Tuesday, August 18, 2009

Have you read the Flocking news yet?


Tuesday, June 16, 2009

Thursday, June 11, 2009

Historical, cultural and philosophical approaches to massage

Fundamentals, task 6. Due date: June 12, 2009

Barbara Newton

Historical, cultural and philosophical approaches to massage.

“Massage is a very ancient form of treatment, so ancient that one may consider its history to be as old as mankind, and its beginning prehistoric.” (Emil and Kleen, 1921 as cited in Calvert, 2002, p.1)

As we look to the future of massage therapy and its position in the health care profession it is important to have an idea and basic understanding of the history of the different cultural and philosophical approaches, and of its evolution to the present state.

Massage has developed from the most primitive of all sensations, that of touch (Salvo, 2007, p. 82) in three main streams: that of the traditional healer, eastern massage, and western massage. This development has occurred in a cyclic manner with regard to massage usage and in general the ebb and flow of its popularity following new knowledge and technique developments.

Traditional massage (holistic)
The traditional massage had its beginning with the village healer whose modem was based around a holistic approach: physical, emotional and spiritual, with treatment incorporating herbal remedies, manipulations, energy work and calling on the spirits.

Eastern massage (holistic + energy)
Eastern massage in the ancient cultures of China, Japan, India, Persia, Arabia, Greece and Egypt (American Cancer Society, 2009) was also developed from the traditional holistic methods but from an energy movement system approach, and incorporating massage without the use of lubricants but using compression, stroking and stretching. These include: the Chinese methods of Amma/An-mo, Tai Chi and acupuncture; Japanese Shiatsu; Thai massage; and the Indian head and Ayurvedic massage.

Western massage (body, scientific)
On a completely different track western massage on the other hand has developed from the traditional techniques wholly on the physical and physiological theory. This evolved under the influence of the scientific approach to modern medicine, and the increased awareness of the human anatomy resulting in the development and basis of what is one of the most common forms of massage used and known today as Swedish massage.
Its development was started by Geek physician Hippocrates of Cos (460-375 BC) who is generally recognized as the father of Western medicine, who set in place the practice of looking at techniques, figured out how they worked and analyzed and recorded the results. He was a proponent of massage (Salvo 2007, p.14) based on scientific and physical ideas.
These ideas of Hippocrates were advanced by the efforts of Galen of Pergamon (c. AD 130-200), another Greek physician whose writings and dissections greatly improved anatomical understandings enabling the relationship of anatomy to physiology to be made.
This early development and association of massage with healing by Hippocrates and Galen happened during the peak of the Roman Empire until its collapse and the period known as the “Dark Ages” or devolution of civilization came about. A resurgence occurred in the Renaissance or enlightenment period( or 2nd cycle of popularity) when Swedish physiologist and gym instructor Pehr Ling ( 1776-1839) revived massage practice using physiological principles to explain why his “gymnastics” had health benefits. While his efforts, based on active exercises, passive stretches combined with massage, were sound, innovative and successful he failed to gain credibility from the medical fraternity due to his of lack of medical training. Despite this he gained world wide recognition of his techniques and systems through his widespread teachings in Europe.
It was Dutch physician Johann Metzger (c 1817-1893) who took massage to the next level by establishing massage as part of medical practice. Around this time French names and terms were used in massage by Metzger’s followers.

