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The Importance Of Curriculum Change For Massage Therapy

When I graduated from massage therapy school in 2005 I had already completed my bachelor of science and felt very comfortable in my knowledge and abilities to become a great therapist.  

It became very evident to me over the ensuing years that there was a lot more I needed to know and understand in order to more effectively treat complex problems, particularly those who lived with persistent pain.

It was through the experience of seeing my wife struggle with disabling pain and realizing the treatments she was receiving from medical doctors and allied health care providers were inadequate.

Something was missing in how myself, and other health professionals were educated.  

The conceptual framework and understanding of the human pain experience and how we conduct our treatments appeared incomplete.

This quest for answers led me on a fantastic journey that completely changed how I view the body, the brain, and how I treat my patients.  Last February at the San Diego Pain Summit I was convinced that the path I was going on was the correct one.

Treating people in pain is what we do, and there is a much better way to do it than what we learn in school.  I felt inspired and realized one of the main problems with our profession is that there are not enough of us with advanced degrees to lead the profession towards the changes it needs.

I decided that in order to help advance our profession I couldn’t sit on the sidelines, I would need to be involved and pursued more education.  In September I started my Masters in rehabilitation sciences at the University of BC.

Already, in a short period of time I feel I have gained invaluable tools for critiquing research, finding and utilizing evidence for practice and critical thinking skills.  These skills need to be fundamental to all health-care professionals.

Changes are necessary for us to evolve.

National Standards For Massage Therapists

The profession of massage therapy in Canada (particularly in British Columbia), has a long history of being leaders in its curriculum, standards of education and licensure that can exceed our colleagues in other parts of the world.

There is a strong desire among our membership in BC to increase our education to that of a baccalaureate program.  Our professional association, the RMTBC has completed great work in attempting to make this happen.  Ideally, it would be great if all education for massage therapists was standardized regardless of what province or state you were educated in, much like it is for physical therapists, nurses, pharmacists, opticians, and medical doctors.

Currently in Canada the regulated provinces are working on a national standard of competencies.  

I applaud their attempts in pioneering this endeavour as it could provide a framework that other massage therapy regulatory bodies throughout the world could follow.  However, the lack of quality research used to support the development of the competencies is embarrassingly evident.

As a regulated health-care profession, the educational curriculum and practice standards of massage therapy need to be based on strong scientific principles and good quality relevant research.  In order to make informed practice decisions and incorporate an evidence-based approach to treatment planning the educational standards of RMT’s must be recreated.

As it currently stands, the Interjurisdictional Competency Document and its companion, the Guidelines for Foundational Knowledge in Massage Therapy Educational Programs, which together form the framework of what is taught in the massage therapy colleges and creates the material for what is required to pass board exams, are both regrettably unacceptable as documents around which an entire profession’s competencies are created.

Creating A Greater Understanding Of Massage Therapy

What is wrong with this document and what is a fundamental problem in our profession?

The primary faults I see is the research on the actual mechanisms of manual therapy are ignored and an inadequate understanding of pain and its bio-psycho-social components are missing.

Unfortunately, manual therapy professions base their treatment models and understanding of pain and dysfunction through out-dated biomedical beliefs, structuralism and connective tissues modalities.  There is a better direction to go, we simply need to follow the science.

Manual techniques exhibit the majority of their effects based on mechanoreceptor input from the skin, not the muscles or fascia.  

The words we use, how we interact with our patients and the explanations we give are more important than any miraculous technique that we learn.  This short article provides a great discussion of the need to move beyond our techniques.

All positive or negative changes our patients have in their pain perception or movements are from alterations in their nervous system.  Nervous tissue is the only tissue in the body that can adapt and change quickly within the confines of a treatment session.

Once a therapist realizes that every effect we have is through the nervous system, primarily the brain, massage therapy becomes much more simplified, more powerful as a therapeutic tool and prevents unnecessary and unrealistic treatment plans that do not serve the best interests of the patient.

Research has shown that connective tissue cannot be altered for any length of time through manual techniques, and we shouldn’t want to alter it anyway.  Here are a couple great articles worth the read that refutes fascia’s importance, here and here.  I could post numerous links to all the research, but these two sum it up succinctly.

Trigger points, another sacred doctrine of massage therapy are likely not a problem in muscle tissue, more plausibly it is referred pain from peripheral nerves.  Posture and biomechanics are not always as important as we think they are either, here is a free full text pdf available worth the read.  

These links are not meant to completely invalidate other ways of thinking.  

They are to identify the science and other opinions in the manual therapy field.  As a profession we need to be more open-minded and become science-based clinicians, and not continue to base our curriculum and practices on historical beliefs.  This is still possible while not forgetting the art of what it is we do.

https://flic.kr/p/bN15Tk

Photo by: BU Interactive News

Three Pillars Of Massage Therapy

The three pillars that guide our profession as outlined by our regulatory Colleges is safe, effective and ethical health care.

By purposely neglecting the wealth of evidence on manual therapy mechanisms we are failing on all three pillars.  This purposeful neglect is unforgivable with the wealth of modern science on pain, fascia, biomechanics and the mechanisms of manual therapy.

By focusing on out-dated beliefs and a biomedical structuralist approach to care, and furthering the pseudoscientific beliefs about fascia, trigger points, cranio-sacral therapy, visceral manipulation, postural asymmetries and adhesions to name a few, we are supporting unsafe, unethical and ineffective practices.  

