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What Is Really Contraindicated With Diabetes?

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A little while ago we wrote a piece on circulation and whether massage is actually moving fluids around and increasing circulation.

As it turns out, we aren’t increasing circulation the way we used to think was happening (you can read that post here if you like).

One thing that came up as a result of that post, was the question of whether we need to decrease the length of our strokes when giving a massage in certain conditions?

Looking back through my textbooks and notes from college, conditions like diabetes and hypertension were given similar contraindications. In fact with diabetes CI’s it was recommended that massage strokes are modified to short, segmental strokes to prevent large volumes of venous and lymphatic fluid return to the heart. It is also recommended that repetitive, passive large limb movements should be avoided as well.

So are these CI’s really necessary?

Stroke Length

When someone has diabetes and blood glucose is high for extended periods (years), then plaques can form in blood vessels causing damage and impaired blood flow to neighbouring cells. This is called Peripheral Arterial Disease (PAD).

This poor circulation can be one of the causes of peripheral neuropathy along with excess body weight and high blood pressure. 

One study showed that using massage therapy helped increase circulation in the lower limbs of type II diabetic patients with improvements in arterial pressure and greater skin blood flow. Fortunately the study acknowledged the parasympathetic nervous systems role. Indicating decrease in heart rate and a rise in oxygen saturation. This study was done to see if there were improvements in peripheral arterial disease and fortunately it showed that massage could help slow the disease progression. 

This study used very specific treatment patterns using both long and short strokes to the back and the lower limb of the patients. But notice they used both long and short strokes. 

As we learned in the post we did a little while ago, during a massage we aren’t increasing overall circulation anymore than the circulation increased by the person walking into your clinic. So how then would altering the length of your stroke make any difference?

I’d venture to say it doesn’t.

As far as passive large limb movements being CI’d, again there is no way it is altering circulation more than the effort it took to walk into the clinic. If professional athletes like Bobby Clarke and Max Domi can play hockey at the professional level while managing their diabetes, a passive limb movement during a massage isn’t going to cause much of an issue.

Centpacrr at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Ketoacidosis And Diaphragmatic Breathing

Ketoacidosis occurs in diabetics when their cells don’t get the glucose they need (due to a lack of insulin, or too much insulin resulting in low blood glucose), the body starts to burn fat as a replacement.

As this process develops, ketones can build up in the blood (ketones are an acid developed from burning fat) which then changes the pH balance in blood making the balance too low, where it becomes more acidic. This in turn sends a person into diabetic shock, which is a life threatening emergency. A person with diabetes can have this happen for three reasons:

  1. Missing a meal.
  2. Stress or sickness.
  3. Insulin reaction (low levels of insulin in the bloodstream).

We were told in college that diaphragmatic breathing was a contraindication for our diabetic patients as it could cause ketoacidosis. From the textbook we were taught “To compensate for a tendency towards acidosis, the person may need to breathe more rapidly. Diaphragmatic breathing may actually change insulin levels”.

Now, don’t get me wrong, I give full props to the authors of that text as there was lots of good instruction in it, but research has been updated since then.

According to diabetes.co.uk rapid breathing is a symptom of ketoacidosis, so this is typically occurring if the person hasn’t taken enough insulin. So yes, if the person is at the point of breathing rapidly we should not be giving them a massage as this is now becoming a medical emergency.

One study (1) actually showed that diaphragmatic breathing is an effective therapy for decreasing oxidative stress, improving blood sugar levels after eating, and improving glycemic parameters overall for those with type II diabetes.  

Another study (2) (done on people without diabetes) showed that diaphragmatic breathing decreased glycemia and increased insulin production after a meal (likely through activation of the PNS). The study suggests that even though it was done on athletes, it is worth looking at for the diabetic population because of the outcomes.

Now I know what you’re thinking, those two studies showed that diaphragmatic breathing altered insulin and blood sugar levels…isn’t that exactly what the text was talking about?

Well it is, but we were taught it was a contraindication. Studies are now recommending that the diabetic population should be using diaphragmatic breathing.