With all this growth and the favourable acceptance and use of massage from the medical fraternity massage became a victim of its own success (Fritz, 2009, p. 16) during the 1890’s with an increase in demand for trained therapists. Consequently it was necessary to establish more training facilities and this in turn resulted in a flood of therapists on the market.
Unfortunately the standards and levels of training were not always of a high quality, and dubious massage parlours recruited and exploited those from poor neighborhoods, who in turn under the guise of “massage” turned to prostitution in an effort to repay the debt incurred in their training. In addition outlandish claims were made as to what they could do, scandals abounded and the combined effects resulted in a massive negative impact on the industry, (McQuillan, 2009). And so the second trough in the industry occurred. That downward period was relatively short-lived until the early twentieth century when a number of new exciting techniques were introduced, (resulting in a resurgence occurring in massage), and in particular, among others, those by Kellogg, Vodder, Travell and Cyriax.
The American John H Kellogg (1852-1943, Sanitarium founder) developed a combination of massage therapy techniques consisting of “seven types of basic manipulations: touch, stroking, friction, kneading, vibration, percussion, and joint movements” (Wakuda, T., Wada, T., Noguchi, E., Saijo, K., 1999). He also helped popularize massage to the general public in the USA through his numerous writings (Salvo, 2007, p.9), and interests in the fledgling spa industry.
A technique called massage lymph drainage that moves the skin over the underlying tissues using repetitive and circular movements was discovered and developed by Danish practitioners Dr. Emil and Estrid Vodder and which they went on to train others in. Shortly afterwards Janet Travell pioneered a technique known as trigger point release “for treating and controlling [myofascial] muscular pain”, (Pain education, 1998). She also published a huge volume of material on her work. James Cyriax was an orthopedic surgeon, who devised a specific massage technique, called deep transverse friction, for the treatment of muscles, tendons, ligaments, joint capsules and tendonitis scar tissue (Yaaqoubi, 2006). He also introduced the range of motion assessment which today is a big part of massage assessment (McQuillan, 2009).

New Zealand’s own indigenous massage is based around the traditional holistic healing approach in two main methods: Mirimiri and Romiromi.
Mirimiri is based on the four dimensions of physical, family, mental and spiritual health with emphasis on the later with regard to faith; who and what we are; where we are from and where we are going to.( Durie, n.d.) On the other hand Romiromi is a more physical technique using parts of the body: the elbows, hands, knees, feet, and tools: such as raakan (wood/stick), kohatu /toka (stones), and moana (seawater). This method is similar to the western massage deep tissue work, whereas as Mirimiri is similar to the relaxation massage. (McQuillan, 2009).

Massage New Zealand ( MNZ) evolved in 2006 out of the Therapeutic Massage Association (TMA) which had been formed following the merger in the late 1990’s of two separate professional organizations ( MNZ,2009): Massage Institute of NZ (MINZ), the first professional organization established in 1985 & the NZ Association of Therapeutic Massage Practitioners (NZATMP), established in 1989 by Jim Sanford. The main focus of this organization is on raising education standards and promoting professionalism in the industry for the whole industry (McQuillan, 2009).

Western massage had a hands on focus based loosely around biomedical and physiological models with a Swedish massage base. But contemporary massage is not just hands on massage. With recent advances it has diversified and encompasses strong elements of orthopedic assessment, and effective advanced soft tissue approaches, such as myofascial, neuro muscular, lymphatic drainage techniques.

According to Fritz (2009, p. 39) “in reality the body, mind and spirit cannot be separated” and this is born out by traditional massage which encompasses all three elements. The eastern massage in particular had its focus on the mind and /or energy work which were largely ignored by the West.
The advent of knowledge, anatomical understanding, from a medical and scientific background developed the Western focus to that of the body or physiological perspective.
Subsequent research and advancement in new techniques and therapies has edged the focus back to that of body/mind, with many of the touch therapies now combining ancient and modern techniques from both the East and West.
In essence the philosophical approaches to massage since its inception you could say have literally gone in a circle. From the traditional beginnings of a holistic approach to body / mind/spirit by healers or Shamans, and the Eastern world with more emphasis on the energy interaction component ( body /mind), to that of Western contemporary massage which had a physiological focus as the more skeptical western man obtained more medical knowledge.

With the cumulative knowledge built on from the past; research; education; complimentary and alternative medicine; and more integrative approaches to healthcare all combine to feed the current growth of the massage industry worldwide (McQuillan, 2009). At present the industry is undergoing an upward trend as “the credibility and acceptance of natural approaches to health and illness are developing, and knowledge bases are beginning to overlap” (Fritz, 2009, p.20).

In order to better understand where we are headed we definitely need to comprehend the past.

