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spring 2011 issue

A Wake-up Call to
Better Sleep
United Front 11


p24 Editorial 5
News 10, 15,
20, 21,
Post-surgical Therapy 16 25,
for Mastectomy 13
RMT Tech Talk
and Implants, Part 1
Massage Therapy 15
Understanding Stress, 22 Canada Online
Part 2
Resource Directory 28
Forearm for the Feet 26

Massage Therapy Canada • spring 2011 3

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any Canada – 1 Year $29. unfortunately. experienced the benefits of massage therapy? P. as opposed to relying solely on association messaging and/or Printed in Canada annual campaigns? ISSN 1499-8084 We need to challenge ourselves to do more.O. (includes GST . Box 530. 105 Donly Drive South.95 – 2 Years $49. but what Massage Therapy is published four times a year: can we do as individual therapists to assist with this task? What can we do January. approval does not imply any endorsement of the products or services advertised. ON N3Y 4N5 use of handouts. for our profession. ©2011 Annex Publishing & Printing Inc.Volume 10. so that we will be working Occasionally. All rights (905) 516-8793 Managing Editor I Maria DiDanieli • mdidanieli@annexweb. There is still a very large population Group Publisher that sees massage as a nice thing to do – a Massage MassageTherapy TherapyCanada Canada• •suMMer spring 2009 2011 5 . Our clients are “ the converted. But. on an Tel: (866) 790-6070 ext. No liability is assumed for errors or omissions. ON N3Y 4N5 have an understanding of the benefits of massage – they are already in PUBLICATION MAIL AGREEMENT #40065710 RETURN UNDELIVERABLE CANADIAN your hands. 105 Donly Drive South.. We could commit to doing Circulation e-mail: cnowe@annexweb. RMT • jrogers@annexweb. Mailing Address P. No part of the editorial content of this publication may be reprinted without the publisher’s written permission. for massage therapy awareness a few public awareness talks per year. how can we make an impact on those who have not yet ADDRESSES TO CIRCULATION The main question asked by the radio broadcast hosts was “do people (519) 429-5183 • (888) 599-2228 ext. or just one-on-one chatting. prefer not to receive this information. ON N3Y 4N5 out the year. 239 the profession. www. Opinions expressed in this magazine are not necessarily those of the editor or the publisher. Spring 2011 . BOX 530. websites. Our associations do a great job promoting us as a profession.95 sage therapists. 207 individual basis. Such jrogers@annexweb.massagetherapycanada. (289) 259-1408 • (888) 599-2228 ext.#867172652RT0001) For USA and Foreign rates please contact Cheryl Nowe Everyone can jump on board with this effort. 247 n September please contact our circulation department in any of the four ways listed above. Sandra Mels • smels@annexweb. feedback and ideas to jrogers@annexweb. or know As true as those benefits are. (519) 429-5173 • (888) 599-2228 ext. Martin McAnulty • mmcanulty@annexweb. as individuals to increase awareness of the benefits of massage through- Simcoe. iSSue 2 from the editor Editor Jill Rogers. If you Send your comments. April. Subscription Rates We’d like to hear from you if you have been involved in.95 interesting public awareness projects being undertaken by registered mas- – 3 Years $64. stress-down treat. We will then share those ideas with readers. 219 still think of massage as a luxury?” Production Artist Kelli Kramer The answer. We could offer each client. I was invited Sales Manager by two radio shows in my home city of Hamilton to speak on behalf of Christine Livingstone • clivingstone@annexweb. Jill Rogers. Simcoe.O. Massage Therapy Canada will mail informa. Published and printed by Annex Publishing & Printing Inc. They Simcoe. ON N3Y 4N5 e-mail: cnowe@annexweb.” or at least on the way to being so. through the Fax: (877) 624-1940 Mail: P. a great number of people still do not perceive President massage as a frontline modality or a component of a team approach to Mike Fredericks • mfredericks@annexweb. RMT All advertising is subject to the publisher’s approval. Box 530. information regarding benefits of massage. I spoke about the benefits of massage therapy and took Sales Assistant calls from listeners.. Publisher reserves the right to refuse advertising that does not meet the standards of the rehabilitation. is yes. together! tion on behalf of industry-related groups whose products and services we believe may be of interest to you.

some inhibitory mechanism that “turned traditionally not learned much about the subject. the time about the short-term and long-term health implications of insufficient sleep. But in fact. is viewed as the first examination of sleep highly regulated neuroactivity during which processes essential from a physiological perspective. It is not surprising. rMT A Wake-up Call to Better Sleep How the RMT can assess and promote healthy slumber A lthough sleep has been a human preoc. Nathaniel to life and health take place. representing one of the biggest Until the latter 19th century.” understanding of the importance of sleep is expanding rapidly in began his work in the 1920s. It is perhaps ironic that scientific Kleitman.Feature by debra CurTies. Basically. prevailing theories postulated that areas of focus on massage therapy effectiveness in the medical- sleep resulted from stoppage or suppression of brain function – scientific literature. we as massage practitioners have through. off” the brain – or that neurons were paralyzed during sleep and The purpose of this two-part article is to make valuable infor- could not communicate with each other. However. sleep medicine is an even newer area of Although modern sleep science is still young and contains many study. the current view of sleep has completely Sommeil. is a fairly well-researched subject. The reason for this lag in curiosity with regard to sleep. that interest in what transpires during sleep remained at a study of sleep is surprisingly recent. Massage therapy’s impact on sleep the historical view of sleep as merely an absence of wakefulness. published by French scientist Henri Pieron overturned these earlier ideas. and low ebb for so long. the belief that the brain is simply not working while a person cupation through the ages. as com. Sleep is now understood to be a in 1913. the “Father of American Sleep Research. the current an epoch when cultural trends toward devaluing the need for sleep understanding of sleep health has been evolving are very strong. for example. It is also very interesting that massage has been emerging as a pared to other areas of human health and activity. given mation about massage therapy and sleep known to massage 6 Massage Therapy Canada • spring 2011 . The book Le Problème Physiologique du open-ended questions. appears to be powerful sleep-promoting tool. the scientific sleeps. new information is being released all over fewer than 100 years. Dr.

There are homeostatic factors at work in sleep. The brain is night’s sleep. Over the course of a normal comes from insufficient sleep.a. close to the eyes. SLEEP ARChITECTURE at night. of a night’s sleep. Deep sleep stages are proportionately longer in the first half NREM sleep. While it can function as a stress reducer. shallow sleep responses by over-utilizing light sources at night. is one of the most important sleep promoters. “cleaning up” of redundant or excess synapses nap cannot recoup the REM stage that occurs at the end of and updating of factual memory. In this way. a skeletal muscle inhibition state like and is entrained to the alternation of light and dark in our that induced pharmacologically during surgery to prevent uncon. and the evidence supporting that more time in REM sleep that night. REM sleep in a student REM sleep is characterized by intense brain activity during learning new skills – there is scope for adjusting the relative which cerebral blood flow increases and the occupations and length and duration of specific stages over the course of a full challenges of the day are processed neurologically. In other words. this stage of sleep is accompanied by sleep Sleep is also connected to the body’s circadian rhythms atonia (pseudo-paralysis). and sexual interest and fertility can be sequent night. the focus will be to describe the compo.” and with the emotional shakiness that ment) and NREM (non-REM). the ➥ Stage 1 NREM. sleep. eye and body movements dimin. Another area of concern for sleep specialists is the ➥ Stage 1 NREM (moving to theta waves)… a.5 at night is still going to be REM of insufficient deep sleep: the neurotransmitters needed for mood sleep deprived. metabolic rates are is possible to make up for shortened sleep stages on a sub- not properly controlled. or being occurs in REM sleep. of “sleeping on it. such as computer monitors. body temperature decreases (essential for After the age of three.therapists.” Each constitutes 20-25 per cent of a NREM sleep depth intensifies. to note that when people get an hour or two less sleep than as well as functions such as immune resilience. Aided by various chemical and neurological inputs. etc. REM sleep is also essential for limbic system process- SLEEP DESIGN AND CYCLES ing and restabilization – we are all familiar with the benefits Sleep is divided into two principal stages: REM (rapid eye move. To list just a few of many pos. be discussed. and although it is overly simplistic. ish to almost none. one NREM sleep occurs in levels of increasing “depth” that. a major sleep. blood pressure they should. times in a sleep cycle. In this first part. according to need – for example. especially ➥ Stage 2 NREM (theta waves)… light sleep backlit ones. is crucial to nutrient uti. state with slow. of such brain activity. normal NREM and REM sleep seg- certain metabolic processes) and blood flow to the brain lessens ments occur in cycles as illustrated in Figure 1. substantially. the person who naps for 1. stability and pain modulation drop in volume. The body “descends” into a strong parasympathetic The NREM-REM cycle rotates every 90-110 minutes. The majority of dreaming from sleep deprivation are the result of not ensuring. per cent of their sleep time in REM (premature infants even more). deep sleep por- lization. In part 2. external environment. the pineal gland as part of the circadian system.) The health issues that arise pressure. napping work done: for example. As the day or two and then “pass out” for an unrestricted recupera- brain “works. however. growth hor. tissue maintenance routines. a hormone produced by scious patients from lashing out or recoiling physically. extent to which people now interfere with normal circadian somnolence. this recuperative type of sleep to compensate body movements from taking place as an automatic consequence for losses over time. increased protein synthesis in the central cannot compensate for a shorter night’s sleep because the nervous system. normal adult’s night’s sleep. final REM segment that is sac- stabilization and injury healing. ➥ Stages 3-4-3 NREM (delta waves)… deep sleep ➥ Stage 2 NREM SLEEP REGULATION ➥ REM Sleep (alpha waves) The hypothalamus is the key sleep-regulating area of the ➥ 1-2 minute wakefulness episodes brain. It mone is not released in sufficient quantities. Infants spend about 50 massage therapy helps to achieve them. (It should be noted that the ability to do this suc- bursts of rapid eye movements and irregular patterns of blood cessfully diminishes with age. Just as some sleep segments can be increased impaired through reductions in sex hormone release. can be divided into light sleep and deep sleep. Melatonin. glucose/glycogen regulation tions shorten and REM portions lengthen. particularly deep sleep. As “brain processing time.5 sible examples of hormone production and release ramifications hours and sleeps for 6. and its role in health will REM sleep is vital to brain development and to learning. in the could say that deep sleep is “tissue needs time” and REM is simplest sense. 75-80 per cent of sleep time is spent in NREM and Deep sleep and REM sleep are the two major workload 20-25 per cent in REM. hypothalamus: ➥ Final REM Stage • directs the homeostatic aspects of sleep ➥ Person wakes up • integrates with and modulates circadian processes • harmonizes sleep/wake cycles with autonomic functions Massage Therapy Canada • spring 2011 7 . As the night progresses. stable vital signs.k. Its maximal secretion time is Figure 1. In order to prevent potentially dangerous unable to have. Individuals who are learning a new skill during the day spend nents of high quality sleep. It is significant and production/release of glandular secretions and hormones. adult sleep. itself. heart rate and respiration. drowsiness. it is the long.” physiological manifestations occur that include tive sleep. stepping up at dusk and increasing as the person seg- ues toward sleepiness and through the first half of the night’s Wakefulness (alpha waves) sleep. individuals can be underslept for a operating in an energy state similar to that of being awake. There is also brain maintenance rificed.