Our actual concern should be timing of food intake before someone with diabetes comes in for a treatment. If someone hasn’t eaten for three or four hours and comes in, their breathing patterns are not what is going to cause them to have a diabetic reaction, it’s the fact their blood sugar is already too low. There is nothing about the massage that is going to accelerate that anymore than if they were walking down the street or sitting on the couch at home. This is an important discussion to have with your patients who are dealing with diabetes and definitely one you should have. Once a proper management schedule is established, go ahead and move them passively, use diaphragmatic breathing and whatever length of stroke you like, they are all things that can help improve their condition.

I’d love to hear your thoughts on this in the comments below, especially if you know of any current research that says we shouldn’t do any of the things discussed in this post, cause maybe I just found the wrong research?

 

References:

  1. Hegde S, Adhikari P, Subbalakshmi N, Nandini M, Rao G, D’Souza V. Diaphragmatic breathing exercise as a therapeutic intervention for control of oxidative stress in type 2 diabetes mellitus. Complementary Therapies In Clinical Practice [serial on the Internet]. (2012, Aug), [cited May 1, 2017]; 18(3): 151-153. Available from: CINAHL Complete.
  2. Martarelli D, Cocchioni M, Scuri S, Pompei P. Diaphragmatic Breathing Reduces Postprandial Oxidative Stress. Journal Of Alternative & Complementary Medicine [serial on the Internet]. (2011, July), [cited May 1, 2017]; 17(7): 623-628. Available from: CINAHL Complete

Is Exercise Appropriate During Pregnancy?

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Pregnancy is supposed to be a time for joy, anticipation and new experiences.

But for a lot of moms it also comes with a lot of anxiety and questions. With all the blogs, articles and social media confusion, moms are forever wondering if they are doing the right thing. For women that like to exercise, they often wonder how much is too much, what’s safe and how they should modify their activity?

The good news is exercise is both safe and encouraged for most pregnant women!

Exercise Recommendations And Cautions

Unless a woman has certain high risk conditions (bleeding, cardiac issues, fetal growth restrictions) both The American Congress of Obstetricians and Gynecologists (ACOG) and Society of Obstetricians and Gynecology of Canada (SOGC) recommend daily exercise.

In 2015 ACOG published guidelines recommending pregnant women get 20-30 minutes of exercise daily. Exercise should be at a moderate intensity level, which means you should be slightly out of breath but still able to hold a conversation. Regular exercise maintains physical fitness, helps with weight management, reduces the risk for gestational diabetes in obese women, and enhances psychologic well-being. Furthermore, exercise in the year prior to conception decreases the risk for pre-eclampsia.

For a mom with an exercise program in place, she can continue to exercise with appropriate modifications. Women can continue walking, lifting weights, swimming and even running to a certain extent.

It is recommended to stop activities where mom may fall on the abdomen or something may hit the abdomen after the first trimester (such as racquetball). Other activities may just need modifications.

For example, if mom is a biker, she may want to consider no longer using pedal clips after the first trimester. Then if she loses her balance it is easy to place a foot down to avoid a fall. The safest option is to move indoors and ride on a trainer or stationary bike. Many women can continue to run as long as they listen to their body. Women may have to change the “goal” of their activity and focus on exercising to be active in pregnancy, not run/bike/walk for certain mileage or speed. It’s extremely important she listen to her body for signs of fatigue, pain, or changes in fetal movement.

Yoga and Pilates is often encouraged during pregnancy. Both have been found to decrease stress levels in moms, improve common pregnancy pain complaints, and improve effectiveness of breathing.

If a mom has been performing yoga or Pilates, little modification is needed. She may want to avoid inversion (head below hips) positions and large asymmetric movements (movements where legs are going in opposite directions). As the baby grows, having the hips above the head for prolonged time can put pressure down and potentially disrupt normal blood flow and breathing patterns. Most moms that have been practicing Pilates and Yoga can tolerate these positions for short time periods without issues. If a mom experiences dizziness, shortness of breath or a headache, it’s recommended she stop these positions. If new to Pilates or Yoga, she should take a class specific to pregnancy with a trained instructor and consider starting with an individualized session or two.

Photo by: seandreilinger

Photo by: seandreilinger

Setting Up New Habits

Many moms use pregnancy as the time to start new healthy habits. We love that!

