Thursday, July 2, 2009

Historical, cultural and philosophical approaches to massage

Fundamentals of Massage

By Sam Steven

Describe the development of massage practice
Describe different cultural and philosophical approaches to massage

Task 6 – Historical, cultural and philosophical approaches to massage

Massage therapy has been a constantly developing practice for many years and from many different origins. Beliefs and ideas from many practitioners and cultures have influenced massage practice. They have all contributed to the current techniques and beliefs which are applied in modern practice.

The most primitive indication of massage is of European cave paintings which illustrate massage or touch for healing purposes dating back to around 15,000 B.C. The earliest reference to massage documented in writing was discovered in China around 1400 B.C. (Chizhik)

Below I will illustrate some of the influences which have helped develop massage practice to how we know it today.

Comparison of the development of massage in the eastern and western traditions

The development of massage in the eastern civilization has stemmed from Asian and Indian cultures with documentation of its existence dating back to 1400 B.C. As described by Myers (2008) much of the focus of this style of massage is by using the natural flow of the body’s energy system - or CHI as it is known - as the source of health. Any illness is considered to be caused by a disruption in the energy flow. Massage techniques such as acupuncture and Shiatsu were developed and are still practiced today with this focus.

The development of massage western civilization has incorporated more of a physiological foundation, focusing more on the body in a physical approach. With the influence and beliefs of many of the individuals below, massage in western civilization has developed significantly.

The role of Hippocrates, Galen, Ling, Metzger, Kellogg, Vodder, Travell & Cyriax in the development of massage in the western tradition

In ancient times, priests and shamans who believed that illness was abnormal and was due to a supernatural force, would massage from the centre of the body outwards through the limbs with the belief that this directional technique would eradicate any illness away from the body.

Hippocrates, (460-377 A.D.) a Greek physician and considered to be the first person to study massage therapy scientifically (Therapeutic Massage). His ideas are thought to have changed the way in which massage is applied. Hippocrates believed contrary to the ideas of the priests and shamans, that illness had a natural cause and that by using strokes toward the heart, wastes would be flushed out of the body.

Galen (129-199 A.D. )was also a Greek physician reiterated many of Hippocrates beliefs in terms of direction of massage. He also added that a variation of strokes and directional techniques should be applied. "The rubbings should be of many sorts, with strokes and circuits of the hands, carrying them not only from above down and from below up, but also subvertically, obliquely, transversely and subtransversely ... But I direct that the strokes and circuits of the hands should be made of many sorts, in order that so far as possible all the muscle fibers should be rubbed in every direction." (Chizhik et al.)

Henrik Ling (1776-1839 A.D.) combined ideas from several massage and exercise techniques including gymnastics to develop the form of massage that would later be developed into ‘Swedish Massage.’ He was not trained in medicine which led to confliction towards his ideas. Eventually however Ling’s theories were accepted and have been accredited for developing passive movement and exercise into what we now practice as “range of motion or stretching” techniques. (Fritz)

Dr Johan Mezger (1839-1909) of Holland, simplified existing techniques and categorized them into what we now know as ‘Swedish Massage.’ Mezger is responsible for presenting massage therapy as a form of medical treatment. His techniques developed into the French terms; “effleurage, petrissage and tapotement.”(Fritz)

Dr. John Harvey Kellogg (1852-1953) “had some eccentric ideas and methodologies including that almost all illness originated in the stomach and bowels and virtually all disease was caused by sexual intercourse.” (NNDB) He wrote many books about health and firmly believed and presented massage and hydrotherapy as beneficial forms of medical treatment.

In the 1930s Emil Vodder, a Danish physician, developed a light form of massage which focussed on the lymphatic system. This technique is still used today and is known as manual lymphatic drainage.

Dr Janet Travell discovered trigger points in 1942 and has written several books about the theory behind trigger points and the treatment of them.

James Cyriax was the son of Edgar Cyriax who was an advocate of Henrik Lings Swedish movement, and published many books presenting the benefits of this treatment. James was an orthopaedic surgeon who developed transverse friction massage. He identified pathologies relating to pain caused by soft tissue dysfunction.

Comparison of Maori massage with western massage

Mirimiri is a traditional Maori form of massage which incorporates a range of different techniques based on holistic, physical manipulation, energy and herbal medicine. “Literally translated it means to massage flesh, bones, tissue, blood, and then move any issues that may need clearing.” (Maori Healers)

It focuses on physical health, spiritual health, family health and mental health to identify “the core of the problem” (McQuillan) and to heal appropriately. It is similar to principles of eastern massage in that there is a great deal of holistic and spiritual focus. Western massage principles as mentioned earlier, are more focussed on the physical aspects.

The massage scandals of the 1800s and their impact on the massage industry

During the late 1800s the integrity of massage therapy in the medical field was hit with a number of scandals.

The consistency in quality and the standard of massage was questioned leading into a further investigation about the level of education and qualifications practitioners were obtaining. There were patterns of increasingly high fees, dishonesty, stealing, corruption and unethical practice. Massage was being taught by unqualified teachers to students without academic pre-requisites. Prostitution was associated with massage therapy with the introduction of ‘massage parlors’ – essentially brothels. This association is still evident in the modern interpretation of massage today.

Organizations were established to re-identify massage therapy as a reputable form of medical treatment: Massage could only be taught in approved schools by qualified teachers, the level of training was inspected and examined and honest qualifications were awarded. However the effects of some of these scandals are still recognized today as influential associations with massage therapy.