Our profession needs to move towards an evidence-based model that includes plausible scientific principles of manual therapy.

We do not need to make up stories to explain what we are doing.  Touch is therapeutic, massage and movement is analgesic.  These effects occur because of our interaction with another person’s nervous system.

By adopting a curriculum that includes biopsychosocial approaches to pain management, peripheral and central mechanisms of pain, understanding nonspecific treatment effects, motor control, graded exposure to movement, principles of patient centred care and the pillars of an evidence based practice, we would be much better suited to provide safe, effective and ethical care.  

Those approaches are much more supported by science and encourage a feeling of security, robustness and self-efficacy that can elicit more consistent results and better patient outcomes.

The problem with overcoming this dilemma is the belief systems are so ingrained in the profession.  Too much of what we do is based on faith and not on fact.  Changing the profession will require great force of will and continuous efforts, because it is an entire culture that will need to adapt and change.  

From the top down, national massage therapy organizations, provincial regulatory Colleges’, massage therapy educator’s, current RMT’s, and students will need to adjust.

Changing Massage Therapist Focus

We are so focused on our modalities and learning new techniques to add to our toolbox, that we lose focus on what really matters.

Our profession has made the care we provide more complex than it needs to be.  

If we could focus on having a solid foundation in the core sciences, learn how to interpret research, critically think, and learn advanced skills to more effectively interact and educate patients we would be significantly farther in our progression as a useful component of the health care system.

Patient centred care and evidence-based practices should be the foundation of what we learn in our education.  Assessment and manual skills are important and these skills will always be central to our profession.  RMT’s can still historically do what we have always done, but the time is here for us to adapt and reinvent ourselves.  The regulatory Colleges, professional associations, all the private colleges and most importantly the massage therapists have roles to play in this process and a desire from each organization or individual to implement change is needed for our profession to become leaders in manual therapy education. Change is constant, it is not to be feared, and it needs to be embraced, as change is necessary for the long-term survival and relevancy of our profession.

Visit Somasimple.com, Body in Mind at http://www.bodyinmind.org, the NOI Group at http://noijam.com, www.greglehman.ca, or go on Facebook and interact with clinicians from Skeptical Massage Therapists, Biopsychosocial therapists, Explaining Pain Science or Dermoneuromodualtion among many others and you will find great debate, discussion and heaps of research to sift through that will quickly get you questioning your current practice and beliefs.

Ethics Violation, or Communication Breakdown?

This year I wrapped up five years of service on the North Carolina Board of Massage & Bodywork Therapy. Anyone who has ever sat on a board will probably agree with me that disciplinary hearings involving massage therapists are one of the most stressful parts of that job. It was for me. I estimate that during my time on the Board, I had to sit through approximately fifty of them. It was very distressing to see my fellow massage therapists trying to defend themselves–and in a few cases, just outright admitting to the violation–whenever they were accused of something.

Nine times out of ten, the accusation was of a sexual nature. 99 times out of 100, it involved a male therapist. I’m dead certain there are female therapists out there performing sexual favors every day, but most men won’t come forward to complain about it. Go figure.

My question to myself at those hearings was always this: “Did this person have an intent to do something evil, or was this a communication breakdown or simple mistake that could have happened to you or me?”

If you’ve been practicing longer than a year or two, the chances are good that in spite of your best efforts, you have accidentally exposed a body part. Or you have said something that the instant it left your mouth, you thought “why did I say that?” The very first massage I ever gave, I accidentally touched the man’s penis. I went to tuck in the drape, and all I can say is there it was. He was supine on the table, his eyes were closed, and when my hand grazed it, I saw his eyebrows shoot up. I said “I’m sorry,” and carried on. If I had made a big deal out of it, I could have just made it worse than what it was.

If your only intent is to give a therapeutic massage, then your major obligation is not just about giving the massage; it is clear and direct client communication. This has come home to me again and again, and most recently when one of my friends was accused of a sexual violation. The case has not been settled yet; it hasn’t even been to court, but he has been crucified in the press and by a number of bloggers–none of whom were present in the room and have no idea what truly happened there, but I’ve been watching what amounts to a feeding frenzy by a bunch of sharks who are determined to hang him from the highest tree. He is apparently guilty until proven innocent. And since no one was in the room except for him and the alleged victim, I am fearful of the outcome. Of course I do not want a sexual predator turned loose on the public. But after a career that has spanned about 30 years with no previous complaints, it’s a shame to see that going down the tubes. He has loyal clients who are still patronizing him (including women), but what do you think the chances are of him getting any new ones while this is going on? Zilch.

You can’t be too careful. Let’s be realistic. Most massage tables are set up so that the table is at about crotch-level. That’s a fact. We lean over people. We use our body weight on people. Some therapists get on the table with people. In my younger, skinnier days, I’ve crawled up on the table when someone was prone. I’ve done pelvic work on people of both sexes. I’ve done pectoral work on people of both sexes. I’ve worked on the gluts of both sexes. If you’re performing medical massage, you’re going to find the need to touch those areas–with the client’s informed consent.

Think for a moment about the muscles that originate on the pelvis. If you want to make the belly of a muscle relax, you need to make the origin and insertion relax. That’s just the way it is. If you’re ignoring the origin and insertion, you might be giving a relaxing massage, but you’re not getting to the root of the problem. However, if you abruptly touch someone’s pelvic bone without discussing that with them beforehand, you’re the next disciplinary hearing waiting to happen.The general public doesn’t know squat about origins, insertions, and actions of muscles. It’s up to you to educate them. And it’s up to you to abide by their comfort level. If they prefer not to have their gluts worked on or you getting near their pubic bone, then you don’t do it, period. I have found it helpful to have a muscle flip chart in the treatment room. That allows me to pick it up while someone is on the table and show them the muscle, where it begins, and where it ends. It’s a professional thing, to me.