adequate sleep is essential example. She also travels extensively There is also a great deal of interest in the relationship between teaching continuing education courses for massage sleep and pain. 2005). making it a big risk factor for heart attack and stroke. ability to learn and vigilance as blood pressure. children and teenagers. Underslept children often display signs similar to learning important to the sick. diet and exercise. It is also linked to development of hypertension. with the same adequate sleep. The physi. in Toronto and presently works there as executive director and longtime We are quite familiar with the idea that being underslept makes instructor of pathology and clinical theory. especially hormone-sensitive cancers such as breast Debra is the author of Breast Massage and Massage and colon. Adverse physical and mental health find. such as body temperature regulation and sympathetic versus Figure 2. nap) It is also true that there are individuals who need less sleep than average (and some who need more). leading to frequent misdiagnoses. Experts are adamant that most 5-12 years 9-11 hours people who believe they are doing well on shorter sleep times are Adolescents 9-10 hours kidding themselves. illness and injury? Shouldn’t we routinely be considering Although the reasons for this are not fully understood. including timing of peaks and lows in 1-3 years 12-15 hours (incl. recipient of the Ontario Massage Therapy Association’s Meritorious coupled with pro-inflammatory effects and impaired hormonal Service Award and the AMTA COS Meritorious Service regulation. practitioners. there are a client’s sleep status before doing tissue-altering work? And so on. 2003). She has been involved in us more susceptible to getting colds and flus but may be less cog. Award. 3-5 years 11-13 hours (poss. it has also been found that Figure 2 shows the average required amount of sleep accord. ing surgery. nap) regulated in the two groups. tory taking and regular check-ins with clients? Shouldn’t we be mak- Recent research indicates that individuals who sleep less than six ing sleep promotion a primary aim of treatment. atherosclerosis and thrombosis. moter of cancer. Because key pain-regulating chemicals are pro. we will take a look at sleeping and major health concerns. Therapy and Cancer. sleep deprivation what constitutes good quality sleep and at the evidence for mas- promotes obesity by influencing the release of appetite-regulating sage therapy as a highly effective sleep promoter. Experts are particularly concerned about the current musculoskeletal pain as a result (Davis. Combined with the above factors. hormones. stress- related health changes and poorer quality body tissue. and anxiety. for For babies.” disability and/or mood disorder. pain neuromodulation is impaired by to handle receiving less sleep. impaired. HoW MucH SlEEP Do WE NEED? parasympathetic status Age Average Sleep Needed • ensures efficient transition between asleep and awake states It is true that there are “morning” and “night” people – this is Newborn up to 18 hours referred to as chronotype. Insufficient hEALTh IMPLICATIONS OF SLEEP DEPRIVATION sleep is known to increase proneness to soft tissue injury.wikipedia. people who are deprived of Stage 4 NREM (deepest sleep) develop ing to age. elderly 7-8 (+) hours awakens naturally – without needing an alarm – and does not have Pregnant women 8 (+) hours daytime sleepiness or any adverse indicators pointing to insufficient Source: http://en. This poses some interesting questions for massage therapy treat- More recently. stating that only when a person falls asleep and Adults. 8 Massage Therapy Canada • spring 2011 . in “digest and restore” mode. heart Note: References for this first instalment will be included at the end conduction abnormalities and vascular changes associated with of Part 2. In the second instalment of this article. For example. At a recent conference. incl. throughout the stages of their growth and maturation. who are often There is also a connection with mental health: throughout the sleeping fewer hours than they need. and the prevailing myth that lifespan inadequate sleep is associated with increased depression seniors need less sleep. people. Florence Nightingale wrote “sleep is all- habits. as do emotional resilience. perform in school and capacity to establish normal eating and sleep In Notes on Nursing. nap) their body temperature. could he or she be seen as naturally being a shorter sleeper. one sleep expert argued that sleep should ological processes of brain and body tissue development demand be monitored by health professionals as a vital sign. and being underslept is a significant trigger for people ings correlate very strongly with short/poor quality sleep in older with mood disorders. scientists have started to assess inadequate sleep in ment planning: are we asking enough about sleep as part of our his- the pregnant mother as a source of development issues in babies. There are differences in the way sleep is 1-12 months 14-18 hours (incl. multiple professional organizations in Canada and the U. powerful new facts about the correlation between chronic under. especially follow- to seven hours per night die younger (reported in Stein. and to reduce the speed and quality of tissue recovery. One’s sense of doing well on shorter sleep deprivation. While we tend to think of such actually are when drinking alcohol. The emotional capacity to handle pain is also sleep times is apparently aided by the same type of denial mecha. It is also current expert opinion that the human body cannot evolve duced during deep sleep. the very healthy elderly almost always demonstrate good In general. promoting digestive problems. Pain levels decrease following a restorative sleep regardless nism that allows people to feel much more functional than they of other treatment interventions. effects as secondary in the pain cycle. trend toward undersleep in toddlers and teenagers. and is a nizant that longer-term impacts of a less resilient immune system. have led to an awareness of sleep deprivation as a pro. disruption of glucose/glycogen regulation makes chronic sleep deprivation one of Debra Curties is a graduate of Sutherland-Chan School & Teaching Clinic the top five risk factors for developing Type 2 diabetes. spending less time sleeping means spending less time night-time sleep sleep. A co-founder of Curties-Overzet Publications.