Personal thoughts
Class notes
Text books

American Cancer Society. Massage. Retrieved May 28, 2009 from http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Massage.asp

Calvert, R., (2002). The history of massage: an illustrated survey from around the world.(illust.ed.). Inner Traditions / Bear & Company.

Durie, M. Maori health models. Retrieved May 24, 2009 from http://www.maorihealth.govt.nz/moh.nsf/pagesma/445

Fritz, S. (2009). Mosby's Fundamental of therapeutic massage, (4th ed.). Missouri: Mosby Elsevire.

McQuillan, D., (2009). Fundaments- history of massage. Retrieved June 9, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html

Massage New Zealand, (2009). How Massage New Zealand was formed. Retrieved June 8, 2009, from http://massagenewzealand.org.nz/

Massage World. Manual lymphatic drainage- Vodder method. Retrieved June 2, 2009 from http://www.massageworld.co.uk/articles/manual-lymphatic-drainage-vodder-method

Pain Education.com. (1998). Janet Travell, M.D. “Mother of myofascial –trigger point knowledge. Retrieved June 8, 2009 from http://www.pain-education.com/100143.php

Salvo, S., (2007). Massage therapy, principles and practice, (3rd ed.). Missouri: Saunders.

Wakuda, T., Wada, T., Noguchie, E., Saijo, K., (1999). Journal of Japanese Association of Physical Medicine Balneology and Climatology, 1999. The theory and methods of massage by JH Kellogg, Vol.62, no. 2, p.80-86. Retrieved June 2, 2009 from http://sciencelinks.jp/j-east/article/199911/000019991199A0269840.php

Yaaqoubi, S.,(2006). Cyriax massage. Retrieved May 28, 2009 from http://www.yaaqo.com/th_te_cyriax.html

Sunday, May 24, 2009

Sustainable massage practice

Fundamentals, task 5. Sustainable Massage Practice.
Due date: May 25th 2009 Barbara Newton

Sustainability nowadays (post 1980’s) relates to the human integration with regard to economic, social and environmental principles. That is: "meets the needs of the present without compromising the ability of future generations to meet their own needs” as defined by the 1987 World Commission on environmental development report.

Massage practice can relate in its own small way to all three areas in maintaining sustainability. Because we are dealing with people we need to look at this through the human aspect.

1) Human sustainability context
On the human side we can:
a) Support the health and well being of others by assisting in a number of ways;
· by managing client stress
· reduction of pain
· the improvement of circulation
· and in turn the cleansing of accumulated toxins.

In addition to the massage effects by;
b) Educating the client in
· body awareness – from physical & verbal assessment
· way to prevent and cope with stress as part of their stress management in conjunction with massage plan
· incorporation of exercises and stretching to compliment and maximize the massage therapeutic effect and plan.

c) As a practitioner &/or an employee ensure;
· that we continue up skill, and as an employer offer opportunity to up skill
· maintain manageable work loads
· routine self care
· work within a safe environment based around Health & safety guidelines.

As I see it this human factor has the biggest impact that massage practice can have on sustainability, by ensuring the social and economic viability of our clients through their development, productivity and social interaction.
That is: The ripple effect of them being fit and healthy and therefore able to contribute socially and economically (in an environmentally sustainable way of course) to the wider community as opposed to just solely a client/therapist benefit.

2) Social sustainability
This is all about our interaction with the people we are treating and those we associate with in a professional context.
a) Clients: How we relate to our clients and the resulting relationship ideally compounds to form a positive effect on both parties.
For example: the more comfortable the client (trust, professionalism etc) is with the therapist then the more likely a more positive outcome from the therapy.

b) If we show to our peers, other businesses and health professionals that we are competent, reliable and work well within, or above, our principles and ethics then we can strengthen our social networks and relationships.

3) Environmental sustainability.
Ideally we should use materials within our practice that are from renewable resources and not disposing of goods that cannot be reabsorbed back into the environment without ill effect.