The development of professional massage in New Zealand including MINZI, NZATMP, TMA & MNZ

In 1985 Bill Wareham called a meeting for all massage therapists working in the Auckland area in order to create a standard for which therapists could be recognized. The focus was to develop sufficient education for massage therapists, teachers, and annual conferences designed for further learning and development. From this the Massage Institute of New Zealand (MINZI) was formed. (McQuillan)

In 1989 Jim Sanford felt the need for a nationally recognized professional association for massage practitioners and developed the New Zealand Association of Therapeutic Massage Practitioners (NZATMP). The focus of this association was to identify and create education standards, and to promote massage therapy with a reputable and professional image to the New Zealand public. In the late 1990s the NZATMP changed its name to the TMA (Therapeutic Massage Association) and redirected its focus towards supporting the qualified massage therapist. It provides a standard for education and qualification to which the registered therapist can be identified. (McQuillan)

Massage New Zealand was formed when the MINZI and TMA amalgamated to “promote the ongoing development of massage in New Zealand.”(MNZ) They continue to provide a standard for education and qualification for massage practitioners and provide representation of those who are registered and a network by which qualified massage practitioners in New Zealand can be recognized.

Contemporary Massage

Contemporary massage has developed from a combination of traditional techniques and physiological theory. (McQuilllan, D). It incorporates a range of techniques depending on the physiology and pathology of the client and also the focus of the therapist.

Currently, massage therapy is again growing in popularity. The establishment of associations and organizations which represent massage therapy have restored its integrity as a form of medical treatment. There are growing opportunities for learning and its education and teaching standards have increased significantly. The awareness amongst the public is growing and it is becoming accepted by a range of other health care professionals. (McQuillan 2009)


A discussion of how the following philosophical approaches to massage (body, body-mind, body-mind-spirit) relate to the historical and cultural contexts discussed

The approaches to massage vary between different cultures and practitioners. These differences are representative of the development of massage therapy over many years and the influential beliefs and ideas that certain individuals or have added. The ‘body’ focus of massage and ‘body-mind’ approach are representative of western and traditional massage principles which focus primarily on the physiological and physical aspects i.e.; the body, and mind representing psychological focus of healing. Traditional massage had a big focus on physical and emotional / spiritual aspects. Eastern massage as well as Maori massage practices have more of a body-mind-spirit focus which incorporates a combination of physical, emotional, spiritual and holistic approaches.

In summary, massage has been practiced in many forms for thousands of years. There have been many influences in the way it has developed and plenty of different approaches to how it is applied depending on the cultural, personal and even geographical ideologies involved. The most important aspect I believe is that massage is continued to be promoted by practitioners and organizations that represent it with the integrity it deserves.















References:

Carlson, S. (1996). Hippocrates and Massage History. Retrieved June 29 2009 from:
http://massagetherapy.suite101.com/article.cfm/hippocrates_and_massage

Chizhik, Y. Massage History. Retrieved June 28 from:
http://www.holistic-massage-relief.com/massage-therapy-history.html

Fritz, S. (2009). Mosby’s Fundamentals of Therapeutic Massage (4th Ed.). Missouri: Mosby Elsevier.

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

Maori Healers (2008). Maori Healers. Retrieved June 30 from: http://maorihealers.wordpress.com/2008/07/28/maori-healers/

MNZ (2009). Retrieved 1 July 2009 from:
http://www.massagenewzealand.org/

Myers, T. (2008). History of Massage. Retrieved June 29 from:
http://www.myersmassage.com/history.htm

NNDB (2009).John Harvey Kellogg. Retrieved July 1st from: http://www.nndb.com/people/018/000133616/

Therapeutic Massage. Retrieved June 30 from:
http://www.selfincmassage.co.nz/Our+Services/Therapeutic+Massage.html

Tuesday, June 2, 2009

The Ethics of Professional Practice

Fundamentals of Massage

Describe ethical and legal considerations in massage practice
Describe the scope of massage practice

Task 4 – The ethics of Professional practice Due Date: 20 May

Version 2

There are many ethical considerations that a massage therapist needs to consider within the operation of their practice. Understanding these issues is imperative as they will hugely determine the success of the practice. Poorly implemented they may be the demise, whilst implemented successfully they will lead to a reputable and trusted practice. I have outlined the common considerations a massage therapist will encounter below.

Client-centered care is the focus of the treatment towards the greater benefit of the client. Aspects which should be considered are;

• The relevance of the treatment to the presenting issue of the client
• The consideration and respect of the clients goals, boundaries, ethical, cultural and religious beliefs and emotional state
• The Awareness of power differentials (D. McQuillan, personal communication, 2009).
• Benefits should outweigh the costs of treatment (Perle, 2006)
• Communication should be with compassion, respect of the client and strictly professional.

Informed consent from the client is an essential initial measure in massage practice. It is essential that we ensure that our clients have a full understanding and be in agreement to my treatment procedure and scope of practice, my terms of payment and effects of treatment.

I as a therapist need to inform the client prior to the massage session of their treatment intentions and to which areas of the body I will be applying massage. More importantly my client needs to give the me consent to the treatment. There may be areas that the client is not comfortable being touched and I need to respect this. During the treatment itself it is also necessary to inform the client which areas they would like to massage and again to gain consent before doing so. I have treated a variety of different people already and it is interesting to discover insecurities they may have about certain areas of their body. Some have preferred not to be treated in those areas, some have allowed treatment but were initially hesitant.

Scope of practice. This is defined as the therapists ability knowledge, skills and limitations of application as their role as a therapist in relation to their education, qualification, experience, competency and training. It is vital that the therapist is honest about their abilities and that they are safely able to perform the treatment required by the client. The client should be informed of the therapists scope of practice during the informed consent stage so that there are no inhibitions or misunderstandings about what the roles are of the therapist and those of the client and that the clients goals are appropriate to what the therapist can offer as treatment.

The therapist is responsible for ensuring that they:
• provide a service relevant to their knowledge and ability and any limitations are
acknowledged to the client where necessary. This may require referring clients to a more appropriate health care provider. In my case I need to outline that I am able only to perform relaxation massage at this stage.
• that they conform to the scope of practice as stated by Massage New Zealand
• the treatment and techniques used are appropriate to the clients requirements.

Confidentiality is an integral factor a massage therapist should employ in their practice. Not only is it part of the Privacy Act 1993 to protect the privacy of the individuals concerned it is also important to build trust between the therapist and client.