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massagetherapycanada. She was an instructor and Daniel Goodenough with the & Printing inc. services to enhance your practice. of Massage and Hydrotherapy in Please Specify louise Danieli. His workshop will include scanning stress management and psychology PLeASe iNDicATe YOur TiTLe beLOW: peripheral joints to aid the thera. a to be held at Mount Saint Vincent graduate of Sutherland-Chan School 29 MTspring2011. box 530 about breast massage. and Name: ________________________ trade show featuring products and the CMTO (CANADA). with support Implants and Advanced Upper Body from Lackner McLennan.Code:________________________ Examination – Why. Lewis is a Registered SubScribe TODAY ! pleased to present the Spring Massage Therapist (RMT).O. Alberta and has extensive training in TO ALLOW uS TO SerVe YOu beTTer.Payable to Annex Publishing Acupuncture.indd 1 28/03/11 10:03 AM $ 95 University in Halifax from May 6-8. News Nova Scotia 2011 Spring Conference T he Massage Therapists Lewis will offer two workshops. Drawing from ancient Prov: _________________________ workshop titled The Scanning practices of Traditional Chinese P. an introduction to the visit c/o Annex Publishing & Printing inc. Yoga and energy medicine Dr. spir- Visa Mc Amex and Hydrotherapy for seven years ituality and life mission coaching.massagetherapycanada. He began Danieli is a Massage Therapist. seminar series for massage therapists. Michael Majaess – Dr Majaess ent an Introduction to Awakening City: _________________________ will provide a full day lecture/ the Healer.mtans. Hydrotherapy (CCMH). Barnes in 1998. how it can apply to your prac. Ontario N3Y 4N5 tice and how to approach your clients listings. from the University of Santa Monica pist in ruling out pathology beyond having attained a Masters in Spiritual Massage Therapist ❏ that of the cervical or lumbar spinal Psychology program. and e-mail: cnowe@annexweb. and Teaching Clinic in Toronto. You will also! seminars and workshops as well as a NCBTMB (USA). RMT – Louise Sutton Ontario in 1993. is Treatment. basic general information about breast Conference2011. Recently.pdf. For more Date: ________________________________ Acupuncture – designed to be a information on the conference. Stephanie Allen and Peter Clinic Name: ___________________ Stuart – Stephanie Allen and Peter Address: ______________________ Speakers include: Stuart will be on-hand to pres- Dr. FHT (UK). When and How. a extensive Myofascial release training Dr. He has PAYMeNT: Therapist and holds a Doctorate of also trained with Kimberly Herkert cheque . Certified 4 Issues Conference and Trade Show 2011 Reflexology Healthcare provider. at the Canadian College of Massage Way of the Heart in psychology. GST#867172652RT0001 0211MT massage therapist and instructor Paul 10 Massage Therapy Canada • spring 2011 . Stephanie studied massage therapy e-mail: ________________________ he has started an orthopaedic review at Mount Royal College in Paul lewis. Account #: ____________________________ and is director and co-founder of These are only a few examples of expiry: ___________________________ the College of Acupuncture and the qualified instructors and educa- Therapeutics. Peter Stuart Massage Student ❏ regions or to note areas that may graduated from the Canadian College Other ______________________ ❏ require a more detailed assessment. please Tel: 866-790-6070 Fax: 877-624-1940 Mail: Massage Therapy canada Breast Health. Michael Majaess has been in prac. you will learn a step-by-step process Tel: __________________________ tice since 2000 and is an instructor at that will enhance your effectiveness as Fax: __________________________ the Canadian College of Massage and a therapist and enrich your practice.95 (USD) 2011! Canada and an approved and accred- For even better pricing go to The conference offers a number of ited educational provider with the www. Medicine. or didactic and practical introduction to become an exhibitor at the trade TO SubScribe: to this therapy – and a lecture titled show component of the event. Vodder Combined Decongestive with John F. registration forms. accommodation and venue infor- www. RMT – Well known mation at this web address. Post- Association of Nova Scotia surgical treatment of Mastectomy/ (MTANS). only Plus GST • US $44.95 (USD) • Foreign $59. Louise will present tional sessions that will be available Signature: ____________________________ a workshop titled Introduction to at this three-day event. find complete program details and Simcoe.

physicians. states Canadians spent an estimated $3. non- in their lives. physician-led model has particular ben- efits for CAM practitioners. associate director of the Centre for Health Studies at York University. which itself includes massage. MD. insurance funders. “Many Canadians have already integrated complemen- tary and alternative health practices into their health care. This work is sorely needed. A study funded by Health Canada. reform has unfortunately been geared almost entirely toward tion of public health care. goals.5 and are looking for partners sage. relays. A more recent study by the Fraser Institute estimated 74 per cent of Canadians had used at least one CAM sometime Many physicians are increasingly dissatisfied with linear. A radical shift away from individual CAM professions fighting for funding.8 billion dollars on alternative treatments in 1998. rMT United Front Physician-led “integrated” medicine C omplementary and integrated medicine (CIM) is a physician-led community medi- cal practice embracing CAM. but rather sup. and how efficacy is determined. supportive policy and positive public relations to an integrated. poor outcomes – causes that include a rapidly rising epidemic ers. Expenditures in 2006 were estimated at $5.Feature by don dillon.4 With drug interactions. holistic approaches for their patients. coming from [combining allopathic and complementary and Massage Therapy Canada • spring 2011 11 .”1 “The study shows it is time for us to move on from the mistrust that has characterized the relationship between con- ventional medicine and alternative practitioners in Canada. increasing access and decreasing costs. skyrock. with the greatest potential for effective change ported and supplemented. government health-care policy makers. Dr.2 pathic medicine is an opportunity for mutual benefit. be addressed first. out-of-pocket for visits to CAM providers in Canada. and start examining broader questions about alternative therapies. and a wellness-focused and information-savvy populace. Diamond.” said Joan Gilmour.6 billion in delivering holistic care integrated with other providers. counteract or prevent it. creating increased and affordable access to a failing medical dures in lieu of lower-cost and less invasive options. homeopathy/naturopathy and acupuncture/ traditional Chinese medicine. “The recent focus on health-care The public appears somewhat dissatisfied with administra. W.3 J. long wait system does not address the actual causes of the high costs and times. there is increased interest in seeing health-care reform of chronic disease and a health-care system poorly designed to delivered with less risk and as minimally invasive as possible. Complementary and Alternative Health Practices and Therapies – A Canadian Overview. their place in the health-care system. professor of law at Osgoode Hall Law Pooling resources and maintaining a working relationship with allo- School and a co-author of the study. and 35 per cent of Canadians had tried mas. Collaboration between mainstream medicine and CAM poses benefits beyond more holistic medicine. Interest has grown in CAM. It is the practice of medicine that should Current medical practice needn’t be replaced. and consumption is likely to grow. idiopathic diseases and burned out health-care provid. While these are laudable eting expenditures. unnecessarily invasive and costly proce. chiropractic (osteopathic).

public expenditures of CAM professions. Maintaining their favour- ance companies7 will become more interested in the cost savings able position as gatekeepers. schools and regulatory bodies and press them to open a efforts and influence on government policy. regulators. insurance com- ers and educators demonstrate efficacy. to stage a coup and based practice (and hence greater public safety and cost-savings). gatekeeper health professions or exploitation by profiteering in large lic health and disease prevention. public and media rela. when collaborating. I would counter that. Then approach other CAM pro- in insurance plans. including the same goals: generating research and evidence-based practice. DC. pooling resources and grandchildren are seeking out and financing. 12 Massage Therapy Canada • spring 2011 . With this lack of infrastructure comes insufficient business treatment plan. tions experts or a board of directors (advisors). for years. not to mention better patient out. viders under the direction of gatekeeper health professions. or skilled tion between the two ideologies. William Meeker. there’s too Resource-rich baby boomers and their benefactor offspring much opposition. negotiating with the insurance industry for better service (Australia) and various massage school and professional funding. CAM practitioners would enjoy well- selves and their families. more and more (allopathic) medicine. www. variety of resources for massage therapists. Despite this skepticism. and stronger public confidence. seen by insurers. each profession is provinces to massage therapy schools and associations. and eventually allopathic providers. none of these professions have for CAM continue to rise annually. face exclu- By collaborating with physician-led practices. Unlike administration-led assist in co-ordinating care very well. Please visit www. or other benefits to CAM practitio- Complementary and alternative medicine (CAM) providers ners) or may argue a loss of professional identity with such col- are typically directed into sole practice without the health-care laboration. . and raising the standards of education and training in association newsletters. deal with snubbing by sive allopathic practices and hospitals. In particular. ing and education. I believe CAM pratitioners can ate. physicians and other gatekeepers. Practitioners) would realize better profit margins and cost-savings savvy health-care users. CIM would yield stronger lobbying ciations. an adversarial. our position with government.massagetherapycanada. practitioners could recognize substantial business benefits and cost Detractors from this argument may complain that physicians offsets through collaboration. “Why are we trying to do this by ourselves?” Don Dillon is the author of Better Business Agreements and the self- Moderating the panel “Role of Massage Therapy in Public study workbook Charting Skills for Massage Therapists. pendent CAM professional associations are woefully inadequate Now is the time. ference in May 2010. Massage Therapist care. an opportunity for mutual benefit. could finally enjoy and benefit from the vast knowledge and expe- based practice. physiotherapists and situation that impacts access to care and treatment plan fulfilment. obstacles. research. I would contend. promote and administer a business. we need an “overseer” – someone who can direct the them. Working alone. cal clinics and hospitals. With the support of models or management experience required to successfully oper. asked the salient question. fessions. Massage Therapy Today. tion (Google “massage insurance fraud”).com. our train- funding will support CAM until its providers. especially in complex cases.MTCoach. for the proper administration of policy infrastructure that physicians and nurses have to support health care. lobbying government for policy change and inclusion in health Massage Magazine (online). and there has developed an unfortunate opposi. cost savings and public safety. Our professional identity. Massage therapists are relegated as adjunctive/assistive pro- pathic medicine. CAM providers frequently vided under one roof in a collaborative effort.8 Baby boomers have made it clear they are by overseeing and working with CAM counterparts in their medi- willing to finance a broader range of health-care services for them. More than 60 Health. especially if that care is pro- hospitals or large medical facilities.alternative medicine]. Government and insur. MPH. cost-savings and willing. However. a tionate taxes compared to their counterparts. government. Massage therapist professional associations currently dogging them. and avoid many of the pitfalls rehab and spa facilities. extend CAM scope in pub. Secondly.” Meeker described that CAM professions are all pursuing of his articles have been published in industry publications. with workplace and maintaining real working relationships with mainstream benefits or out-of-pocket discretionary income. change the face and the relationships of public health care. territorial stance becomes complementary and alternative medicine. CAM practitioners sionary health-care policy and negative public and media percep- could reap the benefits of business models employed by progres. have the most authority in such a model and could impair CAM comes and considerably less professional isolation. references. administration (or salaries. share knowl. inde. and they expect health-care providers to oiled business models and could concentrate on providing care work together towards best practices. media and the public as expensive However. panies and other health-care providers and our image in the public ness to work together with allopathic medicine. imagine the momentum generated by a united front and experimental. billing and AMTA Journal. don’t retain the resources or political leverage to overcome these CAM has traditionally been considered an alternative to allo. Don has presented in seven their respective practitioners. limited by resources and is ultimately slow and ineffective. Working alone. CAM providers are already losing ground. experience barriers to insurance coverage.”6 Gatekeeper physicians and registered nurse edge and co-ordinate lobbying and education initiatives. rience base afforded by a truly integrated health-care system. for article with At the Highlighting Massage Therapy in CIM Research con. chiropractors. Massage Therapy Canada. and serving the broader interests of information. better compensation dialogue across North America. CAM is financed massage therapists in many Canadian provinces pay dispropor- primarily out-of-pocket or by employee benefit/workplace plans. It’s unlikely public/government labour service providers in spas. CAM is typically eye have all been depreciating. Individually. more resources towards research and evidence. a chance at integration into mainstream medicine . AMTWP Connections. Meeker and his website. . And public citizens Government agencies and insurance companies want evidence. work without administrative/support staff. provides a suggested CAM professions collaborate on resources. physicians (and Registered Nurse CIM provides. instead of marketing. Talk to the leaders of your professional asso- in providing these assurances.