4) Economic sustainability
At the end of the day we all wish to make a profit, in order to sustain our own living. In turn our profit helps sustain other businesses in general with regard to our living, and other health related businesses should we choose to sell health related products or equipment. Financial sustainability now encompasses the environment and social sustainability otherwise known as “triple bottom line”.

How can my massage practice be made more sustainable?
Looking at the practice there are many small ways in which I can contribute to sustainability. These include materials used such as stationery, lubricants, draping and table linens, and fuel in the form of electricity. Together they encompass two of the three areas of sustainability: environmental and economic.
I purchase all of the above and thereby contribute economically, but are they environmentally sustainable?
a) Stationery is manufactured from a renewable source (trees) and
as a waste product is easily assimilated without environmental degradation. To be more sustainable I could consider saving the use of this resource by concentrating printed material into less- by either using both sides of the paper or reducing the size of the print to use less.
The lubricant I use at present is grape seed oil imported from Italy so I am unable to say with out any surety whether or not it is environmentally sustainable. I do however occasionally use a totally natural locally sourced massage wax which I consider being environmentally sustainable, and perhaps I should be using more often.

With regard to both and in the small scale of my operation this would have very little impact on the nations and worlds sustainability.
Apart from my self there are limited recycling opportunities in the practice.

b)Draping and table linens are however another matter. Much against my personal principles of using natural fibres I have made one small concession in setting up my clinic by using artificially man made material for table covers. These materials are made from recycled materials from a non renewable resource.
My justification for initially using them was that they are affordable, are easily washed and take little time to dry, and hence less fuel resources.
At present I am using large cotton towels for draping, which do attract a considerable cost if artificial drying is required, thereby making an economical and environmental impact, some of which is more sustainable than the other. To address this my intention in the long term is to replace these drapes with something that does not use so many resources – sheets of some description that are less bulky (less water required etc) are faster to dry and require less heat to keep them warm.

c) Fuel usage is a large factor relating to economical and
environmental sustainability and the one that I feel I can make a valuable contribution to. By nature of our climate heating is a necessity. It is required to keep the clinic at an optimum temperature for my own and client comfort, and to warm draping materials. This incurs a cost, which contributes in one area while taking away in the other so in effect I believe it balances out economic sustainability. To ensure this is turned around to my advantage I have recently incorporated a more energy efficient heating system, in the form of an electric heat pump, to compliment existing heating so as to reduce “cold heating”. This has the added advantage of being able to be used as a drying mechanism for the laundry.

By actively being sustainable in my practice, socially, environmentally and economically, I am making not only a valuable contribution our clients wellbeing but to that of “our planet”

Personal thoughts
Class notes


McQuillan, D., (2009)). Retrieved May 22, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html

Wikipedia, Retrieved May 20, 2009, from http://en.wikipedia.org/wiki/Sustainability, and http://en.wikipedia.org/wiki/Sustainable_development

Tuesday, May 19, 2009

Fundamentals Blog: Task 4: The ethics of professional practice. Due date: May 20th 2009
Barbara Newton

Ethics are a set of principle or system of moral values with respect to their rightness and wrongness of certain action ( Dictionary Reference), defined as rules or standards, of expected conduct governing the conduct of an individual, groups, or members of a profession ( Merriam Webster, McQuillan ( 2009) and Salvo (2007).
For the purposes of our study the ethical considerations for massage therapy fall into four main categories: client orientated care; therapeutic relationship; scope of practice; and ethical decision making. Here in New Zealand for registered therapists and members these are mapped out by the Massage New Zealand ( MNZ) Code of Ethics.

1) Client orientated care“ A practitioner shall endeavor to serve the best interests of their client at all times and to provide the highest quality service possible”( MNZ, Code of ethics)
Treatment must first and fore mostly focus on the best interests of the client: according to their goals, be undertaken with respect, and ensuring all communications are clear and understood especially when denoting clear boundaries with regard to role, responsibilities, expectations and limitations to the client, and that this is done with compassion and awareness of power differentials.