There is also no excuse for careless draping. The law in my state says that “the drape may be temporarily moved in order to accommodate treatment.” Yours probably says something similar–or not. Working through the drape may not be ideal, but if that’s the law in a your state, then I suggest you abide by it. Don’t expose more than you need to expose, and don’t leave it exposed. If you have moved the drape in order to work on the gluts, that doesn’t give you license to perform the whole massage with someone’s butt shining. Get it done and cover them up.

Be aware of the comments you make. It’s okay to tell someone they have taut bands or active trigger points in the gluts. It is not okay to tell someone they have a tight ass. You might be thinking it, but keep your mouth shut.

You may think you’re all above-board as a therapist and that you’re never going to be accused of anything. Guess what–all those people who have been accused didn’t expect it to happen to them, either. Two things that did become apparent to me during my years on the Board…one, there are indeed predators out there who decided this profession would be a good place to meet a fresh crop of victims, and two, there are just therapists out there who are guilty–of failure to communicate. Don’t let it be you.

Originally published December 31, 2011

Emergency Action Planning For Sport Massage Therapists

I felt like a deer in the headlights when she asked me.

“Can I get a copy of your Emergency Plan to give to the other team’s trainer?”

My what?

“Your Emergency Plan, you’re supposed to have one ready, or on file before each game to give to the other trainer.”

I had NO idea.

I had volunteered with the team for the previous five years and had never heard of this. However this time I was the head trainer, which came with a whole group of responsibilities I didn’t yet know about.

Part of the league rules were that each team head trainer had to have an Emergency Plan in place in the event that a player was badly injured and needed medical attention beyond what we could provide.

I had yet to do my first road trip and receive one of these documents from another trainer.

All I could do was apologize and promise to have one ready for the next game.

I felt like an idiot.

Massage Therapists As Part Of The Team Within A Team

Even though I felt like an idiot, I was fortunate.

I’ve had to do this kind of thing before and have some experience with it.

There is more to this than just printing up a document. It designates you as a leader, a professional, an expert and a damn good communicator.

When it comes to working in sport, your athletes are your responsibility, but there are times when trainers of opposing teams must work together (actually most of the time it’s important to work together).

I won’t go so far as to speak for other sports (although I’d assume it’s much the same), but in hockey the trainers are almost like their own little team, within the teams. On road trips, it’s not uncommon to forget equipment and have to borrow tools or get help with injuries from the other team’s medical staff. There are constant favors being done back and forth to help each other, whether it’s laundry, equipment trades or holding coaches back from attacking each other (yes it happens).

The same applies when someone is hurt in a game. While your athletes are your responsibility, if they get hurt bad enough that you have to go out on the field, ice or playing surface to help, everyone is on edge.

If the trainer puts their fist up into the air, that’s typically the signal they need more help. At this point, what team you’re on doesn’t matter, it’s all about THAT athletes safety. When it’s done right, it can be seamless, when it’s done wrong it can be a complete cluster…well you know.

There has to be one person in charge and it’s not a time to start second guessing things. When the trainers are working together as a team, in the best interest of the athlete, there can’t be any ego’s. If the athlete is on the other trainers team, they have started first aid protocols before you get there and you may get assigned a somewhat menial task.

If all you are asked to do is call 9-1-1 or go and direct paramedics to the scene, that’s all you need to do.

Why You Need To Develop An EAP

The preparation for these kinds of emergencies starts long before the injury or the game even starts.

Making sure you have a well prepared Emergency Action Plan will give the proper steps to ensure a positive outcome for both trainers and athlete. Also making sure your medical equipment is in good working order and properly stocked prior to game time is crucial.

Like I mentioned before when it’s done properly it can be seamless almost like watching an orchestra of movement. The people who are really good at it, can direct with confidence, which in turn instills confidence in the people they are directing.

I’ve been fortunate to watch several people who excel at it and watch how seamlessly they can direct people to do what they need while still tending to injuries and dealing with a patient.

Being able to direct one person to help deal with injuries, one to lead paramedics in and others to get extra equipment doesn’t come naturally, or easily and it must be practiced.

Part of the reason why it’s important to develop an Emergency Action Plan is because of your knowledge of your environment. When teams come from other towns or cities they don’t have the intricate knowledge of the area like you do. Nor do they have the knowledge of the idiosyncracies of your building or area of play.

Every little thing you know that could possibly delay more advanced medical help arriving is crucial information to be able to share with the other trainer.

For instance:

  • Is there a preferred entrance for paramedics to use?
  • Is there a better entrance/exit to take the athlete away from the playing surface?
  • Are there gates or doors that would have to be unlocked for paramedics to gain access?
  • Where do you keep extra medical equipment stored?
  • Are there more staff/people on hand trained for medical emergencies that can help?
  • Is there an AED stored close by?
  • Where is the closest hospital or medical clinic?
  • Are there any slang names that are used for common areas of the building/sport area?

While these things might seem simple, to someone who isn’t familiar with the area, it can be crucial.