Its intended effect is to deter and prevent deceptive and damaging forms of spam and Internet practices. you would be well advised to maintain records so that you are able to prove. A full copy of this bill can be viewed on Industry Canada’s website at www. 2010. form of consent. This article is not intended to provide legal advice nor a complete analysis of the Act. “Expressed” permission describes a situation in which cli- ents. It also Within the act. What is the difference between the two? to that page is included in the transmitted message. legal experts and inter- ested parties. WhAT IS BILL C-28? Bill C-28 is called the Fighting Internet and Wireless Spam Act (FISA). After long consultations with industry. social media messages. by far. you are now required to obtain permission (either implied or expressed) from your potential clients before you can legally send them electronic messages about your business and services. WhAT IS A COMMERCIAL MESSAGE? A commercial message is a message that contains content that is intended to solicit business or commerce. but rather to inform readers of the potential ramifications to their day-to-day business You may be asking yourself the following question: “As a legiti- mate business and RMT practitioner. This is. Canada has now passed a bill that is intended to increase the reliability and trustworthiness of the digital economy for Canadians. when. if needed. that you have received this permission from them. under the new rules of the FISA. Commercial electronic messages that may affect RMTs includes e-mails. or mail-in a point-of-purchase postcard your clients and potential clients before you communicate requesting your communiqués. The bill is 79 pages long. They check a box on a web- As mentioned. have formally “opted-in” to receive WhAT IS PERMISSION? commercial messages from you. where and why you are authorized to send commercial electronic messages.gc. instant messages. both “expressed” and “implied” permissions includes commercial website page content. and it is complex. Failure to comply could cost individuals up to $1 million in fines and corporations up to $10 million dollars per infraction. text messages. The legislation will deal with how. as it is very clear what your clients’ intent is Massage Therapy Canada • spring 2011 13 .ic. telephone calls. Bill C-28 will come into effect in September 2011 and massage therapists will want to make sure their marketing communications methodologies are on the right side of this law. FISA requires that you receive permission from site registration form. the strongest with them electronically about your business and services. and voicemail messages that are intended to solicit business. or potential clients. FISA covers more than just the words contained in the message.Feature by JessiCa FosTer RMT Tech Talk Bill C-28 and what it could mean for you I n this issue. In addition. but only if a link are acceptable. I would like to raise awareness among registered massage therapists of new legislation passed in Canada on December 15. how can FISA affect the day-to-day operation of my practice?” In a nutshell. organizations.

manual or otherwise. published a disclaimer along with it. “I Until next time. You do. Obviously. as long as their business and duties are are affordable practice management systems available to RMTs relevant to your business and their contact information has that will help you build your practice by engaging your clients been made publicly available to you. with respect to you marketing to them. This leaves you couple of ideas you may want to consider implementing: plenty of time to consider its implications and put appropriate • As an RMT you are required to obtain signed treatment business practices in place to ensure your compliance in electronic consent from your clients before you are able to treat them. Why not add a checkbox to this form that simply states. however. but a must-have. BEYOND PERMISSION There are two more very important issues that FISA compliance requires and that may affect the way you presently communicate with your clients. One of the results of this legislation will be the desirability nications from you. if you are ever required to do so. you. be well! understand and agree that as part of my ongoing care. but is inferred by another action FISA in no way should reduce or hinder your legitimate busi- taken by your clients. communications. The core requirements of FISA are an existing business relationship with customer or clients. it is no longer an option. it can be ther communications from you. need to ensure that mass e-mailing tools and automation – all the while maintaining persons who publish their contact information have not also FISA compliance. there will be adequate documentation for you to provide proof of consent later. to name a visits your website and requests an online appointment with or call toll free 888-373-6996. There may not even know. “Implied” permission. when you already have ness practices. It is also very important that you monitor and honour these “Unsubscribe” requests to ensure FISA compliance. as a health-care professional. it straightforward to adopt into your practice. In both cases. So don’t panic. “implied” permission may include persons you and legitimate contact with clients and potential clients. the new FISA legisla- deviating from your regular day-to-day practices. but are not limited to: • All the commercial message e-mail and electronic newsletters you send to your clients must contain the full name of the sender along with valid contact information. I may receive communications from you electronically about my treatment and related services. you will provide you with their e-mail address and consent to receive fur- quickly recognize that.” Once checked. You could will help you maintain your client list and minimize the time contact them and strike up a conversation intended to initi. for them to “opt-out” of receiving any further electronic correspon- dence from you. stating that they do not While visiting your website. interactive website clients (consumers) of an RMT do not fit this description. very easy for you to obtain permission from your clients without As mentioned at the outset of this article. you with consent if by doing so they believe it will be beneficial to them. • All of your commercial messages must provide the recipient with a working mechanism. potential and potential clients through professional. That said. tools and legitimate e-mail correspondence. 14 Massage Therapy Canada • spring 2011 .massagemanedger. on the other hand. all well within the rules of FISA. through which they may willingly When you stop to think about this for a minute. this would Jessica Foster writes on behalf of mindZplay be an example of clients giving you “expressed” permission Solutions – a leading provider of massage therapy for you to communicate with them about your business and websites and practice management solutions. required to legitimately correspond with your clients through ate referral services. You are likely already doing this. For example. as it is only common sense to provide your clients with a way to get back in touch with you. To services. with FISA. They will welcome the convenience of online website tools hOW DO I GO ABOUT such as online appointments. denotes consent ThE SKY IS NOT FALLING that is not actually stated. These include. is implied that they expect ongoing business-related commu. for RMTs and other commercial ventures to maintain relevant In addition. These systems also but doctors or chiropractors in your area would. This action is inviting a business relationship with you and therefore is “implied” permission for you to communi- cate with them. learn more about mindZplay Solutions for Massage • An example of implied consent would be when a new client Therapists please visit www. potential clients will gladly provide wish to receive commercial messages. Here are just a tion will come into effect in September 2011. and are not costly. newsletter subscriptions and class GETTING PERMISSION? registrations.

