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The Training and Care of a Medical Massage Therapist:
Developing Medical Massage Curriculum by Gregory T. Lawton, D.C., D.N. Founder of the Blue Heron Academy of Healing Arts & Science Medical massage therapy is massage that uses technique that is supported by current knowledge regarding the body's natural physiological, biochemical, and neurological processes. Medical massage is first and foremost massage, and is therefore a natural and non-invasive approach to health care and seeks to support the body's own natural healing capacities. The power that created the body is the power that heals the body. This "power" is identifiable and understandable in scientific terms, to the limits of our ability to observe it, but the frontier of our understanding and knowledge keeps advancing and evolving. Medical massage training and education, like all health professions, begins with a detailed and thorough study of the structure and function of the human body. A major advance in health education is a concept called "problem-based education". In the case of medical massage this simply means that training is based first and foremost on the treatment of patients, or "patient-centered education". The medical massage therapy student, in addition to gaining a detailed and thorough knowledge of the human body, also needs extensive training in the actual treatment of the human body and its pathology. Medical massage curriculum focuses much of its training on assisting students to become knowledgeable about the kind of patient pathology that they will encounter in practice by providing students with actual patients to treat under supervision. At least one half of medical massage training needs to be conducted in a supervised clinic or practicum environment where students treat patients with real presenting symptoms. In addition, students should complete a supervised internship program in a medical or chiropractic clinic so that they gain experience and confidence outside of the school. Since medical massage therapists treat various musculo-skeletal conditions, an effective means of systematically educating medical massage students is by training them body part by body part, joint by joint, or condition by condition. That is, the medical massage curriculum should begin with a body region like the hand and wrist. Hand and wrist bony topography and anatomy is covered first, followed by the hand and wrist connective tissue structures and other soft tissue physiology. After the anatomy and physiology of the region have been covered, the next step in the training process is the presentation of the basic pathologies of the hand and wrist that the medical massage therapist would commonly see in practice. This would include arthritis, carpal tunnel and sprain and strain. The next step in the educational process would be the application of massage techniques and treatment protocols directed at the problem or condition. The medical massage approach would be to use technique to achieve four important clinical objectives: 1. Reduction of the inflammatory process. 2. Restoration of a normal soft tissue environment. 3. Establishment of normal range of motion. 4. Improvement in objective findings and the patients' subjective complaints. It is important that the techniques and treatment protocols being taught conform to current and correct applications of medical massage therapy. Training of the medical massage therapist would proceed to the next body region or joint, perhaps the elbow and the treatment of elbow conditions. By this method the medical massage therapist is systematically taught how to treat the acute and chronic conditions that represent most patients' common complaints. At this point it should be pointed out that medical massage is not "full body massage" and that medical massage therapists do not provide relaxation massage or use oil based spa or salon techniques. The medical massage therapist is trained in the use of "medicated" oil-based products and liniments, but these medications are used as an adjunct to focused medical massage treatments that are applied without oil. The use of these treatment modalities is normally applied after the massage technique or protocol has been completed. The next stage in the training and care of a medical massage therapist is training in clinical protocols and patient management. This is the most difficult part of the training process because the beginning student does not have the treatment and patient experience needed to determine how many treatments are needed, how often treatment is needed, and how long the treatment for a specific condition will take. This knowledge is gained over time with clinical experience in treating various conditions. A good starting point for training new students is the six-visit, three-week approach. The therapist simply informs the patient that he or she needs to see the patient for six visits, two visits per week, for three weeks, after which time, "they will mutually reevaluate the patient's condition to determine if further care, and how much, is required". This patient management scenario allows the inexperienced medical massage therapist to set incremental short-term treatment goals. Since the medical massage therapist is treating patient conditions, and not providing a full body massage, less time is needed during a patient visit. Most medical massage therapists are trained to work on a half hour schedule and can therefore charge less per patient visit and are trained to see at least two patients per hour. By seeing two patients per hour the medical massage therapist can earn as much or more than the relaxation massage therapist tied to a single patient for 60 minutes. When the medical massage therapist is competing with other therapeutic massage therapists they can extend the patient visit time, and still keep their fees low, by using therapeutic modalities such as hot and cold packs, infra red lamps, or cold low level laser therapy. This leads us to the next level of training for the medical massage therapists, therapeutic modalities. A standard component of medical massage therapy training should be therapeutic modalities or the use of adjunctive clinical therapy in treating various patient conditions. These therapeutic modalities are used either before, during, or after medical massage technique is applied to the patients' condition. Therapeutic modalities for the medical massage therapist might include the following: Therapeutic modalities are commonly applied in increments of 15 minutes. The use of these modalities is a historic part of massage practice for medical or clinical purposes and provides the following benefits: 1. Provides beneficial physiological responses in the patient's condition. 