Having a face-to-face with the other trainer before game time to review your Emergency Action Plan is not only beneficial but can be life saving.

https://flic.kr/p/afL5Fn

Photo by: Jon Candy

Setting Up An Emergency Action Plan For Sport Massage Therapists

I’ll never forget the first time I was in command of an accident scene with the fire department.

I was beyond nervous.

On the way a senior officer was driving and giving me tips on what to do before we got there. But I had never been in command before and was totally unsure of myself.

Midway through the call, one of the chiefs arrived on scene. He calmly came up, grabbed me and pulled me out of the accident. We walked up a hill about 15 feet from the accident and he told me “here is where you need to start”.

His point was to take a deep breath, take a step back and look at the entire scene, not just the middle of it. Look at what things could possibly go wrong, take a broader view to make sure everything is safe.

Undoubtedly, you will be in the middle of the emergency if this is your scene. Before anything ever happens, take a step back. When you’re making up your Emergency Action Plan, try to envision everything that could possibly go wrong when your athlete has to be taken off the playing surface, or is seriously hurt on it. Anticipate as much as possible. While you will never be able to come up with everything, it’s a good start. If an emergency does happen and something you didn’t think of occurs, go back, review and update your EAP.

There are several things that need to be included on your Emergency Action Plan. Remember, this should be shared with the visiting trainer before game time:

  • Level of First Aid that is available during the game (team doctors, first responders, paramedics, and how many of each).
  • Location of any First Aid equipment and supplies (AED, spine board, clamshell).
  • How to get more help if needed (the fist in the air is fairly common).
  • How you will respond if needed.
  • Methods of transport if needed.
  • Any prearranged routes out of the area and to medical treatment (you can just copy and paste in a picture from google maps).
  • The role you want the trainer to follow.
  • The roles other team members will follow (ie: equipment managers, coaches)

If possible, make this a one page plan that can be handed off to anyone. You can make it as detailed or as simple as you want, but the above points should all be included. I’ve heard some trainers say theirs is a 4-5 page document. It’s fine if you want to be that detailed, but in an emergency situation, it’s not practical to have to review something that long.

You can download the one I made up by clicking here, if you want to see a simple example of one.

Whether you’re the head trainer or there strictly as the team Massage Therapist, you should have a working knowledge of the EAP. If you’re not the head trainer, ask if you can review it and ask what role you can play if there is an emergency. More importantly ask if you can be part of a practice to make sure things run smoothly if you are going to be part of the emergency medical team. If you are the main medical person for a team, make sure you conduct a practice every once in a while to make sure all staff members are familiar with their role in the case of an emergency. Go back and review your EAP every once in awhile. Every year, equipment needs, First Responder protocols and athlete medical conditions will change. Make sure the EAP reflects everyone of those changes. Just try to avoid being like me and feeling like an idiot!

 

Using Your Massage Therapy Skills To Travel In Australia

Has one sentence ever changed your life?

One night, I stumbled across a single woman’s blog on conquering Australia.

She was easy to relate to, her fear and worries were so similar to mine. She calmed my inner fear as her blog resonated with me on a personal level. She was exactly right, “You’re either going to do it or you’re not”.

These little words strung together geared me up and I was moving to the land down under… Australia!

Alone!

My problem, was I didn’t find any support when I googled BC RMT traveling to Australia.

I knew I wasn’t walking on the moon, someone from Canada had surely already done this. I just couldn’t find them, and I felt alone in my search.

There was too much fear of the unknown! The only option I had was to get as much information as I could to alleviate any negative thoughts about starting my adventure.

There was a place called Magnetic Island and Townsville, Queensland that a friend and I had been conversing about for years. I felt a connection to Magnetic Island even before I even arrived.

My friend and I talked about these places so often that I naturally wanted to see them with my own eyes.

This was my first major overseas experience alone. Thankfully, Australia is a lot like Canada and both countries have a lot of similarities which helped the cultural transition.

The best part, I could chase summer all year round. As I thought about the white sandy beaches and clear turquoise water I knew this was something I really wanted to do.

Prior To Departure

For two years after my board exams, I started taking control of my finances by paying off lingering debt, saving, and also organizing my accounts.

I stopped commission rates at the clinic, paid a set monthly rental and took on my own third party accounts. This gave me control over daily and monthly expenses,  and by having a set rental cost I increased my treatment times without losing a percentage each hour.

I earned approximately $1500.00 more per month in doing this.

I had a vision for change and big goals in mind.

This motivated me to get out of town as fast as I could. With this vision, I sat down and put a plan into place to get all of my ducks in a row and make this happen.

These are some of the things I had to get figured out before I could go to Australia.

  • My Passport.
  • An Australian Working Holiday Visa.
  • Research Massage Therapy regulations.
  • Talk to the one person I knew & find a job.
  • Where to land & start?
  • Accommodations.
  • Banking & Taxes.

Ensure your passport will be valid for the duration of your trip. Get it renewed before you leave if it is going to expire while you’re abroad.

Before entry into Australia you need to have an Australian working holiday Visa.

There are multiple types of Visas and finding the right one can be confusing. Here is a rundown of the different types:

  • Working Visas should not be confused with a Working Holiday Visa. There are two types of Working Holiday Visas: 417 and 462.
  • The Working Holiday Visa is based on your passport. Because I am a resident of Canada I applied for the Working Holiday Visa 417.
  • Working Holiday Visa 462 is for passport holders in countries; Argentina, Bangladesh, Chile, Indonesia, Malaysia, Poland, Portugal, Spain, Thailand, Turkey, USA, Uruguay. Only USA passport holders can apply online for this this visa.