2) Therapeutic relationship
The therapeutic relationship between the therapist and client is all about trust, integrity, experience and whether or not he client feels comfortable in all aspects of the treatment by the therapist. This is probably the most important category and consists of two areas: professionalism and informed consent.

a) Professionalism is conveyed to the client through image and behaviour.
As the massage industry is an emerging one it must differentiate from itself from other health providers by, at least meeting expectations but preferably exceeding them, in the therapists presentation, appearance, attitude and behaviour.
Image: clean, hygienic, tidy therapist and premises.
Behaviour: From the MNZ Code of Ethics: respect for client, refraining from being under the influence of any mind altering drugs or alcohol during treatments, and “a practitioner shall not enter into an intimate or sexual relationship with a patient while the patient is under their care”. This is easier said than done however as adjudged by breaches to other health professional code of ethics reported in the media.

As part of professionalism the therapist must avoid at all costs any conflict of interest, and personalization of the relationship by either transference or countertransference as they must be above reproach in this area.

b) Informed consent
The client should be informed on every aspect of their treatment session:
· of the process: such as clinical procedure, scope of practice, terms of payment, likely effects of massage etc
· their rights as per the Privacy, Health & Safety, Consumer Guarantee and Health & Disability Acts
· right to be informed of initial proceedings, feed back systems, sensitive body area and subsequent treatment plan
· Their right of refusal
· Right of confidentiality
· Clients personal privacy/space.
· Complaints procedure.
· Power differentials: Because the therapist is in both a physical and psychological advantageous position over the client, the aspect of informed consent is of paramount importance and cannot be stressed enough to ensure any power differentials are kept to a manageable level.

The importance of a therapeutic relationship is that it keeps the client not only safe, but happy, building belief and trust in what you are and what you are doing which will in turn relaxes the client. If the client believes and trusts the therapist, and your treatment then more positive outcomes are more likely,
(McQuillan, 2009 (Moerman, 2002)).

3) Scope of practice“A practitioner shall acknowledge the limitations of their skills and, when necessary, refer clients to the appropriate qualified health care professional” (MNZ, Code of Ethics)
This is about what you do and don’t do with relation to your training, experience, competency and qualifications. It is worth noting that training does not automatically mean competency, as this comes with experience.
It is important that others are aware of exactly what we do, not what they think we do, and whether or not it is appropriate, so it is necessary to have well defined communicated boundaries not only for client safety but so that they are aware of your capabilities.
Examples: As defined by MNZ i) A Certified massage therapist (CMT)) as a relaxation massage therapist as one who can manipulate soft tissue for pleasure and stress related reduction and management, and a
ii) Registered massage therapist (RMT) a therapist who can manipulate soft tissue for pleasure, stress reduction/ management, pain relief, injury management and limited exercise prescription.
It is worth keeping in mind the nonmaleficence of client centered care which is to “First do no harm” as massage therapy should benefit the client or “to help, or at least do no harm”! If treatment is not within your scope of practice then the client needs to be referred to someone who is practiced in the required skills.

4) Ethical decision making

Ethical decision making is based on all of the aforementioned. Should you ever be in the predicament of potentially putting your own interests before that of the client, have any doubts what so ever about its ethical status then you must ask yourself if this is in the clients’ best interest. If it is not then it is unethical. Treat every client as you would like to be treated yourself.

In order to provide the best possible massage experience for each and every client every time the therapist must have a thorough understanding of what
client orientated, professional therapeutic care, based on mutual respect, within well defined boundaries, and practiced within the therapists capabilities in a professional manner by informed consent actually is. Ethics help us define these parameters.

Class notes
Text books


Dictionary Reference. Ethics. Retrieved May 18, 2009 from http://dictionary.reference.com/browse/ethics

Fritz, S., (2009), Mosby’s fundamentals of therapeutic Massage, 4th ed., Missouri: Mosby Elsevier.