. the use of natural health products in daily practice. please visit www. backpacks and therapeutic belts. CEO of Core Products.” says Phil Mattison. For more information about Core Products and/or The Vitality Depot. The Myofascial Release Treatment Centres and Seminars announces dates for 2011 ment of The Vitality sessions for health professionals. or any authorized Vitality dealers from coast to coast. Health Products al brand recognition and greatly expand By Victoria Coleman.mAssAgEthERApycAnADA. Inc. DC our patient education NEWS HIGHLIGHT C ore Products is pleased to Myofascial Release 2011 Seminar Dates announce the value and technology. orthopaedic pillows. “This Regulatory Issues Surrounding Natural new alliance will also increase our nation. Some of Core’s products include extremity supports.News Vitality and READ thEsE stoRiEs AnD moRE At Core Alliance www. “This partnership strategically enhances the availability to the health care market WEB EXCLUSIVE for our entire product line. and hopefully offer some clarity to any questions regarding This new opportunity fits into our busi. was founded in 1988. The Core Product line will be available directly through Vitality Depot.” Scott Spencer. ND. The understanding that Core Products is a North American-based manufacture adds great value and interest at all levels. ness model perfectly and allows us to maintain our goal of bringing our valued clients the best in class products. regulatory and quality assurance advisor with Douglas Laborato- ries/Pure Encapsulations Canada. Massage Therapy Canada • spring 2011 15 . Depot as its exclusive importer and master dis. READ Full stoRy onlinE tributor in the Canadian market. Gerry Derganc. Core has continued to expand their family of products and have introduced new concepts and technolo- gies in the hopes of assisting health care professionals with tools to increase patient wellness.vitalitydepot.” Core Products International. intended to dispel myths announce the addition of the entire Core Products line to our family of products. CEO of The Vitality Depot notes "It is with great pleasure we A Q-and-A article with Dr.

mended that all body areas be discussed for inclusion or exclu. or are there just not enough of us engaged in the rehabilitative work to make a large enough impact? I would like to share with you my experiences with post- surgical clients. Examinations set by the CMTO. then. training). the massage therapy profession is not considered. special consent is required for order to gain licensure with the CMTO. soft tissue and joints by manipulation to develop. the treat. The A robe can be worn by the patient while the RMT conducts the College of Massage Therapists of Ontario (CMTO) standards assessment. reduce pain and address issues related to scarring and mobility. REGULATED SCOPE OF PRACTICE Whenever a client requests treatment from a Registered Massage Therapist (RMT). I must ask why. and an increasing number of us may see a naturopathic doctor or even our pharmacist. when we require help to restore range of motion. or relieve pain. It should also be noted that consent can be lent (generally averaging 2000 hours of academic and clinical modified or revoked at any time by the client for any reason. In sion to a given session. When we have a cold. Once registered with the 16 Massage Therapy Canada • spring 2011 . assessment and consent S hould massage therapy be an integral component of the rehabilitation process for post-surgical cancer patients? Yes. we generally think about visiting our family physician. Therapists are reminded that “full body” treatment may ment and prevention of physical dysfunction and pain of the mean different things to different clients. buttocks training program from an approved Ontario school or equiva- and breast areas. consent for treatment is always required.Feature by paul lewis. it is recom. as a recommended adjunct for post-surgical clients. Therefore. Part 1 Scope of practice. during roundtable discussions. rMT Post-surgical Therapy for Mastectomy and Implants. but as well. followed by successful completion of both written The CMTO defines the practice of massage therapy as the (multiple choice question) and Objectively Structured Clinical assessment of the soft tissue and joints of the body. inner thighs. rehabilitate or augment physical function. of practice require consent for treatment from each and every client. outline treatment techniques I used during their rehabilitative process and offer the rationale for the modalities chosen. one must complete a sensitive areas such as the inner chest wall. absolutely. It is my hope that more of us will become engaged in helping post-surgical patients and raise awareness of the possible benefits that massage therapy has for the challenges these patients face. But. where do we think of going? Is it advertising and pub- lic perception that keep massage therapy in the background of treatment options. maintain.

That's when I heard about Bowen. but my body couldn't keep up with the demands of my practice. and do it without burning out. Add it to your practice with as little as 4 days or call: 1-866-DoBowen (362-6936) Massage Therapy Canada • spring 2011 17 .. . I loved my profession. help more people. I was beginning to physically burn out. be a more effective therapist and.Christine After only 4 years as a massage therapist. oh yeah. I added Bowen First to TM my modality to help me preserve my body. Bowen reboots the body by stimulating the autonomic nervous system.I wanted to grow my massage practice.. Register at Bowen College today and reboot your world! For CEU’s and Special Offers for Massage Therapists go to: bowencollege. triple my income.

During each session. I was I’ve begun to reclaim the things I enjoyed in life before my apprehensive about how my body would cope with yet anoth. er form of treatment. lack of knowledge or concern can be taken to help clients feel informed and comfortable about about public opinion. that some of their sexuality been compromised. the process of receiving a therapeutic treatment. contact. When I was referred to Registered Massage swim with my kids while on our recent family vacation. Surgery had left me with limited mobility been restored to nearly 90 per cent. After only two months. once per week for 1. stressful either for the client or the therapist. along with restricted movement in my neck and a ments after we have been through so much to battle the constant numbness and tingling in my hands. She is an vulnerability. and range of motion on my left side has weak and wounded. feeling vulnerable or uncomfortable with their bodies. When a client presents with an issue or an on using in their treatment. any worries I previously survivors. or adjacent structures of the body. chemo.5 hours. been interrupted. and may feel as though they have had minimal control over their APPROACh TO TREATMENT bodies. formation can be facilitated by some simple gestures. as I did. he took I just wanted to inform other survivors who are feeling extra measures with draping and positioning my body – this depressed and self-conscious. but I see this small gesture as an essential part ing and knowledge they provided. As soon as he started his it to get your active life back. These steps may patients. When this their symptoms or underlying cause of injury. I felt I had little cancer. however. for post-cancer rehabilitation. as they transition from feeling skills and treatment modalities in addition to a technique called depressed and withdrawn to outgoing and confident. bringing them to tears. For example. I find this engagement tech. can often be described as emotion- therapists and they will become more confident about treat. I do not attempt to verbally engage them. I suggest KNOWLEDGE IS CONFIDENCE providing a robe that allows for some coverage of sensitive areas I was first introduced to breast massage. focusing rassment regarding their changed appearance. but gentle. but you need to know that massage therapy is worth to lose from trying something new. the client specifically on indicators and health concerns for cancer does not get cold during this assessment phase. Perhaps. But with very limited rotation in my I know it is difficult to think of going for further treat- shoulder. I am grateful to the instructors I had for the train. I stop all skeletal. MOThER AND CANCER SURVIVOR Ms. edgeable and sensitive to cancer-related trauma. and to It is important to take your time in explaining the various steps providing a rationale for the choice of modalities and treatment and procedures that are involved and the techniques you plan techniques employed. many RMTs avoid treating this area. K sums up her experience with massage therapy and the His recommendations for self-treatment were easy to remember synergy that resulted: and fit into my lifestyle with ease. scar tissue has improved. movement and maintain a firm. ing to refer their patients to someone who is both knowl- stretch and therapeutic touch to ensure my comfort and ease. before they the issues surrounding it. that massage therapy allowed me to relax completely throughout the duration of treat- improved my life! Having undergone mastectomy. I reassure them that this is a natural reac- and ask to perform a clinical/orthopedic assessment. Many feel their lives have ing clients who require their expertise and knowledge. I find it nique helps to augment the rehabilitative treatment and is not helpful to create an environment that is comfortable and secure. as well as to doctors. surgeons and therapists look- held went out the window. ment. instructor and director Japanese. and The physical and emotional state of these women. During the treatment of scar tissue injury. Paul explained every movement. This about the extent of their injuries. I then ask if they would like to break for a moment. I’ve gone from someone who on my left side. those clients are typically Even though treatment of the breast tissue is within our regu. or con- When clients are referred to me after having undergone radia. muscular or neurological. decision making) back to the client. its pathology and while allowing you to perform your assessment.CMTO. This trans- Dynamic Angular Petrissage (DAP). I have witnessed the transformation of these courageous For my post-surgical rehabilitative treatments. and gives control (that is. and fearful lated scope of practice. I would recommend it to other assessment of my condition. then breast massage. Therapist. half kimono style of robe. passing this knowledge and training on to others by offering presentations at workshops and conferences. I use a clinical theory by Debra Curties. The cause could be happens. if we INITIAL CLIENT PRESENTATION maintain this cycle of knowledge. my therapy and radiation therapy.) This helps reduce feelings of at Sutherland-Chan school and teaching clinic. There are a few simple steps that is often due to lack of confidence. even combing the little hair I had left was a could barely comb her own hair to someone who can once again painful challenge. the massage may trigger emo- but also at related structures that may indirectly contribute to tions that overwhelm clients. As well. tion or chemotherapy for breast cancer. or a combination of the three. Most clients are able to resume LETTER FROM A WIFE. 18 Massage Therapy Canada • spring 2011 . Assessment is vital to confirming your hypothesis. in just a few months. (Personally. it is necessary to look not only at the area of referred pain.cancer diagnosis. tinue the treatment another day. I am also interested in of building trust in the relationship. Paul Lewis. you are able to practice as a massage therapist. reinforces the feeling of security and reduces embar- advocate of breast massage and women’s health. tion. seem unnecessary. When clients Therefore best practice is to go beyond the standard health history regain their composure. ally fragile and physically exhausted. at the beginning of the palpation and physical assessment. my body was feeling foreign. I use a variety of women. will become less intimidating for start their massage treatments.