I have filed all of my client details forms in a safe filing cabinet to ensure client confidentiality as far as record keeping. It is intriguing how much some clients feel compelled to share with me about their personal lives. By opening up as they have, they are showing that they trust me with this information and so I will ensure that what is said between my clients and myself is kept strictly confidential.

Massage therapists should comply with the following points as indicated by the Privacy Act 1993;
“It is your responsibility as your client's therapist to ensure the privacy of their records. This may be achieved by storing client records in a locked filing cabinet, and never leaving them lying around when you are not in the room.” (Massage practice, 2008)
Massage prctice is also bound by the Privacy Act in that apart from the therapist and the client involved, no-one else shall have access to any of the clients personal information or records. The exception to this is if the client has given authorization to someone else in writing to access their information. The client is entitled to have access to their own records.
“The only times that it is acceptable to breach confidentiality is when you believe that your client may endanger someone else, or be in danger themselves in the future.” (Massage practice, 2008)

Boundaries are personal values which will affect the way in which the massage treatment is performed and the establishment of the relationship between therapist and client. They may include sexual, religious, cultural beliefs, area of personal space, touch, touch to certain body areas, inappropriate language or conversation topics or any range of personal morals or beliefs. Boundaries should be defined during the informed consent stage of the massage treatment. These should include the clients personal boundaries as well as the therapists boundaries. Honesty and assertive communication is essential in relaying these boundaries so they can be understood and respected throughout the massage treatment. Everyone is different and has individual boundaries. What some people are sensitive to or may be offended by can be completely different to anothers so it is important to establish an understanding of what is appropriate and what is not early on in the relationship. Again informed consent should be used in communications throughout the session to ensure these boundaries are respected.

As I mentioned above in regards to informed consent, i have discovered some of my clients have areas that they prefer not to have treated. Some have indicated why, some haven't. These are boundaries that I need to respect as they are issues that the client has and it would be totally inapprpriate if I ignored their wishes.

Power differentials. There is a natural power differential between the therapist and the client due to a culmination of psychological, physical, emotional and educational parameters related to the massage setting.. These may include the positioning of the client compared to the therapist, the therapists knowledge and skills, the clients emotional or psychological state and also the clients level of consciousness during the massage session. The therapist is therefore empowered by being in control of the setting. It is important that this power differential is minimized to ensure the comfort of the client during the session and that their boundaries are not abused but also that it is present to an extent so that the client can trust the therapists abilities.

Relationships. It is important for the therapist to build a trusting relationship with the client. The relationship is influenced by first impressions and developes over time. It will promote the longevity of the custom of the client to the therapist and ensure a comfortable setting for each massage session. The relationship is the product of appropriate communication, the building of trust, compassion, respect and consideration of client goals, beliefs, boundaries and understanding of each others roles in the massage setting.

The relationship between the therapist and the client should be kept strictly professional at all times.

“A practitioner shall not enter into an intimate or sexual relationship with a patient whilst the patient is under their care”. (Massage New Zealand, 2007)

Transference and Counter-transferrence
“Transference is the personalization of the professional relationship by the client.” (Fritz, 2009)

There is a state of vulnerability within clients in a massage setting due to the power differential between client and therapist. It is important that the therapist does not abuse this situation. The client may show signs of dependency toward the therapist, offer gifts or invitations outside of the professional environment.

It is the therapists responsibility to deal with these occurrences as they arise by communicating and maintaining clear boundaries with the client. If necessary the client should be referred to an alternative therapist.

“Counter-transference is the inability of the professional to separate the therapeutic relationship from personal feelings and expectations of the client; it is the professionals personalization of the therapeutic relationship.” (Fritz, 2009)

The therapist may develop an emotional or sexual attachment to the client. Signs may include thinking about the client outside of the professional relationship and feelings of inadequacy when the client does not show signs of improvements after treatment. Common traits of people who experience counter-transference include the need to fix other peoples problems, to be perfect, need to be loved and are dependent on affirmation or acceptance.

Again it is the therapists responsibility to deal with these occurrences as they arise. They may be required to refer the client to alternative therapist. The therapist needs to think about and analyse the clients boundaries and assess your behaviour accordingly.

In conclusion, I am really enjoying the interaction I share with my clients during my massage practice. Although it is only in its early stages there are already firm ethical foundations being set so to ensure that I build my practice up in a reputable manner. As I have already outlined, it is so important to create a safe, trusting environment for my clients.

References:

Perle, S. (2006). It’s All Greek to Me. Retreived May 20, 2009 from http://www.chiroweb.com/archives/24/02/14.html

Massage practice and the Privacy Act 1993. (2008). Retrieved 20 May, 2009, from http://www.wikieducator.org/Legislative_Acts_which_establish_boundaries_of_massage_practice_in_New_Zealand/Privacy_Act_1993"

Massage New Zealand (MNZ) (2007). Code of Ethics. Retreived May 20, 2009, from: http://massagenewzealand.org.nz/about-us/code-of-ethics/

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

Sunday, May 24, 2009

Sustainable Massage Practice

Fundamentals of Massage
By Sam Steven Due Date: 25 May


Describe how issues of sustainability relate to massage practice.

For a business to survive in the modern climate there are certain parameters that should be considered in order to maintain the sustainability of the business and subsequently quantify its performance and longevity. I have outlined some of these parameters below using the example of a massage therapy practice.

Environmental sustainability describes the effect on the environment of running a massage clinic. We can take steps to reduce the detrimental effect on the environment by considering the way in which we operate our business and the products and resources we use. For example:

  • By using energy efficient light bulbs to reduce the toll on electricity. This is beneficial to the environment but also for economic sustainability.
  • Using natural light where possible. This reduces the need to use of electricity (reducing the electricity bill) as well as being healthier for the practitioner and the patient by providing a natural source of vitamin D.
  • Sources of heating and cooling of the room.
  • By using biodegradable or environmentally friendly laundry powder when washing linen.
  • Using recycled paper when taking notes.