For moms starting a new exercise routine, walking is generally the safest cardiovascular activity. Light free weights or machines are a great way to start strengthening. Strengthening should focus on the muscles of the arms, upper back and leg muscles. Balance may be affected by pregnancy but strengthening and exercise is a great way to decrease fall risk. So the take home message is don’t be afraid to have your patients keep moving during pregnancy! If a mom is unsure how to start a routine or modify her routine, this is where you can help. If exercise prescription isn’t in your scope of practice, refer her to someone qualified to set up a program. Exercise has many benefits to mom and baby, so keep moving!

 

References:

ACOG Committee Opinion No. 267. Exercise during pregnancy and the postpartum period. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;99:171-173.

Artal R, O’Toole, M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003; 37: 6-12.

Barakat R, Pelaez M, Montejo R, Luaces M, Zakynthinaki M. Exercise during pregnancy improves maternal health perception: a randomized controlled trial. American Journal Of Obstetrics & Gynecology May 2011;204(5):402.e1-7

Beddoe A, Yang C, Kennedy H, Weiss S, Lee K. The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing. May 2009;38(3):310-319.

Dempsey J, Butler C, Williams MA. No need for a pregnant pause: physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia. Exerc Sport Sci Rev. 2005 July;33(3):141-149

Moran-Perich S, Benson E. Power Pilates: Empowering Your Pregnancy. 2004 June.

Deconstructing Magical Thinking

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Most of us have had the experience that somehow we “knew” something that we did not have specific prior knowledge of. It’s tempting to start indulging in magical thinking but the science-minded therapist knows that’s not how it works. So how does it happen? One obvious answer is pure coincidence. Another less obvious answer is unconscious learning.

Todd Hargrove wrote one of my favorite articles on the subject, “Why Massage is Like Chicken Sexing.” In it he describes how unconscious learning can lead us to believe in magical thinking. I’d never really thought about it but he had a good point.

In fact, I came to realize that probably most of our learning is unconscious. We learn to talk by being immersed in language and, little by little, learning to decipher what is being said by those around us without applying conscious effort. While our parents may try to help us learn to walk, the fine points of balance and running and adapting to varying terrain are learned by experience rather than specific attention to them.

The placement of buildings and trees in our environment is something we may not purposely attend to but our brain is still taking in this information. If something in our environment changes it catches our eye, even though we may not have paid much attention before.

Intuition Vs. Experiential Knowledge

About five or six years into my professional life I reached an uncomfortable plateau.

Until then, it seemed I was constantly learning new things, always progressing, but I started to feel as if I were stagnating, even going backwards. One day, while giving a massage to a more experienced massage therapist I voiced this. She said to me, “You must be learning something because you keep stopping in all the right places.” I had no idea I was doing this.

It occurred to me that my brain, through my hands, must have been picking up subtle cues that my conscious mind did not notice.

Years later there were other experiences, one with a competitive skier. About ten minutes into a massage he commented that he could tell I was very experienced. I asked him exactly what made him say that since I was just warming up and not yet doing anything specific. He he told me, “I can feel you adjusting and changing your pressure in the places that are tight and sore.” Again, I did not realize I was doing this.

The occasion that particularly stood out was with a dancer. He was the oldest member of his dance troupe and had been with them the longest. He was taciturn and clearly tired. I asked him how he felt. “Tired. Sore. Too much jumping,” he said in his Slavic accent. He pointed to a few places and lay down on the table. As I was massaging the back of his upper leg, I felt something that got my attention and the thought popped into my mind, “Old injury.” I’m cautious about what I say to athletes and performing artists prior to their performance, I don’t want to undermine their confidence in any way. Although I would never say it anyway, one should never say, “Wow! You’re really tight!” shortly before a performer is going onstage. I asked him, rather casually and neutrally, “How does this feel?” “Hurts,” he said, then added that he’d pulled a hamstring jumping. “When was that?” I asked. “Two years ago.” Wow, I thought, did I nail that or what?

Of course, it doesn’t always work like that but it was a cool moment. Later, when I told another massage therapist about it, they asked, “How did you know that?” I started thinking, exactly how did I know? Intuition? But what is intuition? Is it some sort of magic or is there a plausible explanation for it?

Then an answer came to me: my hands have been on thousands of bodies for tens of thousands of hours in varying states of injury and pain and no pain. Without my conscious awareness, my brain is paying attention at every moment. There is a large body of experiential knowledge. Probably something felt similar to other old hamstring injuries I’d felt many, many times before.