Paul Lewis.paullewis. I have discovered how critical it is that each client’s treatment plan is unique to her set of circumstances. augmentation. so that they are effective and realistic for the client to use in her particular is important to provide an environment that is secure and comfortable. INDIVIDUALIZED ASSESSMENT AND TREATMENT In my experience of having worked with individuals who have undergone a biopsy. For more details visit www. This requires personalizing the assessment information. treatment. reduction or transverse rectus abdominis myocutaneous (TRAM). and gives control for decision making back to them. and will be presenting at various conferences and teaching engagements in Canada. In my experience. for many of the women this emotional release is part of the healing process. the author will discuss in detail self- care exercises for post-operative patients who have undergone breast procedures. as well as treatment approaches he uses and the rationale for techniques and modalities utilized. In Part 2 of the article. Massage Therapy Canada • spring 2011 19 . practises out of his clinic in Mississauga. single or double mastectomy.These patients may feel vulnerable and compromised -. It will appear in the Summer 2011 issue of Massage Therapy Canada. I accomplish this by using various modalities – this combination contributes to the overall result. Europe and the United States (CEUS). as well as any self-care exercises prescribed to the client.

functional acupuncture model. the CCAA is international. Dr. Interdisciplinary Conference on Medical Acupuncture T he Canadian Contemporary taught at the McMaster Contemporary Acupuncture Association Medical Acupuncture Program. and Dr. Mike for this event. This unique professional Canadian experts will include Dr. which already has several hun. McMaster Medical Acupuncture Program and proponents of the neurofunctional This exciting event will see the cul- since 1998 (known as Contemporary acupuncture model has already been mination of almost a decade and a Medical Acupuncture for Health secured. Mike Contemporary Medical Acupuncture Contemporary Acupuncture Association Cummings from England. David Salanki. For more information. interdisciplinary association is devoted to Elorriaga. graduates of the original Participation of prominent educators Chris O’Connor. and RMT www. Claudio Couto from Ohson. or to register the dissemination of the very successful a list of chiropractors including Dr. Program devoted to the expansion and (CCAA).News International. 20 Massage Therapy Canada • spring 2011 . (CCAA) has announced its first As part of these efforts.” Two years ago. Dr. among them Dr.contemporaryacupuncture. interdisciplinary organizing an international meeting titled meeting to be held in Niagara “Contemporary Acupuncture Integration Falls from May 3-6. integration of a 100 per cent neuro- dred members. 2012. into Today’s Health Care. Thomas half of hard work by the McMaster Professionals). Dr. please visit contemporary neurofunctional model Prebeg and Dr. formed the Canadian Lundeberg from Sweden. Fargas-Babjak.

through NaHSSA each year. Ask about it today! Priority code: MTC Massage Therapy Canada • spring 2011 21 . dietetics. please visit http://www. Massage Therapists Select Developer CRANIOSACRAL THERAPY #1 Technique to Learn CranioSacral Therapy 1 Anchorage. the University of improve the patient and health-care provider /win • An international network of professionals to help you grow professionally and Proud Member personally of International Alliance of • Full range of educational materials to Healthcare Educators support your classroom experience 1-800-233-5880 • www. ON Sep 8-11 Edmonton.nahssa.News System Transformation by Canada's Future Health Leaders C anadian students from every health-care dis. This year’s conference. chiropractic. BC Jun 6-10 • Light-touch techniques that are easy on Upledger Celebrates 25 Years! your body Win a FREE CranioSacral Therapy 1 workshop! Register online www. NaHSSA was the first interprofessional sional patient-centred care.upledger. John E. and many more health-care disciplines. bringing to improve education and health care continue to network together students from occupational therapy. Students who are driven Each year NaHSSA holds an annual conference. medicine. Established in 2005. AK May 19-22 Isn’t it time you discover the benefits Edmonton.” said Toronto. and Luciano Di Loreto. Sciences Students’ Association or NaHSSA. rehabilitation sciences. Upledger. uniprofessional patient care to one that focuses on interprofes. BC May 26-29 *New! Upledger’s CST Core-Pak. and rep- how improved collaboration and teamwork in resented the participants’ growing awareness that cross-cultural health care could improve health outcomes for diversity management in health care is extremely relevant to all Canadians. AB Sep 22-25 of Upledger CranioSacral Therapy? SomatoEmotional Release 1 • Effective new skills to enable you to Toronto. AB Sep 22-25 • Enhanced credentials to help you Advanced CranioSacral Therapy 1 broaden your practice Vancouver.” student association in the world. tory therapy. ON May 26-29 Ottawa. and Memorial Chiropractic College (CMCC). included a workshop for student-run clin- Students’ Association and recent graduate of the Canadian ics. ON May 26-29 address a wide variety of health issues Edmonton. To learn more about NaHSSA. AB Sep 22-25 CranioSacral Therapy 2 Now for just $100* per month! Anchorage. The event was a meeting of the National Health today’s professionals. president of the National Health Sciences Ryerson University. Canadian Naturopathic College of Medicine. we are passionate pete to provide an interprofessional plan of care based on an about shifting the health-care system from one that focuses on assigned case study. an interprofessional problem-based learning session. the National Health Care Team Challenge where teams com- “As Canada’s future health-care providers. Dr. The theme cipline gathered in Toronto the weekend of of the 7th annual conference was Crossing the Bridges of March 12-13 to strategize and share ideas on Socioeconomic and Cultural Diversity in Healthcare. AK May 14-17 Vancouver. nursing. a joint venture hosted by the “NaHSSA was built on the belief that collaboration can Canadian Memorial Chiropractic College.

which alters sodium. Part 2 of this article features an interview with Dr. loss of muscle bulk. an editorial. calcium and potassium balance. stress and pain. Leon Chaitow. a blog or a tweet written by Dr. consider evidence such as that offered by Issberner et al. Gerwin et al. massage any insights into the potential impact of acidic pH on the soft. is thought to result in. is an internationally renowned lecturer and prolific author of health-care-related books. The role of pH in local soft tissue dysfunction and pain 22 Massage Therapy Canada • spring 2011 . when acidity increases. muscle damage) seems to be sufficient to cause profound And this (acidosis) influences what is known as NMDA receptor changes in the threshold sensitivity of pain receptors. clinical osteo. tissues/fascia of the body? lc: This is a very complex area of human physiology that has (1996). MTc: One of the cornerstones of naturopathic medicine is nutrition. (2004) have suggested that an acidic pH al. porosis. stress and pain to support his view that massage ther- apy can. play a beneficial role in the treatment of stress. tory precursors such as bradykinin and helps to explain the Acidosis also increases during pregnancy. breathing. can result in what is known as respiratory alkalosis. Balancing the body’s pH (by addressing nutritional practices as well as other factors) is one of the first issues most naturopathic doctors will address. articles and journal publications. Chaitow. An acidic pH also stimulates the production of inflamma- tion and an increased tendency to epileptic episodes (Yuan 2006). an article. pain associated with active myofascial trigger points. who will explain. Chaitow. rMT Understanding Stress – Part 2 An interview with Dr. can you share with us Given the interaction between pH. would not be painful is perceived to be painful by age. indeed. not only has been linked to cancer but to other issues as well. that a stimulus – say manual pressure – that. an ardent advocate of massage therapy. One effect of acido. who showed a positive correlation between pain not been fully studied. An acidic milieu alone (without Western diet is thought to produce a low-grade systemic acidosis.Feature by CaTherine ryan. According to Li and Fidler 2000. so function. diminished growth hormone secre. Chaitow. breathing. which if already dysfunction. for Massage Therapy Canada magazine. under normal This low-grade metabolic acidosis. You’d be hard pressed to find a manual therapist who hasn’t read a book. Leon Chaitow T he name Chaitow is pretty much a household word amongst manual therapists! Dr. which is a charac- It’s against that general background that we should teristic of myofascial trigger points. the interaction between pH. What we do know is that the modern levels and local acidity. indeed. formation of the taut band phenomenon. among other things. which is directly involved in sarcomere contraction that leads to has effects I’ll try to explain briefly later (Levitsky 1995). which is often found in solid neoplasms. editor of The Journal of Body Work and Movement Therapies. Dr. therapy can. sis is an increased breathing rate. play a beneficial role in the treatment of stress. induced by diet and amplified conditions. an acidic environment or acidic pH.