Social sustainability:
Marketing: By educating the public on massage and its benefits you will produce an informed population and thus, an informed/educated client list. Consequently, this education is likely to lead to ‘word of mouth’ marketing for your business ultimately expanding your business through positive feedback cycles.

Forming allied healthcare: By building and maintaining communication and referral lines between other healthcare providers (particularly those of which patients may well ‘trust’ such as doctors) exposes your massage practice to those practitioners as well as establishing trust and respect between the professions. This is not only beneficial and sustaining for the individual practices involved, but for the future exposure and therefore sustainability of massage therapy alongside ‘mainstream medicine’. Note: I say ‘mainstream medicine’ in the context of the most common therapies to date (doctors, physiotherapists etc). Regarding massage sustainability, the future of the profession will be much more prosperous if it can become a ‘common popular therapy’. This does not mean sacrificing the foundations of massage therapy to fall into line with general practice, but educating society so that massage is regarded as a therapy to credit for all it offers.

Working within the massage scope of practice: This allows practitioner safety against any potential future jurisdiction, and patients awareness of the parameters of your practice. Communication lines should be kept open to ensure the scope of practice is fully understood and likewise any personal considerations of the patient are respected appropriately.

Economic sustainability. Essentially a massage practice is a business, the operation of which requires money, and essentially is a medium by which the operator earns a living. Economic sustainability requires that ‘money in’ at least equals money out (or more equals profit).

Expenses must be reflective of the money coming in (how many patients you are seeing). An example is office/room rent. Although practice location is important for marketing, if the rent exceeds what is being made, this is unsustainable. In saying that, marketing can assist in the development of a company/business. Start small, once marketing strategies have been put in place and actual growth (i.e. client list) is seen, you can look into expanding and relocating to a practice that more adequately reflects your earnings or spending more on extra expenses. However it is suggested that extra expenses always be spent with the aim of further promoting the growth of your business. Always aim at your current cash-flow and expenses, rather than what you aim to be making/doing. This is sustainable investment. Alternative expenses such as the implementation of a receptionist, cleaner and advertising are the kind of expenses that may be justified (and required) with growth of a business.

Personal sustainability for the therapist is also a vital avenue to be considered to ensure the long-term health and well being of the practitioner. This will ensure productivity and efficiency in the treatment they are performing. There is no point exhausting the therapist so they are unable to work efficiently in the future – *the broken healer. Areas to consider include:

  • The techniques being used, for example using correct technique – entire body to apply manual therapy, correct body position etc.
  • Diet
  • Exercise
  • Hygiene
  • Adequate recovery time/sleep to avoid exhaustion
  • Lifestyle balance
  • Using products (oils/waxes, linen etc) that are safe for both the patient and the therapist.

Areas where I can improve sustainability which I have picked up from this study and which I will employ in my massage practice include:

Using more natural light in my treatment room. By opening the curtains during daylight hours I will be able to save costs on electricity and also reducing the strain of electricity production on the environment. The light will also give a more natural aura to the room.

Likewise to control the temperature of the room, I can either close the curtains to retain warmth or open them to allow the suns heat to warm the room as opposed to a heater. Opening windows to cool the room as opposed to using a fan will also be more sustainable both environmentally and economically by reducing electricity usage.

I find I often fall into incorrect body position while giving treatment. By ensuring I use correct posture and technique while applying massage I will be ensuring my own sustainability by reducing the chance of injuries and will be able to provide more sessions and a more efficient and productive service to my clients.




Tuesday, May 19, 2009

The Ethics of Professional Practice

Fundamentals of Massage
By Sam Steven

Describe ethical and legal considerations in massage practice
Describe the scope of massage practice

Task 4 – The ethics of Professional practice Due Date: 20 May

Client-centered care is the focus of the treatment towards the greater benefit of the client. Aspects which should be considered are:

• The relevance of the treatment to the presenting issue of the client
• The consideration and respect of the clients goals, boundaries, ethical,cultural and religious
beliefs and emotional state
• The Awareness of power differentials (D. McQuillan, personal communication, 2009)
• Benefits should outweigh the costs of treatment (Perle, 2006)
• Communication should be with compassion, respect of the client and strictly professional.

Informed consent from the client is an essential initial measure in massage practice. Your client should have a full understanding and be in agreement to your treatment procedure and scope of practice, your terms of payment and effects of treatment.

The therapist needs to inform the client prior to the massage session of their treatment intentions and which areas of the body they will be applying massage. More importantly the client needs to give the therapist consent to the treatment. There may be areas that the client is not comfortable being touched and the therapist needs to respect this. During the treatment itself it is also necessary to inform the client which areas they would like to massage and again to gain consent before doing so.

Scope of practice. This is defined as the therapists ability knowledge, skills and limitations of application as their role as a therapist in relation to their education, qualification, experience, competency and training. It is vital that the therapist is honest about their abilities and that they are safely able to perform the treatment required by the client. The client should be informed of the therapists scope of practice during the informed consent stage so that there are no inhibitions or misunderstandings about what the roles are of the therapist and those of the client and that the clients goals are appropriate to what the therapist can offer as treatment.

The therapist is responsible for ensuring that they:
• Provide a service relevant to their knowledge and ability and any limitations are acknowledged to the client where necessary. This may require referring clients to a more appropriate health care provider
• That they conform to the scope of practice as stated by Massage New Zealand
• The treatment and techniques used are appropriate to the clients requirements.

Confidentiality is an integral factor a massage therapist should employ in their practice. Not only is it part of the Privacy Act 1993 to protect the privacy of the individuals concerned it is also important to build trust between the therapist and client.