To be eligible for a Working Holiday Visa 417 you:

  • Must be at least 18, but not yet 31 years of age.
  • Do not have a dependent child accompanying you at any time during your stay in Australia.
  • Have a passport from an eligible country.
  • Your partner can accompany you to Australia, but they will need to apply for their own visa.

This Visa allows you to:

  • Stay in Australia for up to 12 months.
  • Work in Australia for up to six months with each employer.
  • Study for up to four months.
  • Leave and re-enter Australia any number of times while the visa is valid.

Approx. Fee : $420.00 AUD

Walk to work in Australia

Massage Therapy In Australia

This PDF file will provide you with the information you need to know about scope of practice, types of massage, education standards, continuing professional development and health fund provider recognition. It is an easy read, but lengthy.

Helpful Translations:

Health FundA benefit plan or extended health plan

Health Fund ProviderA person that is reliable to provide treatment for reimbursement to health fund, this person has “provider status”

RemedialTherapeutic style treatment

RTORegistered Training Organization

RPLRecognition of Prior Learning

There are three nationally recognized Massage Therapy qualifications.

Certificate IV

  • Competent to perform general health maintenance, can be associated with Spa Therapists.

Diploma Remedial

  • Competent to perform treatments involving specific remedial techniques to alleviate common musculoskeletal presentations such as low back pain.

Advanced Diploma Levels

  • Competent to treat complex musculoskeletal presentations with a more extensive range of treatment protocols.

Both Diploma & Advance Diploma:

There are two Massage Therapy Associations, Australian Massage Therapy (AMT) and Australian Association Massage Therapy (AAMT). Both offer classified ads and advertisements for work on their site, so it can also be a good starting point in looking for jobs.

If you’re not sure what your training is like compared to the Massage Therapy training in Australia, there are two schools that I looked at,  Evolve college and NSW School of Massage, they can give you an idea of what Australian tuition and schedules look like.

Tuition range from $7,000 to $11,000 AUS Dollars.

Duration of study is dependent on courses; average 20 weeks – 2 yrs.

Australian Provider Status and Liability Insurance For Massage Therapists

To gain provider status valid for a health fund Australians must have:

  • Certification from RTO.
  • 100 Continuing Education points per year, which roughly equates to around 20 hours or three days per annum.
  • Membership to a professional organization/association such as ATM & AAMT.

Applying for provider status in Australia takes some organizing. This checklist will help you understand what is required, and you can download the word document here to print off if you need it:

? Have your qualification overviewed.

  • This is called Recognition of Prior Learning (RPL). A Registered Training Organization (RTO) does a review of this.

? Provide your transcripts to RTO

  • Include units studied and hours to each unit.

The RTO will compare all the information against the Australian Qualification.

? Provide current resume and include:

? Qualifications

? Work experience

? Letters of endorsement from clients & other professionals to enhance your opportunity.

? Hold Australian First Aid certificate and knowledge of Australia’s Occupational Health & Safety legislation.  

  • Remedial Diploma requires Senior/Level 2 First Aid.
  • HLTFA301B/C – Use this code when searching for the appropriate course information.
  • Check in with your first aid certificate to see if it is internationally recognized. You may have to get your certificate compared to the Australian standards.
  • This is a one or two day course, approx. $110.00-$200.00 AUD.
  • Make sure your First Aid Course is approved by your RTO and is appropriate for the state you chose to live in .

? Set up an interview with the RTO

  • all the evidence you supply must be verifiable.

? Ultimately you will be awarded the current qualification

  • HLT50307 Diploma in Remedial Massage.

There are costs involved and vary from College to College / RTO

There is a list of RTO’s on the AAMT website.

Whether you plan on getting a provider number for Australia or not, you’ll need Liability Insurance. Some companies may provide it, but most require you have it already. This company is commonly used for insurance coverage in Australia, www.aon.com.au.

Finding A Massage Therapy Job In Australia

Before I left Canada I knew one person in Australia.

Luckily my friend on Magnetic Island was neighbours with the owner of Massage on Magnetic. We emailed each other and I had confirmed a Massage Therapy job before I landed in Australia.

I stayed with Massage on Magnetic for five glorious weeks. I had 47 weeks left in Australia and I was on the search for a new job.

Two sites that were helpful in searching for job postings were seek.com.au and gumtree.com.au.

I had not written a resume in over 10 years.  Preparing a couple of resumes before you leave will be helpful, preferably one resume for Massage and one for another skill set if available.

  • Is your email appropriate and professional?
  • Can you get a personalized email? ie: info@yourname.com
  • Use and have an Australian phone number that works.
  • Make electronic copies of your college transcript, RMT diploma, continuing education and first aid, these are excellent additions to your resume.
  • Why should they pick you?
  • What makes you unique and stand out?
  • Get a few testimonials together.
  • Prove your experience don’t just state it.
  • Use a comparison profile. List what they require from you and specifically how you do that. This can be in addition to your resume and should change or be modified to suit each employer’s requirements.

Be persistent in applying for a job and do not get discouraged! If you are not responded to right away do not take it personally.

Businesses in Australia are bombarded by hundreds of emails responding to job postings. A lot of those emails are from struggling backpackers and travelers looking for part time work.

Working In A Spa vs A Clinical Setting.