2. Prolongs the patient visit without tying the therapist to the treatment room. 3. Allows the therapist to see more than one patient per hour. 4. Reduces patient fees, allowing more patients to seek affordable care. 5. Broadens the therapist's scope of practice. 6. Makes the treatment program more effective. 7. Combats therapist burnout by diversifying the therapist's workday. Since the training of the medical massage therapist is based on standard medical terminology, health sciences, and clinical approaches to patient treatment and management the medical massage therapist is comfortable in medical interface and communication. The medical massage treatment model is, however, not a "medical model" nor is it "allopathic", but is rather, since it is massage therapy, based on a natural and holistic philosophy of care. The medical massage therapist needs to be trained to work in a variety of health-care settings including private or group practice, holistic clinics or treatment centers, hospitals, and medical or chiropractic clinics. Because of the diverse practice opportunities for medical massage therapists, they need to be trained in medical office practices, administration and billing procedures. An individual who is trained in medical massage can work in any environment that they choose for their career, especially clinical facilities and practices. Medical massage therapy training should include practice administrative procedures that include the use of medical case or SOAP notes, medical diagnostic and procedure codes, and medical report writing. This is just a language and nothing more, but just like English is rapidly becoming an important world language and the metric system the universal standard of weights and measures, billing codes, medical terminology and record keeping are just part of the ordinary process of doing business in health care. Whether you decide to bill insurance or not, if you treat any patient condition, a headache or a sore bicep muscle, you are required by law to maintain patient case records. Medical massage students are required to maintain patient case files and use medical terminology and medical coding for all patients treated during practicum and internship. In addition, if any massage therapist is involved in a malpractice suit, the only proof they have against any allegations that are made against them are their case notes and patient records. In the absence of this evidence, courts tend to accept the testimony of the complaining patient. You cannot teach what you do not know! Medical massage schools and instructors need to be trained in these various aspects of medical massage curriculum. Medical massage school staff should include instructors who are both massage therapists and allied health care professionals such as physical therapists, occupational therapists, and nurses. These multi-skilled health care professionals are fluent in "medicalese" and can easily bring this dimension, which has not been a traditional component of contemporary massage education, into a massage training program. The medical massage therapist is, therefore, thoroughly trained in the human sciences of anatomy, physiology, and pathology, as well as the clinical sciences of massage therapy and manual therapy. The medical massage therapist also receives training in traditional therapeutic modalities and the clinical aspects of patient management, office administration, and patient record keeping. The medical massage therapist is capable of maintaining a professional and competent office environment while at the same time providing all of the clinical and holistic benefits of massage therapy. General massage training and education is commonly based on hours in training and many massage school have not broken this training down into specific tasks - the emphasis is on the total number of hours spent in a training program. In some massage schools a significant portion of the training hours are spent in the practice of a single full body massage form, often practiced by students on students, with little or no internship experience being provided to the students. Medical massage training as previously mentioned needs to be both "problem centered" and "patient based" and it needs to be focused on the accomplishment of specific tasks and educational objectives. Medical massage training programs, like nursing programs, can vary in length, in depth of study, and in level of certification. Medical technical schools produce nurse and medical assistants in a few months of part-time training, and so can well organized massage schools with competent instructors. With the growing emergence of medical technical schools and community colleges entering the massage field, the massage profession can expect to see more focused and streamlined massage training programs entering the massage training market. Program development and organization simply requires a basic curriculum outline, a competent and experienced teaching staff, and an active clinical environment for students to train and gain experience in. Opportunities for massage therapists who are trained to work in clinical environments are rapidly increasing within the health care profession, and for those who prefer private practice, the ability to treat patient musculo-skeletal and neurological disorders helps the massage therapist to develop and maintain a thriving practice. Gregory T. Lawton, D.N., D.C. is the founder of the Blue Heron Academy. He is a licensed naprapath in Illinois and licensed chiropractor in Illinois and Michigan. 2001 marks Dr. Lawton's 50 years in oriental martial arts and healing arts. See the Blue Heron Academy website at http://www.blueheronacademy.com |