Massage therapists should comply with the following points as indicated by the Privacy Act 1993;
“It is your responsibility as your client's therapist to ensure the privacy of their records. This may be achieved by storing client records in a locked filing cabinet, and never leaving them lying around when you are not in the room.” (Massage practice, 2008)
Massage prctice is also bound by the Privacy Act in that apart from the therapist and the client involved, no-one else shall have access to any of the clients personal information or records. The exception to this is if the client has given authorization to someone else in writing to access their information. The client is entitled to have access to their own records.
“The only times that it is acceptable to breach confidentiality is when you believe that your client may endanger someone else, or be in danger themselves in the future.” (Massage practice, 2008)


Boundaries are personal values which will affect the way in which the massage treatment is performed and the establishment of the relationship between therapist and client. They may include sexual, religious, cultural beliefs, area of personal space, touch, touch to certain body areas, inappropriate language or conversation topics or any range of personal morals or beliefs. Boundaries should be defined during the informed consent stage of the massage treatment. These should include the clients personal boundaries as well as the therapists boundaries. Honesty and assertive communication is essential in relaying these boundaries so they can be understood and respected throughout the massage treatment. Everyone is different and has individual boundaries. What some people are sensitive to or may be offended by can be completely different to anothers so it is important to establish an understanding of what is appropriate and what is not early on in the relationship. Again informed consent should be used in communications throughout the session to ensure these boundaries are respected.

Power differentials. There is a natural power differential between the therapist and the client due to a culmination of psychological, physical, emotional and educational parameters related to the massage setting.. These may include the positioning of the client compared to the therapist, the therapists knowledge and skills, the clients emotional or psychological state and also the clients level of consciousness during the massage session. The therapist is therefore empowered by being in control of the setting. It is important that this power differential is minimized to ensure the comfort of the client during the session and that their boundaries are not abused but also that it is present to an extent so that the client can trust the therapists abilities.

Relationships. It is important for the therapist to build a trusting relationship with the client. The relationship is influenced by first impressions and developes over time. It will promote the longevity of the custom of the client to the therapist and ensure a comfortable setting for each massage session. The relationship is the product of appropriate communication, the building of trust, compassion, respect and consideration of client goals, beliefs, boundaries and understanding of each others roles in the massage setting.

The relationship between the therapist and the client should be kept strictly professional at all times.

“A practitioner shall not enter into an intimate or sexual relationship with a patient whilst the patient is under their care”. (Massage New Zealand, 2007)

Transference and Counter-transferrence
“Transference is the personalization of the professional relationship by the client.” (Fritz, 2009)

There is a state of vulnerability within clients in a massage setting due to the power differential between client and therapist. It is important that the therapist does not abuse this situation. The client may show signs of dependency toward the therapist, offer gifts or invitations outside of the professional environment.

It is the therapists responsibility to deal with these occurrences as they arise by communicating and maintaining clear boundaries with the client. If necessary the client should be referred to an alternative therapist.

“Counter-transference is the inability of the professional to separate the therapeutic relationship from personal feelings and expectations of the client; it is the professionals personalization of the therapeutic relationship.” (Fritz, 2009)

The therapist may develop an emotional or sexual attachment to the client. Signs may include thinking about the client outside of the professional relationship and feelings of inadequacy when the client does not show signs of improvements after treatment. Common traits of people who experience counter-transference include the need to fix other peoples problems, to be perfect, need to be loved and are dependent on affirmation or acceptance.

Again it is the therapists responsibility to deal with these occurrences as they arise. They may be required to refer the client to alternative therapist. The therapist needs to think about and analyse the clients boundaries and assess your behaviour accordingly.



References:

Perle, S. (2006). It’s All Greek to Me. Retreived May 20, 2009 from
http://www.chiroweb.com/archives/24/02/14.html

Massage practice and the Privacy Act 1993. (2008). Retrieved 20 May, 2009, from
http://www.wikieducator.org/Legislative_Acts_which_establish_boundaries_of_massage_practice_in_New_Zealand/Privacy_Act_1993"

Massage New Zealand (MNZ) (2007). Code of Ethics. Retreived May 20, 2009, from:
http://massagenewzealand.org.nz/about-us/code-of-ethics/

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

Saturday, May 9, 2009

Research Methods - Blog 4

Research Methods
Assessment Task 1 – Blog 4 – Evaluation of Research Findings
Sam Steven
May 2009
Unraveling the Mysteries of Unwinding

Unraveling the Mysteries of Unwinding. (2008).
Retrieved May 6, 2009, from
http://www.terrarosa.com.au/articles/Terra_News2.pdf

The first thing that occurred to me when I downloaded this article was that the authors name was not published. After a more in-depth search of the website I was still unable to identify who had written the article so I figured the next best method of evaluating the articles source was to evaluate the source in which the article was published.

Terra Rosa ‘Your Resource for Massage Information’ is an online site full of educational information relating to massage therapy. It offers a wide range of articles, learning tools and links to relevant topics. The article itself is published in the Terra Rosa Bodywork e-news, issue 2, December 2008. I was unable to identify how frequent the newsletters were.

The newsletter itself contained a dozen articles by different authors. This suggested that perhaps the authors were all experts in the specific fields they were writing about. Therefore I assumed that the author of ‘Unraveling…’ was also at least a fairly credible source of information.

I found the article itself informative in parts. Unwinding is an unfamiliar method of treatment to me so I was interested to learn the basic principles behind it. It had a good introduction where it highlighted the terminology “unwind” describing the significance of the treatment and the basic principles of the technique. However I felt there was a lack of definition in regards to when this treatment would be used compared to other treatment methods, what type of tissue damage would benefit from this treatment and perhaps an example of how the muscles or tissues respond. After reading on I found what I thought perhaps should have been included in the introduction:

“Tissue Memory
The metaphors used to explain fascial unwinding include: unwinding tangled telephone wires or twisted rubber bands. Most common explanation is that our tissues hold memory of trauma, and unwinding will allow the client’s body to move to self correction. Fascia may become short and tight due to trauma, poor posture, and physical stress. Upledger and Vredevoogd (1983) described it as follows: “When an injuring force occurs, the tissue which receives the force is changes. Perhaps it retains the energy of the impact. The human body the either dissipates that energy and returns to normal; or the body somehow localizes the impact energy and walls it off.” Unwinding attempts to free these stored energy. (Upledger, 1987)”

Perhaps the following subtitle identifying the ‘Benefits’ also would have been more suitably located if it was chronologically toward the beginning of the article after the introduction rather than in the middle.