Spas can be more accommodating if you do not have a provider number for Australia. I found numerous postings available for spa practitioners, especially in tourist areas.

If you desire a clinic setting, it will be valuable to gain provider status. Large cities and multidisciplinary clinics are looking health fund providers.

Either way, pick an area you would like to live and work in (search this area on seek.com.au and see what positions are available) and then create a resume at home that will appeal to an Australian Spa or Clinic Owner/Employer and email it to them.

From seek.com.au I found a rocking job out on the Great Barrier Reef as a Massage Therapist.

Massage Therapy On The Great Barrier Reef

While searching seek.com.au I came across a posting by Calm Experience. This was a massage therapy company that was owned by by Intuitive Massage located in Airlie Beach, Queensland.

In conjunction with Cruise Whitsundays, the local ferry system, Calm Experience is contracted to provide Massage treatments on Reefworld.

Reefworld is a permanently located pontoon that sits adjacent to the coral reef walls of Hardy Reef. This pontoon is accessible by Cruise Whitsundays for day and overnight tours. The pontoon itself is home to the Harmony Hut (where Massages are given), the dive centre, snorkelling equipment, underwater semi-submersible sub and underwater viewing chamber.

It was an excellent tour to see nature at its finest. You could spot turtles, humpback whales during migration, reef sharks, hundreds of fish, dolphins and of course Nemo.

Watching this video will help you to understand the Reefworld Tour.

I was persistent in applying for this position.

It took four emails before I received a reply. I called three times and I didn’t stop until we spoke on the phone.  My persistence paid off as I landed this job during my first telephone conversation.

The whole team would arrive by 7:30am to prepare Seaflight; the guests would arrive on board at 8:00am sharp.

Seaflight is a 37m vessel ideally suited for outer reef cruising, each tour started with a short announcement of activities available at Reefworld. Announcing my Massage Therapy skills to a boat full of international strangers was the last thing I thought I would be doing in Australia, so I was a little nervous at first but eventually it was a stress free routine.

My accent seemed to work in my favour.

I was often the only Canadian and my ‘slow’ accent made it easier for people to hear. My approach was:

  • Practice my script each morning on the walk to work
  • Address the audience with a clear and precise message of the Massages I offered.
  • Review, reflect and re-write as needed.
  • Be the first on the microphone.
  • Described my uniform, all black, I was easily found.
  • Speak in an enthusiastic tone.
  • Leave the audience with a call of action and urgency.

“Book your appointment now. I have a limited amount of time and I do not want you to miss out.”

Aside from this small presentation that took only minutes of my day my duties were to:

  • Prepare seated chair massage with fresh towels & face pieces.
  • Book appointments for my day, after my announcement.
  • Provide seated chair massage on Seaflight, to & from Reefworld.
  • Provide Table treatments at Reefworld, 4 hours available.
  • Record daily sales with payment.
  • Return used linens to main office once back at shore.
  • Help provided memorable experience for guest.
  • Work as a team member.

I was paid on commission which relied on my ability to connect with passengers and close a sale. Marketing myself on Seaflight pushed me out of my comfort zone so far I felt like I was going to fall overboard.

I came from a healthy practice where in house referrals fuelled my success.

This job spoke volumes on how much I relied on others for referrals, so this was my time to learn how to market myself and successfully gain clients.

My daily sales ranged from $200-470.00 AUD, minus commission. Averaging $800-1000/week. I made more money in Canada but I was travelling, not making my fortunes; I was just fortunate enough to be there.

I earned a good living, built community support around me, saved money and moved onward to travel the East Coast for nearly three months without working.

This was success for me.

Alicia at the Reef

Reflections Of My Massage Therapy Jobs In Australia

I honestly didn’t need a provider number for the two places I worked at.

I chose to live in tourism based places where having a provider number did not separate me from another, my resume and education stood for itself.

If you choose to not have a provider number, get your insurance and start applying to spas and vacation destination places. You might get paid a little less, but the scenery will most likely make up for it.

If you want a provider number for a health fund it shouldn’t be too difficult, especially now that you are informed.

This would be an excellent advantage if you chose to live in a larger city. If you were planning on staying for a long period of time in cities such as Melbourne, Sydney, Gold Coast, Sunshine Coast and Brisbane you would have a greater chance of finding work with a provider number.

Be mindful when applying for jobs as a Massage Therapist in larger cities, be aware of job postings with bad verbiage, late working hours and low fees. This is not to scare you off, only to inform you.

I went to a job interview in Melbourne that never mentioned it was above a pawnshop (not that there is anything wrong with that, BUT… let’s just say they were surprised I had a resume) the girl working there got her techniques off YouTube and if I was honest, I’m pretty sure it was for prostitution.

I thought, what was I doing?

I knew it was wrong and I left.

I had a little cry with a great friend who helped me overcome the situation and it was onward and upward from there.

I eventually had a really beautiful time in Melbourne, not to mention all the lovely friends I met, but also I worked for a family that owned a small children’s toy shop called, Saraghi.

This was where my other resume came into play.

My child care and reception skills made me the perfect candidate to help people purchase gifts for baby showers and birthday presents, it was cute, fun and I drank a lot of coffee.