McQuillan, D. (2009). Ethics. Retrieved May 17, 2009 from http://elluminate.tekotago.ac.nz/play_recording_confirmation.html
Merriam Webster Dictionary. Ethics. Retrieved May19, 2009 from http://www.merriam-webster.com/dictionary/ethics
Salvo, S., (2007), Massage therapy, principles and practice, 3rd ed., Missouri: Saunders Elsevier.
Velasquez, M, Andre, C., Shanks, S., & Meyer, M., What is ethics?. Retrieved May 17 from http://www.scu.edu/ethics/practicing/decision/whatisethics.html
Whats happened to my ethics blog I wonder- missing in cyberspace no doubt. Wll give it a few more hours to come down to earth

Monday, April 27, 2009

Research Methods

Research Methods
Assessment task 1- Blog 4- Evaluation of Research Findings

Barbara Newton Due date: May 2009


Kania, A., Porcino, A., & Vehof, M., (2008).Value of qualitative research in the study of massage therapy [Electronic version]. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, Vol 1, No 2.

Evaluation of quality.

1) Source of information.
• The paper is from an academic, peer reviewed scholarly journal produced by the independent Massage Therapy Foundation. Their mission is “to advance the knowledge and practice of Massage Therapy by supporting scientific research, educational and community service”. (Massage Therapy Foundation, 2009)
• The authors work within the Department of Community Health Sciences at the University of Calgary, a comprehensive research educational facility in Canada and are accomplished professionals in the health sector with numerous published papers between them.
E.g: M. Verhof coauthored one of the related referenced texts; Assessing efficacy of complementary medicine: adding qualitative research methods to the “gold standard.” J Altern Complement Med.2002; 8(3): 275-281

These two points substantiate the authority or the status of the source through verification of the authors and their credentials and the information relevance. Publication date of December 2008 makes it current.

2) Quality of information
• The article’s content analyses and evaluates information which has been gleamed from a wide range of relevant, suitably titled, current, primary source references in relation to the key words. (Qualitative research; methodology; massage therapy).

Sandelowski, M. Using qualitative research. Qual Health Res. 2004 14(10):1366-1386.
Weinrich, S. & Weinrich, M.,(1990) The effect of massage on pain in cancer patients. Appl Nurs Res. 3(4):140-145.

The referencing is made in the body of the text content.

• Web references are sourced from non commercial authoritative sources.
E.g.; Government Health and Massage Therapy Foundation sites.
Most importantly they relate the information to the massage therapy field.

• The examples given are all health related.

The references are authoritative, thereby ensuring the credibility, objectivity, quality and accuracy of the source.

3) Comprehension of the material

• The material is presented in an easy to follow order beginning by distinguishing between the two methods of methodology- quantitative and qualitative, and explaining what qualitative research is. That is followed by a brief description of how quantitative research is carried out and outlining the value of such illustrated by a number of clinical examples.

• The range of examples and comparison of qualitative versus quantitative not only highlighted, illustrated the value, and the importance of the qualitative findings, but further aided in increasing my understanding of the different methods,
“The results of the study demonstrate that, although standardized [quantitative] outcome measures are useful, alone they may not capture the broad range of possible outcomes or meaningful effects of an intervention as they are experiences or perceived by individuals”.

• The material also explores the possibility of both the massage therapist and the recipients’ perspectives being integrated.

• The authors explained the value of such qualitative study.
“Qualitative research findings therefore will not only help massage therapists practice more effectively, but also differently, with greater awareness and mindfulness”.
This in fact could be an understatement that only future studies and time will verify.

Overall I felt that the information as presented achieved the aim to give the target audience, a novice massage therapy researcher who is unfamiliar with qualitative research, a comprehensive overview to more than sufficiently gain an understanding of the topic “Value of Qualitative research in the study of massage therapy” in a balanced and well illustrated manner. The paper addresses a gap in the knowledge or application of massage therapy not previously widely known because of a lack of suitable qualitative research. In doing so it more than fulfilled the credibility criteria identified in my previous information quality blog.


Massage Therapy Foundation retrieved April 24th 2009 from http://www.massagetherapyfoundation.org