Another aspect of the article I found odd was the instructional descriptions of how to perform Unwinding techniques on a client. Firstly the article appeared to be a broad insight to the treatment, its background and principles, to inform people of Unwinding. Then all of a sudden it gives a range very information lacking instructions on how to perform the treatment itself including pictures, which certainly helped get an idea of what the instructions were unable to describe but which I found rather inappropriate for what I thought was the purpose of the article.

The Author identified a host of references - 14 to be precise, which I thought might have been a little over the top, all of whom were however current and credible sources relevant to the topic.

In summary I believe the purpose of the article was to inform the reader of the Unwinding treatment and to give an insight to how it is performed, how it works and its benefits. The author achieved this however I think there was too much information. It was sometimes unclear and poorly structured. There are grammatical errors and some parts of the article were irrelevant to what I figured was the purpose of the article. In fact, I would have been satisfied had I simply read the introduction, the information on ‘Tissue Memory’ and ‘Benefits’ and the summary.








References:

Upledger, J.E., Vredevoogd, J.,
1983. Craniosacral Therapy.
Eastland Press, Seattle, WA.


Upledger, J.E., 1987. Craniosacral
Therapy II. Beyond the Dura.
Eastland Press, Seattle, WA.


Unraveling the Mysteries of Unwinding. (2008).
Retrieved May 6, 2009, from
http://www.terrarosa.com.au/articles/Terra_News2.pdf

Sunday, April 5, 2009

My Search Process

Research Methods Blog 3
My Search Process by Sam Steven

You must describe your search process including the creation of your search query, databases accessed, and sources found, and information quality.

Prior to starting this paper I was relatively unfamiliar with the research process; in particular the specific guidelines or processes recommended employing when researching a foreign topic or hypothesis. Due to my unfamiliarity with this concept along with my living/travelling situation at the start of the year I found it reasonably difficult to pick up and understand the concept of what was required of me.

Travelling from Auckland via Taupo to Wanaka and Dunedin at the beginning of March meant a later course start date. This created more problems than perhaps I had anticipated. I had limited access to the internet and was therefore not up to date with feeds, emails and elluminate sessions. My mind was focused heavily on ironman and when I tried to allocate time to study I was not very efficient. This led to me falling further behind and I would stress about how much work I had to catch up on. Often, I wasn’t aware of what I was supposed to do or how to go about it and due to not being near a computer I was unable to get immediate clarification.

I have been a little restricted by way of resources by not having access to the Student libraries in Dunedin whist living in Wanaka however have made do with internet and access to some of my fathers books on law, mediation and negotiation. I guess this has helped illustrate to me the importance of sourcing quality information across a wider spectrum as opposed to only the fields I am exposed to related to this course.

I have realized how in previous research based assessments how the work I did could have been improved had I used the research process we have learned so far. I would have collected and analyzed more material, analyzed it more thoroughly and used references more accurately. I guess in general I never really took enough time to sit down and do things as thoroughly as perhaps I should have.

Godfrey (1991) states “Sometimes the correct data are not collected. The right answer can’t be found because companies don’t have the necessary data-much less the correct information. In other cases, the data are available, but no one has “tortured the data until it confesses.” Sometimes organizations do the correct analyses, getting exactly what they need. But sometimes they fail to act.”

Key areas I have been employing in my search thus far include:

  • To identify relevant pieces of information by searching titles with significance to my topic – this could be by identifying key words or phrases in the title itself, recognizing the author/publisher or the date of publish
  • Collecting as much relevant material as possible to analyze as opposed to the first several I come upon which is a method I would usually have used. I have tried to collect from a range of sources with a variety of differing views on the topic.
  • Analyzing information by searching its content for amount of relevant information, its accessibility, credibility based upon, date, references used and clarity.
  • Developing my referencing in accordance of the APA referencing style.

For the collaborative research project our groups hypothesis is “How many massage sessions would it take to reduce sudden onset of chronic pain symptoms?” the hypothesis was refined from an idea during one of the early elluminate sessions.

As per any collaborative task personal commitments of group members need to be considered. I guess the fact that I am mainly based in Wanaka creates implications. For example I was unable to attend the recent group meeting. Thankfully I was able to obtain notes on the meeting which detailed the tasks which we need to address.

I have a vague familiarity with our hypothesis as it explores some similar avenues to the thesis my partner has been working on for the past 6-8 months as part of her degree in Osteopathy. I will therefore be able to use her knowledge as an avenue of information in order to get a better understanding of chronic pain and how to analyze and research our hypothesis.

Other sources I expect to find useful include the internet, Bill Robertson and Central libraries, General Practitioners, physiotherapists, chiropractors, psychologists and other health practitioners.










Reference:

Godfrey, A. (1991). Quality management. Retrieved 2nd April 2009 from
http://www.qualitydigest.com/jul/godfrey.html



Thursday, April 2, 2009

The Effect of Massage Strokes

Fundamentals of Massage Task 2
The Effect of Massage Strokes by Sam Steven

The effects of massage on the autonomic nervous system

The effects of massage on the autonomic nervous system depend on among other factors; where on the body the massage is applied to and the technique(s) used. Slow, gentle and smooth techniques such as effleurage applied to areas of the trunk will cause relaxation through the parasympathetic division of the nervous system. Muscular stimulation may decrease and steady heart rate, increase activity of the digestive system and relax sphincters and increase vasodilation in the arterioles of skeletal muscle. This may cause drowsiness and a general state of relaxation.


Some forms of massage applied in a faster more vigorous method can be used in order to stimulate the sympathetic nervous system. Activation of the sympathetic nervous system will cause some of the following effects; increased heart rate, dilated bronchioles allowing more oxygen to reach the alveoli which would increase oxygen exchange, increased muscle strength, muscle tone and decreasing digestive functions. These effects can be beneficial for sport or competition preparation.