Just to touch back on the Massage Therapy side of my life, I resisted the idea of a working at a spa in the beginning, I was a clinic-based practitioner. My patients were recovering from motor vehicle accidents, work related injuries and serious limitation issues. I resisted the idea of a spa and in the end working at them helped me find more love for massage. I was uplifted because people were on holidays and they were happy. Their energy transferred on to me, so I was happy too. There you have it… all the information you need to start your journey as a Massage Therapist in Australia. I am going to say to you now…there are no excuses and “you’re either going to do it or you’re not”. All the best, I believe you can achieve your dream and I am here when you need me. If you would like more information and useful links, click here. Now that you have decided you are going, Yippee!

Corrective Exercises For Scapular Winging That Every Massage Therapist Should Know

The frustration was getting to her.

Connie is a dedicated gym-goer with a 6-day/week workout routine.

She’s a personal trainer and yoga instructor, follows her own regiment religiously, never misses a day, and embodies the image that many women would kill for.

Connie’s struggle of late has been difficulty in getting better at wide-grip pull-ups.

She added assisted pull-ups to her weekly back and bicep workout, trying to see improvement.

The result:

FAIL! After four months, she was still stuck maxing out at four pull-ups, assisted! This raises a flag, we can assume she has a thorough understanding of muscular training adaptation to be able to structure her workouts and see the desired result.

This tells us there’s a glaring discrepancy somewhere in her body mechanics preventing her from achieving her goal which needs to be addressed, much like we’ll almost always see when treating clients for musculoskeletal injuries.

After hearing her complaints about the lack of progress being made, I took notice of her shoulder blades. If you saw them at the time, you would have seen her scapulae winging out during any shoulder retraction, cueing us to some kind of bio-mechanical error that needed to be addressed.

Shoulder Mechanics And Massage Therapy

With a working knowledge of anatomy and physiology, we know that the scapular muscles (most significantly the serratus anterior, but consisting of several other muscles of the shoulder girdle) are meant to stabilize the scapulothoracic joint.

These muscles should be active in maintaining the position of the scapula against the rib cage during posture and to control its movement during ranges of motion at the shoulder.

When those muscles get weak, we see this winging, causing a change in the total angle of the shoulder girdle and improper recruitment of larger muscles which are now attempting to compensate for the lack of stability.

If that sounds complicated, just know that if scapular muscles get weak, big shoulder muscles get overworked, shoulder strength and health deteriorate.

I see this problem arise quite often in individuals who follow traditional weight-lifting programs, whether it’s team-sport athletes, body-builders, or average-Joe’s. What’s happening is that the nature of your traditional weight-lifting routine (isolated exercises, weight-machines, supported shoulders against benches) remove the use of the small, stabilizing muscles from the equation.

High end body-builders who receive proper training subvert part of this problem by properly adding isolation of those smaller muscles into their routines, effectively strengthening the scapular stabilizers and preventing the winging of the shoulder blade that would ruin the aesthetic appearance they need.

However, these individuals are still prone to chronic shoulder injuries such as rotator cuff tendinopathies and biceps tendon impingement.

Why is that?

It’s because the strength of those muscles may be well-trained, but the stability is still lacking. (Note: This is a tendency, not a rule. Don’t hate.)

We see errors quite often in the clinical setting when it comes to retraining muscular stability.

In much the same way traditional weight lifters will train themselves, a therapist can easily get caught up in prescribing basic isolation exercises in either excessive amount or for too much time.

True, if there is severe weakness and inactivation of a particular muscle, then of course it needs to be targeted specifically at the start of a rehab plan. But as we progress an individual to the more advance stages of returning to function, synergistic muscular training is key.

We can’t expect proper shoulder mechanics (which requires stability provided from multiple smaller muscles working together) to arise from training each muscle separately and isolated through range of motion.

Exercise Recommendations To Use With Your Massage Therapy Patients

After realizing the large discrepancy in shoulder stability, I gave Connie two very simple exercises to do.

The first one was a scapular push. This one is hard to explain in written words, so take a look at the video below. This exercise was to be done daily for two sets of 10 reps per side.

The second exercise, the T-curl is an isolation one (as I mentioned is still often important as a supplement) for serratus anterior, one of the major stabilizers. This one was prescribed for 2-3 sets of 10 reps on Connie’s “pull” day at the gym.

Keeping the upper arm parallel to the floor and the entire limb in the frontal place, the cable is curled in with the palm flipping between every rep.

Connie did these two exercises, as instructed, for 8 weeks, without modification.

After four months, pre-intervention, of Connie barely being able to muster out four assisted pull-ups, she is now pushing towards ten reps, unassisted.

The results speak for themselves.

Big lats and biceps are only part of the equation; you need to take care of the small stuff as well. It’s important to not neglect the prime movers, but when attempting to retrain healthy movement, the foundational support needs to be considered first when prescribing exercise.

Exercise rehab like this is clearly vital in the clinical setting. However in Connie’s case, her condition was not yet pathological and causing pain. In the case of clinical clients, we’ll need a bit more intervention on the therapist’s side.

With individuals who have such severe scapular weakness, you’ll also typically find significant spasm and adhesion in those same muscles due to the body attempting to create stability any way it can. It’s also important to look at the antagonistic muscles to what we’re focusing on; in this example that would mean taking some time to work through the pectoralis muscles that, combined with the weak upper back, will likely contribute to a rounder shoulder and t-spine posture. Connie is going to continue her training using these interventions, possibly with some further modification, and I can confidently predict that her progress will not plateau any time soon. Luckily, we were able to target her weaknesses before they became pathological issues, but this won’t always be the case. However, whether or not your treatments in the clinic start with basic exercises or even Massage treatments alone to begin with, the progression that I did with Connie is an excellent example of late-stage rehab that we can use to get our clients above and beyond their pre-injury state.