norepi. The • Heightened pain sensitivity shorthand for all this is sympathetic arousal. and when these are • Increased risk of osteoporosis constricted this causes a narrowing of these “tubes” with a • Loss of muscle bulk range of effects. this. Think of the fight/flight response to any alarm situa- tion. more recent research. chronic. The formula is in place for a range of general and • Increased tendency of hyperventilation and local changes that include one of the main effects of respira. where areas of local myofascial trigger points ischaemia are likely to evolve. has tion appropriately. broblasts) are also present in fascia – providing fascia with sion. 2004). that revealed significant differences in which helps eliminate carbonic acid (via carbon dioxide in the levels of pH (as well as substance P. Eighty per cent of neurological disturbances such as altered motor control. tissues/fascia)? An additional note here.has been further confirmed by a recent histological study systemic acidosis. hEALTh ISSUES ASSOCIATED WITh ACIDIC Ph sure. respiratory alkalosis (resulting in increased incidence tory alkalosis. increased blood pres. Suffice it to say that “stress” commonly identified that smooth muscle cells (in the form of myofi- results in. and. 2005). and the automatic adaptive responses of the body that follow. leading to muscle fatigue. with MTc: “Stressed out” seems to have become an all too effects that include tendencies to cramping. in a state of relative increased degeneration Massage Therapy Canada • spring 2011 23 . including faster heart rate. and with the repercussions on • Increased incidence of active myofascial trigger local tissue pH I’ve already touched on. the breath). smooth muscle constriction. calcium and potassium levels blood. • Increased incidence of chronic muscle and breathing. Chaitow. feelings of anxiety and apprehen. as part of these processes. this tions. The result of that is a disturbed calcium level. Smooth muscles of muscle cramping and altered motor control) surround the gut and blood vessels. there is likely to be a chronic state of over. including reduced delivery of oxygenated • Altered sodium. more rapid breathing and increased muscle tone. and this can result in widespread (respiratory) myofascial tension alkalosis. the kidneys start to excrete bicarbonate to balance fascial trigger points. points Equally. compared with normal individuals. subsequently. turbed breathing patterns. For • Increased risk of atherosclerosis and arterial wall example. ischaemia. with more or less • Increased sarcomere contraction – associated with permanently heightened muscle tone. … the soft. as well as familiar mantra in our modern culture. or aggravates. bradykinin. can you share with us any insights on has direct effects on the soft tissues of the body (Chaitow the impact of stress on pH (and. forth at the International Fascia Research Congress. brought lc: A book would be necessary to answer this ques. as alkalosis emerges. and as already indicated. (Shah et al. there will be an increase in breathing rate. Dr. • Increased tendency to epileptic episodes It’s important to remember that the self-regulating fea. The bottom line is that stress can lead to a variety of (Gallup poll – 2000) The World Health Organization has changes that involve pH. as mentioned. and the pain • Diminished growth hormone production and other modifications I mentioned earlier. and that certainly involve dis- now identified job-related stress to be at epidemic propor. This involves • Increased production of inflammatory precursors a chronic state of affairs developing. workers polled reported that they feel stressed on the job. if over-breathing is nephrine and other substances) in people with active myo. • Increased risk of certain forms of cancer tures of the body kick in.

such as that produced by over-breathing. Hastreite et al. Ryan is the managing and commissioning editor for TouchU. quality and commitment of BC’s registered Chaitow to support his reponses to the interview questions. MTc: At the First International Fascia Research Congress (FRC). the rib-cage and the thoracic scientific attention. was in fact a ThE FIRST INTERNATIONAL FASCIA functional. dence. British chaitow. visit www. and an extensive postgraduate training My website. “It is because the importance of fas. intercostal muscles.bc. Ida P. some free downloadable articles. as well as to assist in freeing the structures that different kinds of tissues that are involved in musculosk. is in recognition of the For the author’s or as a subject matter expert. She is available to teach work- shops and can be reached at: cryanrmt@gmail. as well as references used by Dr. involved the fact that people who have lax ligaments.” Although there is an extensive ders that can be addressed by manual therapists? body of research on connective tissue. one of the questions you put forth to the panel of scientists pertained to breathing pattern disorders in relation to ligament lax- ity. in Vancouver. region in general. Manual therapists can free the structures that do the breathing as What I wanted to know from researchers was whether there well as teach simple. My hope is that researchers will explore this further. cia has been underrated over the last 30 years. are more prone to hyperventilation (the extreme of over-breathing – Martin-Santos et al. the study of fascia lc: Manual therapists are uniquely placed to recognize the and its function as an organ of support has been largely signs of over-breathing and to teach simple. The selection of the MTABC by the please massage therapists (RMTs). that the The issues have been amply covered in a book I coauthored Boston 2007 conference was a necessary step in address. CMTO’s provincial licensing examinations. that is. Current fascia research implies that myofibroblasts (like other smooth muscle cells) are regulated by the SNS. effective retraining methods for over-breathing. with physiotherapist Diana Bradley and psychologist Chris ing that neglect” – Serge Graceovetsky.). com or excellence. since before and after the main proceedings are also planned! 1990. vasoconstricting substances and neurotransmitters (Schleip 2003). visit www. national conferences dedicated to the newly emerging MTc: What are a few key aspects of breathing pattern disor- field of “Fascia Studies. www. etc. plus details of the book and a tors of the Fascia Research Congress. The background to the question I posed. a project of the direct link to Amazon if anyone wishes to purchase it. examiner and examiner trainer at the www. Gilbert: Multidisciplinary Approaches to Breathing Pattern The Third International Fascia Research Congress is Disorders (Churchill Livingstone 2002). 1998. A further aspect of the background to the question relates to the increasing knowledge we have that smooth-muscle-like cells are seeded throughout the fascial structures of the body (Ahluwalia 2001. Bulbena et al 1993). yet effective. accessory eletal dynamics. to assist in RESEARCh CONGRESS “tightening” lax ligaments? The First International Fascia Research Congress in The answer that emerged was that as yet there is no such evi- Boston (2007) inaugurated a continuing series of inter. possibly physiologically useful.” during remodelling following trauma. PhD. The 2012 Fascia Research Congress will centre on the latest in fascia research and relating the research findings Cathy Ryan has maintained a diverse.the ability to actively contract or regulate “intrafascial” tension (Staubesand & Li 1996). has more information on this vast topic.massagetherapycanada. She is a long-standing member of the OMTA and has served For more information. apparently to provide “architectural support. strategy. 2001). retrain- neglected and overlooked for many years.massagetherapy. lc: My question to research scientists at the Fascia Congress related to the observation that smooth muscle cells also constrict in an alkaline treatment-oriented massage to clinical issues and practical applications. 2012. Workshops therapy practice. was evidence that the increased tendency for these cells to con- strict in an alkaline environment might suggest that the over- breathing exhibited by hypermobile individuals. Rolf Research Foundation. as well as Columbia. who are hypermobile.leon- scheduled for March 28-30. fascia has received comparatively little breathing muscles ( which pro- vides education for touch professionals. students and the public. Would you expand on any of your insights (already noted) with regard to the impact of altered pH on the soft tissues/fascia. Among the ing methods. 24 Massage Therapy Canada • spring 2011 . do the breathing: the diaphragm.

It makes the review for a while. supervisors are thrilled that every- green that most clinics would not One half hour before clinic begins. and a supervi. organizers worried would become cohort of patients.” in. she says. if. but we have sor needing access to the files for the paper charts. and meeting with “That’s the best part of our story. Our eight-drawer were American. but not that single binder!” guidelines. notes relating to treatments and the credenzas have now been reduced to form to provincial governing body patient’s medical history. “We done just that. One small filing cabinet quickly became two huge credenzas taking up a large amount of space.” corrupt and crash. That ously sought out software for chart.” clinic receptionist enters the informa. it was the the evening and a notebook computer. Access to the patient files was another chal- lenge because we have between 10 and 18 student therapists needing Students of the Ontario College of Health and Technology massage therapy program are the patient information at the same pleased with the results of "going green. When new patients arrive. we seemed to be overwhelmed with folders. area. as well as environmentally SOAP Vault offers two portals. so it will certainly work access to the patient files in order to Vault. Logan states that feedback from onto computers by disks that clinic “After trying SOAP Vault on a the students has been wonderful. single page is then shredded and the ing but every option seemed to be tion to only a select few. pletely green and eliminate all of people all the time. others were to be loaded personal contact information. Some programs therapists can see all of the previous cally into a binder. News Student massage therapy clinic goes green T he Ontario College of Health and Technology stu- dent massage therapy clinic announces its shift to green practices. fewer therapists involved!” Massage Therapy Canada • spring 2011 25 . we decided to go com. solution to this mounting administrative one and a therapist so that the students have access to it problem. of the student files faster and more wisest route to pursue. director of academics at the college. “The students and the them fill out a single-page patient ‘go for it!’ The web-based option clinic supervisor can all just log onto information sheet. the review the patients they have coming “My advice to clinics wanting to secure web-based charting program. To this end. we have make a green change like we did is says Logan. “we had no idea how quickly patient charts would accumulate. As well. The for a smaller practice situation with add their treatment notes. The students love evaluation. in fact. printed off the works in our very complicated envi- the SOAP Vault website and have initial patient intake form on SOAP ronment.” “Then we found SOAP Vault. Although annually we would shred any files of patients who had not returned. and didn’t con. the students are given a schedule for professional. and the challenges during the shift to going books that all had wireless capability.” notes Logan. The administrative level gives before the appointment begins. and sign a consent form. an tion into her computer immediately friendly. with great success. the clinic foresaw many purchased 12 inexpensive tablet note. the clarity of the program. thing documented is legible and have to worry about and wondered. “When we started the Ontario College of Health and Technology student Massage Therapy Clinic five years ago.” says Mary Ellen Logan.” The college wanted to find a more practical. so they can log on to the website and efficient. it had previ. full access to all patient informa. while the signed consent form is filed alphabeti- the wrong solution." time for every appointment. “It’s hard to please all the up to 50 therapists.

