous system so by the body being in this state digestion will occur. Digestion is increased by the body getting rid of wastes eg bowel contents.

Massage improves healing of connective tissue. It helps hold nutrients in bones which helps with fracture healing along with increased circulation. Deep massage limits scar tissue formation and helps form a strong scar that wont interfere with body movement. Massage also decreases adhesions forming.

Massage helps clients with sleep disorders. A massage at the end of the day for these clients can help the client relax, helping them to sleep. The increased delta wave activity encourages sleep and relaxation as well.

Concentration can be helped with massage by decreasing stress and relaxing the mind. This increases mental alertness. Increased levels of dopamine and serotonin improve mood and satiety. Increased levels of oxytocin improves relationships and bonding. Also reduced feelings of depression, improved body image and self-esteem help with improving mood and satiety. If you feel good you look good. Positive attitude and energy can encourage happy relationships.


Resources:
Class notes
Text books

Gilroy A. MacPherson B. Ross L. (2008) Atlas of Anatomy, New York, Thieme Medical Publishers Inc.

Salvo S. (2007) Massage Therapy Principles and Practice 3rd edition, Missouri, Saunders Elsevier

The story of stuff

Where do I start, arent we just in a little pickle!!

The system discribed isnt good. One thing Ive noticed huge effect on is the climate. I can remember as a kid summer was hot, winter was cold, the weatherman had a good chance of getting his prediction for the next day right because the weather was so predictable. And now, its only the beginning of march and we are having a frost. Our summer in parts had unbearable heat (I mean here in central otago, maybe not so in Dunedin) and then the next minute was freezing cold. Makes you think what sort of crap we really are polluting into the air to have this affect!!

Im all for recycling but people are lazy so we need to make it easier. When we lived in Scotland last year we had to drive 10minutes to drop recycling off but the wheeliebin man kindly came every fortnight and took away anything in our bin at our doorstep. Not just that at the recycling place it was hard work. For exampe glass had to be divided into clear, brown, green or other. The reality is people cant be bothered or we have become so busy we dont have time. Its just too convienent to put things in the wheelie bin and have it taken away than putting the extra effort to recycle.

I think every bit you do does help but its not just us consumers thats the problem. The factories that are pumping out nasty bi-products, they need to be held responsible for their part. All these advertisments on TV that is filling our head with the "need to buy" is another big problem. The main players in this operation need to change their ways and set an example. How this is going to happen though I dont know. The government has funny ideas at the best of times, dont know if they can help. They should be more concerned with doing what is right.

We do need to work on a system that can sustain itself but it will require some huge changes.

My 2 favourite boys!

My partner Fergus and I at eurodisney

and

our puppy Cruz