Or maybe it was pure coincidence.

Photo by: StockSnap

Unconscious Learning And Accumulated Massage Experience

Unconscious learning probably plays a much larger role in our lives than we realize.

Is this any less awesome than thinking some sort of magic is at play? I don’t think so. It’s incredible that our brain can do that and very useful, too. If we had to put conscious effort into every single thing we learned, we wouldn’t learn very much at all.

All of these intuitive moments came about as a result of years of accumulated experience. In the beginning, sometimes someone more experienced would palpate something and point it out to me. “Here, feel this?” I would have no idea what I was supposed to feel. I had no body of experience (or enough experience of bodies) that allowed me to interpret what I was palpating. It’s important for beginning massage therapists to understand this and not become frustrated if they feel lost. It’s also important that one should not be overeager to jump to conclusions prematurely.

Too often, massage therapists are quite certain they feel things that are simply a product of their imagination, what has been called “palpatory pareidolia.” (Pareidolia is seeing patterns where none exist, such as seeing a face in a rock or a horse in a cloud.) Palpatory pareidolia can lead a therapist to pathologize normal tissues, causing unnecessary worry to the client or making themselves look ill-informed.

We want to avoid making assumptions so they don’t get in the way of seeing what is, rather than what we imagine. We want to be fully open to the client as they are, not as what we project onto them. However, as we gain many hours of experience with many, many clients, we can develop a kind of knowledge which we think of as intuitive that is probably a result of many years of unconscious learning.

In practice, when an idea comes from that intuitive place, I always check with the client, asking in a neutral manner so as not to alarm them or lead them to an answer. After all, I could easily be wrong.

The next time you have a moment where you seem to sense something without knowing why, take a few minutes to think about what past experiences or cues may have led to that. It may not be immediately apparent, but if you contemplate it for awhile you may get some clues. It will help you appreciate the role unconscious learning plays in your life. Pretty amazing, isn’t it?

Why Massage Is Like Chicken Sexing

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I’ve written before on my blog about how manual therapists can develop some very questionable ideas about exactly how they are helping their clients. Like thinking they can manipulate energy fields, chakras, chi or cerebral spinal fluid patterns. Interestingly, my own observation is that many therapists who believe the craziest things actually get some pretty good results! How could this happen? How could they get good results without knowing how they do it?

There are probably very many good explanations. I thought of a new one while reading an excellent book called Incognito, by neuroscientist David Eagleman.

The theme of the book is that most of the activity of the brain is completely inaccessible to our consciousness. The brain is thinking and solving problems all the time, and our conscious selves basically have no control over these processes or even knowledge of them. We become aware of answers to problems long after our subconscious brain has been working them out.

The conscious brain is like a CEO who is handed a final product that has been slaved over by thousands of workers for years. The CEO might have provided some general guidance for the basic process (and might even take all the credit afterwards) but he or she knew nothing about 99% of the actual work that went into making the product.

So when problems are being solved and things are being figured out, the conscious brain is often the last to know. Which brings me to the topic of chicken sexing.

CHICKEN SEXING

When chicks are born, farmers often want to figure out which ones will be someday be laying eggs and which should be fattened for meat. Deciding whether a chick is male or female is much harder to do than you might imagine, because chicks are more androgenous than a 1980s pop star. So farmers hire special employees called chicken sexers to determine who’s a boy and who’s a girl.

The interesting thing is that many of the world’s best chicken sexers seem to have no real idea at all how they make the call. They just pick up a chick, look at its butt, then decide that it’s either male or female. When its time to train a new chicken sexer, they don’t give the trainee a procedure to follow or a set of criteria. They just tell the trainee to look at the chick’s butt, ask them to make the call, and then tell them if they are right or wrong. Sooner or later the trainee learns to make reliable decisions, but never develops any conscious understanding of how they do it.

CARD PICKING

Similar principles can be seen in a more controlled and scientific environment. In one interesting study, volunteers were asked to pick a card from one of two decks. Some cards were “good” and provided monetary rewards while others were “bad” and caused losses. Further, one deck contained more bad cards then the other. The question for researchers was: when would the players learn which deck to pick from?