The effects of massage strokes


Touch/Holding includes the primary physical contact between massage practitioner and the client. Therefore it is mandatory for the therapist to create a welcoming, reassuring and effective impression during this stage. As it is generally a precursor to strokes such as effleurage which encourage relaxation, performed correctly touch and holding will also create a sense of relaxation to the muscles, decrease and steady heart rate, decrease breathing rate and a promote a general state of relaxation. Performed less appropriately it may promote anxiety in the client, increase heart rate, increase breathing, cause rigidity and tension in muscles and a general state of discomfort for the client.

Effleurage is a natural and frequently used massage technique. At the start of a massage it is beneficial in establishing initial contact with the client and promotes relaxation. Effleurage is a rhythmical technique which increases blood flow to the area being massaged. This allows extra nutrients to the area of the massage. The increased blood flow also helps to remove wastes from that area. Effleurage assists in relaxing and stretching muscle groups and relieving pain/tightness in the muscles. Speed and pressure of effleurage may vary to create either a soothing affect, (slow, gentle) or a more stimulating affect (deeper, faster) which may be used prior to a sporting event.

Petrissage covers a range of similar techniques which focus on lifting or rolling muscles and associated tissues. Petrissage is also a rhythmical technique and like effleurage should vary in pressure and speed. Petrissage techniques include: Cross-overs, Kneading, Rolling, and Wringing. Petrissage techniques assist by dilating local blood vessels increasing local blood circulation increased nutrients to the area and removal of unwanted wastes, increasing muscle tone, stimulate sebaceous glands creating softer skin, may be used to stimulate muscles for vigorous activity or sport, stretch muscle and associated tissues which helps to release adhesions.

Compression is a muscle and nervous system stimulation technique rather than a relaxation technique. It is applied to the belly of the muscle and can be used at varying pressure levels and speed depending on depth of tissue and the desired effect. “The pressure used is always within the client's pain tolerance” (Massage Stroke Glossary). Pressing downward into the muscle tissue against the bone causes the muscle to spread and the fibres to stretch. In order to prevent overstretching and damage to the muscle, the spindle cells of the muscle stimulate it to contract. The stimulated nerves can control the muscle to reset to its normal resting length while the application of compression technique continues.

Tapotment is a double handed ‘percussion’ technique in which the hand position can be altered to perform a range of similar strokes including cupping, hacking, pounding and clapping. This technique is used to stimulate sensory nerves delivering stimulatory signals to the tissues to either relax the muscle or alternatively to encourage the muscle to fire, brisk application may be used prior to activity or sporting event as it stimulates the nervous and muscular system, increase blood flow, nutrients, oxygen and waste material, increase circulation of lymph. Tapotment is sometimes used on the chest wall of clients to help loosen mucus in the air passages

Vibration is a technique involving short rapid shaking or vibrations to an area of the client in order to promote relaxation to that muscle. It is also often used to add variety to the massage session where the clients body has adapted to continued or familiar massage strokes. Vibration works to ‘wake up’ muscles by stimulating sensory nerves. “The massage practitioner can use manual vibration to stimulate muscles by applying the technique at the muscle tendons for up to 30 seconds. When this is complete, the antagonistic muscle pattern relaxes through neurologic reciprocal inhibition.” (Fritz, 2009). “Vibration is particularly helpful to people suffering from low-back pain.” (Basic Techniques).

Other effects of massage

Blood flow is increased due to increased temperature to a localised area being massaged. Blood vessels are encouraged to dilate which allows greater circulation, blood flow and therefore greater exchange of oxygen and nutrients as well as removing toxins/wastes from that area.

Massage can increase the rate of lymph flow by speeding up the rate at which interstatial fluid is transferred into the lymphatic system. This enhances the circulation and transportation of waste fluid and toxins away from the tissues.

Massage is beneficial in releasing muscle tension. Muscles and associated tissues can become chronically contracted due to stress or overuse. Muscles may be massaged in order to stretch the tissue, releasing adhesions or bound muscle fibres. Increased blood circulation allows increased gas exchange bringing more oxygen and removing carbon dioxide, lactic acid and other wastes allowing the muscle to heal.

Massage is a beneficial treatment for the connective tissues of the body. As previously stated massage releases muscular tension, increases blood flow and circulation which acts as a transportation of oxygen, nutrients and also wastes to and from the body’s tissues and organs. It increases the lymphatic system and can also improve the range of motion at joints due to the mechanical improvements of the muscular tissue and pain relief. This can assist in decreasing passive and active stiffness in the joints and bones.

Massage also influences the neuroendocrine system and chemicals which are naturally produced in our body. Chemicals such as Dopamine and Serotonin influence the way we act or feel. Greater amounts of these chemicals are released into our system during massage. Dopamine affects our mood and levels of concentration. Higher levels of Dopamine promote happiness, alertness, enthusiasm. Serotonin also influences our mood as well as satiety enabling us to resist or avoid cravings. Levels of serotonin also influence the sleep/wake cycle which has an effect on concentration levels and also influence sleep patterns.

Sleep patterns are influenced by the presence or absence of epinephrine and norepinephrine hormones related to the sympathetic nervous system. If levels are low the person will show signs of drowsiness, lack of enthusiasm and arousal. Too high levels and the person will be too aroused to sleep. Massage helps to regulate levels of these hormones. These hormones and the effects also contribute to the person’s concentration levels.

Digestion may be enhanced by the stimulation of the parasympathetic nervous system which will increase digestive activity assisting the contraction of smooth muscles which propels the contents of the digestive organs. This process is called peristalsis. This stimulation can also help to relax sphincters.

Massage can reduce blood pressure by encouraging vasodilation of the blood vessels. This increases the volume of blood which can be transported in the blood vessels.

Pain can be affected massage in a number of ways. By releasing muscular tension. By increasing circulation of both the blood and lymphatic systems to transport more nutrients and oxygen to assist with repair and removal of waste fluids. The release of hormones which act to nullify pain symptoms or assist in the tissue repair process such as endorphins or cortisol. The reassuring, relaxing and therapeutic sense of touch with rhythmic strokes and varying degrees of pressure during massage help to alleviate symptomatic pain even though often for a short period of time.