yet effortless. Finally. lMT. I received 15 hours of reflexology training within my program. Second. it was exhausting for my thumbs. digestive problems. stimulate nerve endings and all the organs I could remember from the reflexology map. the In response to these factors. too fragile. they are protocol for foot treatments. Although my program did not offer enough training to diagnose such things – nor qualify me to include “reflexologist” on my business card – I did come to know that I could give a great foot massage. The only problem was that all this work was done with my thumbs. There had to be an easier way to do this work. I made a few adaptations to my thumbs are not adequate tools for performing massage. plantar fasciitis – I would diligently use my thumbs to break up the tension on the sole of the foot. and other physical ailments. The supine position allowed me no leverage to work the sole of a client’s foot. TOP: Glide forearm down the calf to the Achilles tendon. If a client came in with really tight feet – or worse. I’d heard stories. that reflexologists could diagnose headaches. It was during this training that I first witnessed maps that linked various body parts and organs to specific areas of the foot. Massage is a labour-intensive profession. RESPONDING TO TREATMENT AND PRACTITIONER ChALLENGES There were a few factors holding me back from giving effec. The key to lon- gevity is learning how to work smarter – meaning clients get the relief they are looking for while the practitioner uses as little energy as possible to fulfil this goal. I wasn’t complementing the foot work with I decided to have the client lie in the prone position so enough massage on the muscles of the calf that are attached to I could use my body weight to drop down onto the sole the bottom of the foot. foot treatment to my clients. I knew from massage school that one of the more common injuries among massage therapists is a thumb or thenar injury. In class. of the foot.Feature by shari auTh. laC Forearm Massage for the Feet Spare the thumb and still spoil the client I n massage school. I couldn’t use body weight to engage the sole 26 Massage Therapy Canada • spring 2011 . and turn tired and achy feet into light and happy ones. I traced across the sole of my partner’s foot while looking at reflexology maps. from people who had travelled in Asia. Although this was effective and felt good for the client. First was the ABOVE: Sink your body weight down between the heads of gastrocnemius. client’s positioning. I could work out “crystals” on the sole of the foot. in the long term. tive.

Be sure that your outside leg. is in front of you and the leg I had to push my thumbs horizontally into the sole of closest to the table is behind you. By using my body weight and forearms. work the plantar surface of the foot. including the feet. This took the work out of the job and was much easier on my thumbs. Using body weight to sink into tight tissue and of your torso to be open toward the area you’re working wait for a release takes little effort. It also addresses how to hold the rest of your body while using your forearms. instead. the gastrocnemius and the soleus. By using the forearms and practising good body mechanics. AUTh METhOD FOOT PROTOCOL A treatment protocol designed for the sole of the foot must include the muscles of the calf with tendons that attach to the sole – namely the tibialis anterior. RIGHT: Glide down the tibialis anterior with your forearm. This allows the front the foot. followed by the tibialis anterior. Because the forearms are more durable than the hands. The Auth Method is also designed to blend in with existing massage routines. MIDDLE: Glide your forearm down the tibialis anterior all the way to the front of the ankle. calf glide technique • Stand alongside your client’s calf in a lunge stance fac- ing down his/her leg. Continued on page 30 with practice. are just as sensitive – they are a bodyworker’s most prized tool. To begin. The Auth method allows the therapist to use the forearms to work the client’s entire body. of the foot with my client in the supine position. using muscular force to on – in this case. Tightness in these muscles can often contribute to tightness on the sole of the foot.LEFT: Glide your forearm from the top of the heel to the ball of the foot. then the sole of the foot. start by working the gastrocnemius. I could work out the bulk of the tension in the sole of the foot and polish off the toes with my hands while the client was in the supine position. These concepts of efficacy and efficiency led me to design the Auth Method of Forearm Massage with the health of the practitioner’s body in mind. contacting the entire surface area of the sole of the foot. the practi- tioner can work longer with less wear and tear on his/her body. and then fin- ish by polishing the foot with your hands and integrating in your existing foot massage routine. leg farthest from the table. Your front foot and your I also began using my forearms instead of my thumbs to client’s ankle should be in line with each other. the calf muscle. the Massage Therapy Canada • spring 2011 27 . • Bend your front knee slightly. fingers. or thumbs – and. engage the tissue takes a lot more energy.

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tive. you • Glide your forearm down the tibialis anterior all the will sink into the next layer of tight tissue. but the sole of the – not the point of the elbow. To contact Shari or learn more about her on the inner and outer arches of the foot. • If there’s room. but also your client’s experience will be less painful and • For more leverage and a deeper stroke. patiently dropping your body weight the top of your client’s tibialis anterior. This stroke can rior and rest your other forearm on your client’s thigh. it is time to work the sole of the foot. lift your forearm off the foot creator of the Auth Method and has a full-time practice in New York and begin the stroke again. bend the knee of your front Forearm technique for the tibialis anterior leg. Glide down the tibialis anterior with your forearm (Image 5). this will move you down the client’s feet. Again. Position your upper forearm medially and laterally to glide down the belly of each head of closest to your client’s feet at the top of the tibialis ante- the gastrocnemius all the way to the Achilles. visit www. methodically. DVD titled Auth Method of Therapeutic Massage: • Patiently work layer by layer. This allows me to give my own feet a rest FOR ThE FINER ThINGS while working. If you’re sitting been released. connected to ing the deep work is done and you have reserved your hands for the Earth. • Position your upper forearm (this includes your elbow Foot massage is a favourite among clients. you can integrate your usual foot routine. Use your hands to pol- • Take the hand farthest from your client and position it ish off the toes and work the top and sides of the foot. Repeat this stroke as necessary. be done with or without a bolster. • As you glide down the leg. The tibialis anterior’s tendon • Glide your forearm down the calf to the Achilles tendon. or reposition your forearm Keep your back straight. drop into your client’s tissue. is certified in the Rolf method of structural integration. but the continuation of foot is used to withstanding a lot of pressure. Auth teaches continuing education workshops and offers a to wait for releases in tight areas of the foot. stimulate under your client’s ankle for support. Remember. • Repeat this stroke on both sides and as many times as not only will the massage work you do be thorough and effec. points or do soothing strokes. Big jobs require big • Glide your forearm from the top of the heel to the ball of onto the first layer of tight tissue. stand alongside more enjoyable. • Place the upper forearm closest to your client at the top • After you’ve thoroughly massaged the sole of the foot.authmethod. it is the bending of the knee that takes you forward Forearm work on the tibialis anterior can be done with in the stroke. stabilizing with your other hand. waiting for releases in the tissue. and repeat. slowing down as necessary City. of the arch of the foot. know- on the table. facing his/her head. visit www. ankle and the other is at the level of your client’s hips. your client’s left ankle and your right upper forearm at Work layer by layer. Co-ordinating the bending of the knee height of your client. either forearm. stand either alongside the table by with the stroke integrates the movement within your his/her feet. As that layer releases.Continued from page 27 any areas that need special attention. stance so that one foot is at the level of your client’s ent’s body – it will tell you how fast and how deep to go. Spread your our clients. Reposition your forearm medially and later. To increase the intensity. your client turn over to the supine position and begin • Take your other hand and place it under the ankle. so tension in the tibialis sinking your body weight down between the heads of can contribute to tension in the arch of the foot. Depending on the tibialis anterior. Work patiently and way to the front of the ankle (Image 4). Using your forearms instead of your thumbs and practising the foot. it can take a lot of pressure. drop more of your body weight down onto the foot. the foot can be deep and difficult to release. ally to get different angles on the sole of the foot. just below the popliteal fossa. She is the • At the end of the stroke.shariauth. keep one foot on the ground. spreads along the arch of the foot. working the tibialis anterior. bend the knee that is • Reposition yourself so you are standing down by your closest to your client’s feet. I like to put one hip on the table. and tension in the forearm) at the top of your client’s heel. focusing com. If the client is taller than the table. there will not be room for CONSERVING YOUR hANDS you to sit. but something we do with them. the foot supports your Shari Auth is a licensed massage therapist and acupuncturist. contacting the entire surface area of the sole of good body mechanics will contribute to your career longevity and the foot (Image 3). needed. workshop information. massage is labour-intensive. resulting in better body mechanics. waiting for releases in the A Guide to Using the Forearms. • At the end of the stroke. Listen to your cli. so Now that the bulk of the tension from the plantar surface has conserve your own energy when possible. massage isn’t something we do to the table at the level of your client’s knee. lighten your pressure and glide up • Stand by your client’s feet with your left hand under the inner calf back up to the top of the calf. and client’s entire weight. Remember. as well as on practice. Angle your forearm with the contours a happier you. 30 Massage Therapy Canada • spring 2011 . or at the bottom corner of the table. own body. doing your fine-tuning work on the feet. the gastrocnemius (Images 1 and 2). • As you glide down the tibialis. For DVD and plantar fascia. depending on your position. Position your torso so that you are hovering Forearm technique for the sole of the foot over the leg and can effectively use your body weight to After working the muscles and fascia of the back of the calf. By doing this. have of the gastrocnemius.

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