Acute Quadricep Contusion Management For Massage Therapists

He was a little slow getting up.

An opposing player tripped him, he fell to his knees and slid into the boards.

I was following the rest of the play and the student working with me pointed out he was hurt.

Looking down at the end of the bench, he was standing and shifting his weight back and forth from leg to leg and was bearing weight on the leg no problem. The whistle blew, so he went out for a quick skate to test it while there was a stop in play.

When he came back to the bench he was wincing and gave me a look that said he wanted some help.

As we walked into the dressing room, he had a bit of a limp.

Once he sat down, I started taking his gear off and there wasn’t much of an issue pain wise.

There was some tenderness just above the knee cap and his range of motion was pretty good, a bit of pain with muscle testing and some minor swelling in the area. We pulled him from the game and had him ice the quadriceps.

After the game he came into the treatment room and asked what he should do that night? Since we had a game the next night, I advised him to ice the quad, elevate it and take some ibuprofen.

Then the discussion started.

The student I was working with thought it was better to get inflammation to the area rather than prevent it.

After we discussed it, we still decided to go with ice and anti-inflammatories.

Treatment for Acute Quadriceps Contusion

There has been so much debate over this for the last while, it’s no wonder there was some confusion for treatment protocol.

I think Paul Ingraham explained it better than I could with his article titled “The Great Ice vs Heat Confusion Debacle”.

We use ice as a treatment application to reduce pain with acute injuries as well as reduce inflammation. While there is much debate on whether to reduce inflammation, the body has a tendency to over do it, so in the acute stages (in order to manage pain and mobility) ice is a good thing.

As with any other injury, you want to make sure you do a thorough assessment to determine its severity.

If you’re working on the sidelines in sport, your assessment happens immediately on impact or collision that causes the contusion.

Running through a quick checklist in your head can help:

  • Was the collision severe enough to cause a fracture?
  • Can the player bear weight?
  • Did they need help to get off the ice or playing surface?
  • If they can bear weight, are they walking with a limp?
  • Are they able to bend the knee?

Once you get them into your treatment room, or away from play, your more concise assessment can start.

In the case of a Quad contusion, they are divided into three grades:

  • Grade I (mild)
    • Mild swelling and pain and able to walk without a limp.
    • Passive movement beyond 90° may cause pain.
    • A muscle test for knee extension may cause minimal discomfort.
  • Grade II (moderate)
    • Walks with a limp.
    • Can bend the knee between 45°-90°.
    • Swelling prevents full knee flexion.
  • Grade III (severe)
    • Progressive bleeding and swelling occur within 24 hours.
    • Swelling won’t allow knee flexion past 45°.
    • Flexing the quads is also painful or not possible.
    • They will need to see a doctor.

The easiest way to do this is just by having the person lay prone on your treatment table (if possible) and you’re essentially going to perform an Ely’s test.

Once they are face down on the table just passively flex the knee (within pain tolerance) as much as possible to see what grade you get. Anything past 90° is mild, anything less than 90° is moderate to severe, the person should not bear weight and should be given crutches.

In order to treat a mild contusion an application of ice while the knee is braced in full flexion (this can be done using a large tensor bandage), puts a stretch on the muscle and helps maintain range of motion but the bracing should not be done for extended periods of time because it can weaken the tissues. One study showed that bracing for 24 hours immediately after injury (in addition to stretching and strengthening exercises after brace removal) had people back to full athletic function in 3.5 days.

For the first day or two continue with ice and anti-inflammatories to keep the swelling down. Use passive and active range of motion to keep the surrounding joints moving as well as preventing tissue changes.

With any hip or thigh injury, if the person can’t bear weight (grade II or III) they should be sent for more advanced medical care.

https://flic.kr/p/5xd2TQ

Photo by: The US Army

 

Return To Play For Massage Therapists

Once past that initial 24-48 hours and swelling has started to go down you can look at getting your athlete involved in their sport again.

Massage Therapy treatments can start in addition to functional exercises. As long as the athlete can do the functional movements associated with their sport, pass all functional tests, and range of motion is within 10° of the other leg, they should be good to go.

In the case of a Grade I, this could be the next day, Grades II-III will take longer and if the athlete has been sent for more advanced medical care, their return to play should be coordinated with feedback from the doctor.

There are a couple of complications that should be ruled out with Grade II-III (possible compartment syndrome and myositis ossificans) and this requires a doctor’s care.

It will be rare to see an acute quadricep contusion in a clinical setting, but if you are interested in or are already working in sport, there is the potential to see this all the time. While there are many guidelines that can be used, good clinical reasoning on your part will be the best guideline for whether an athlete can return to play again. The player treated in this story was back on the ice and in the game the next night. Using some ice and anti-inflammatories helped manage his pain when he got home that night, so that he could get a decent sleep. The next day, the swelling had gone down, he was functioning well and we put a bit of extra padding in place for protection. Athletes are a bit of a different breed compared to the general population in cases like this, they will do whatever they can to get back in the game and sometimes to their own detriment. In his most recent book Ron MacLean tells a story about Trent McCleary, a former NHL player who repeatedly used his body to block shots which meant constant swollen and bruised ankles and knees, and the odd charley horse that took him out of a game or two. But he didn’t like to get out of the way because he thought that was putting himself ahead of the team. Besides, he was getting good at managing contusions with ice and flexing.