Massage also releases oxytocin hormone which as well as being involved in pregnancy is said to assist with Bonding. This includes intimacy in a relationship, between parent and child or assist in creating an intimate or reassuring sensation during a massage session.








Reference List:

Massage Stroke Glossary. Massage Therapy 101. Retrieved March 30 2009 from
http://www.massagetherapy101.com/massage-techniques/massage-stroke-glossary.aspx

Fritz, S. (2009). Mosby’s Fundamentals of Therapeutic Massage. (4th Ed). Vibration (pp. 292-293). Missouri: Mosby Elsevier.

Basic Techniques of Swedish Massage. Massage Therapy. Holistic Online. Retrieved April 1st 2009 from
http://www.holisticonline.com/massage/mas_techniques.htm

Friday, March 27, 2009

Information Quality
by Sam Steven

Describe how information from different sources may vary in quality, and how to differentiate good quality information from poor quality.

Information quality is an integral factor of research as it is for any organization or business. Unfortunately the quality of information varies comprehensively. There are so many revenues to collect data from in the modern age that not all of it is of reliable or of relevant significance to the researcher or the intended audience.

“Information quality is a slippery subject. Although many might disagree, there is rarely a single absolute truth. In many cases, what is truth to me, may be nonsense to you. The best resources for a medical researcher are useless to the elementary school student and vice versa.”(Fenton 1997)

Common sources of information include: text books, internet sites, magazine, newspaper and journal articles, interviews or any number of the like. As the source field is so broad so is the quality of the information. Some of the factors contributing to the information quality include:

  • The relevance of the data to the topic
  • If the information is based upon opinion or belief – for example if the author is an advocate with an inbuilt bias to a specific theory the information may be rendered void or inaccurate at best for lack of consideration to an alternative or more accurate theory
  • Appropriate amount of information – “the extent to which the volume of information is appropriate to the task at hand” (Kahn, Strong, Wang 2002)
  • Lack of factual evidence to support information
  • The accessibility of the information – “the extent to which information is available or easily and quickly retrievable” (Kahn, Strong, Wang 2002)
  • The credibility of the source (author/publisher)
  • The date which the information was published (whether or not the information is up to date may bear relevance to its accuracy)
  • Lack of clarity in which the way the information is presented
  • “Evaluation of the quality of the information” (Fenton 1997)

It may take some time before the researcher is successfully able to distinguish the quality of the information. By scanning titles, author/publisher, date etc, you may establish some idea of the content of a particular article. If it covers relevant data to the topic the article can be further analysed for specific statements which could contribute to the research.

Similar issues to those above arise which the researcher must take into consideration whilst analysing the data in order to present the findings to their audience.

‘In many cases, the problem occurs when organizations fail to analyze the data they have. When the analysis is lacking, key information is lost. Other times, they add errors to the data, the analysis or the presentation. Sometimes they have everything they need, just not when or where they need it.’ (Godfrey 1991)







References:

Fenton. S.J. (1997) University of North Carolina Chapel Hill School of Information and Library Science. Retrieved March 23 from http://www.ils.unc.edu/~fents/310/

Kahn.B.K, Strong.D.M, Wang.R.Y. (2002) Information Quality, Products and Service Performance. Retrieved March 24 from http://web.mit.edu/tdqm/www/tdqmpub/KahnStrongWangCACMApr02.pdf


Godfrey.A.B. (2002) Quality Management. Retrieved March 24 from http://www.qualitydigest.com/jul/godfrey.html

Sunday, March 15, 2009

The Research Process

The Research Process

The first step of the research process is to come up with the question which we intend to research. This is based on a refined topic or idea, usually one we have a general interest in.

The second step is called a literature review. During this process you need to collect information that is relevant to your idea/question. This information should come from an array of sources including previous research about your topic. The more the researcher is able to read and learn about the topic the better their understanding will be.

Methodology is the proces of organising what methods you intend to use in order to collect and collate your data into answering your question. Become clear on your goals and what you want to achieve during the research.

“Defining the goals and objectives of a research project is one of the most important steps in the research process. Clearly stated goals keep a research project focused.” (Walonick 1993)

Methods should include how you will approach the data collection aspect, what resources, equipment, funding, (if applicible) and to identify any problems you may run into during your investigation and how you can overcome these if required to do so.

Once all the information has been collated, the researcher is required to analyse the interpretations of the information gatthered. Your final analysis and interpretation on your findings should include all perspectives on the topic in order to attain a fair presentation of the research.

You are now able to draw a conclusion to your question by using the evidence from your research. This should be a statement which represenets your findings and in turn answers your question.

“Once the research project’s been conducted we then obviously like to publicise the research so that people can make use of it.” (Keogh 2007)

The final step is Discussion. This is the process of sharing your research with a wider audience.




References:

o Science Learning. Keogh. J. July 2007. Retrieved March 14 2009 from http://www.sciencelearn.org.nz/contexts/sporting_edge/sci_media/video/research_process

o StatPac. Walonick. D. S. Ph.D. 2003. Retrieved March 14 2009 from www.statpac.com/research-papers/research-process.htm

o Assessment notes: Guidelines on writing a research proposal. Molloy. F. 2009.

Sunday, February 22, 2009

About me

Hi my name is Sam.

I'm from Wanaka and will be returning there in two weeks time. I'm currently living in Auckland and for the past year have been working as a drainlayer

I love sport and am currently competing in triathlons. I'm hoping to complete the Taupo Ironman at the start of March on my way back down South. I also enjoy cooking, boating, snowboarding, eating... the list goes on and on.

I did several papers of this cousrse last year and am now really excited about the hands on aspect of the course this year - although I'm starting a little later than the rest of you, I've tried to keep up by doing the basic massage course up here in Auckland.

When I graduate I hope to get into sports massage and work with athletes of all levels. I also have very itchy feet and cannot wait to travel again.

See you soon.