It took players about twenty five draws before they stated a preference for one deck over the other. But their unconscious brains figured things out much quicker. How do we know? Because the researchers monitored physiological data from the players’ skin to determine the state of their autonomic nervous systems (the “fight or flight” system.) After as few as thirteen picks, players were showing some anticipatory fear prior to choosing a card from the bad deck. In other words, they were already getting an accurate idea about which deck was bad, before they had any conscious awareness of having that knowledge.

BACK RUBBING

I think that many massage therapists are kind of like chicken sexers. Their unconscious brains figure out what makes clients feel better without ever gaining any conscious awareness of how they do it.

A massage therapist needs to make many decisions every minute. Where do you push, how hard, at what angle, at what frequency, for how long, and with what part of your body? Many therapists will deny that they have any specific criteria for answering these questions, or even that they consciously consider them at all. They just start working and their hands seem to have a mind of their own.

And if you ask them what they are doing, they might not be able to give any kind of specific explanation. Whenever I asked my Rolfing teachers what they were doing when they were giving a demonstration, they usually said something like: “I’m having a conversation with the shoulder”; or “I’m listening to the hip” or something similarly ambiguous. They really didn’t know exactly what they were doing or why. But they were definitely doing something right, because when they put their hands on you, you knew right away they were experts.

CONSCIOUS INCOMPETENCE

The lack of conscious awareness over the actual methods used in a massage session might have some advantages. When you are learning a new skill, you need some level of conscious attention to perform the skill. But once you get good at it, the unconscious takes control, and at this point, too much conscious involvement can hurt performance. This is why you can sabotage your skills with too much self conscious analysis. Imagine trying to hit a pressure putt in golf while thinking about whether you breathe out at the point of contact.

This reminds me that Ida Rolf (the creator of Rolfing) and Moshe Feldenkrais, (the creator of the Feldenkrais method) each recommended that their students avoid an analytical mindset during sessions. Rolf sometimes admonished students that they were too “in their head.” Feldenkrais stated that in order to be optimally effective during a session, he had to think as much as possible in terms of creative imagery as opposed to formal logic. Even though both Rolf and Feldenkrais were trained scientists, and each proposed scientific explanations for why their methods worked, each wanted to get as far as possible from their scientific and analytical minds during a session.

I think part of what they were doing was making sure that their unconscious brains were in charge of the session, because most of the knowledge of “what works” was stored there, inaccessible to the conscious brain. They didn’t want their conscious minds to interfere with the process.

I think this goes along way towards explaining why many therapists seem to have no idea why their therapy works, why they are attracted to explanations which are magical as opposed to scientific, and why some are even hostile to very idea of applying science to massage at all.

To put it another way, I think that it is in the large gap between knowledge and awareness that magical thinking creeps in.

Critical Thinking And Planning Your CECs

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I’m coming up on my 15th year as a physical therapist.  It’s hard to believe, as I still feel so young and I still have so much to learn!  

Over the years, I’ve spent many weekends in courses, trying to become a better physical therapist. Earlier in my career, I would walk in, wide-eyed and hopeful that I was going to learn the ‘one thing’ that I was missing from my skill set…another tool for my toolkit.

Over the years, I’d like to think I was more helpful than harmful , but I don’t have any data to support that.  I can recall smooshing on ‘trigger points’, trying to release very specific muscles, and giving ridiculously long home programs. I followed protocols, and made a very organized binder of Muscle Energy Techniques.

I would often go home a bit tired, because I spent the day trying to figure out what I was doing wrong, trying to figure out why some people got better and some didn’t. I spent lots of time, energy, and money hoping my next class would be the one where I’d walk out with the skills that would let me help more people.

Then I started hanging out with Sandy Hilton. And reading more research. And talking about what we know vs. what we do vs. what we say we’re doing with researchers and clinicians from all over the world.

It was discussions like these that really made me reconsider how I was looking at continuing education.

How To Start Critically Thinking About Your Continuing Education.

Below is a list of four methods I like to use when picking my next CEC. While it can be tough making these choices at the start, it has been a really beneficial way to start changing my outlook and my practice for the better.

1. Look for courses that teach you principles, not protocols.

  • Recipes are wonderful when you’re baking. However, people are not all the same. Trying to make everyone fit the same box results in lots of  ‘non-responders’ or ‘non-compliance’

2. Look for instructors who don’t mind being questioned, and question them.

  • It’s often said that if you’d really like to learn about something, teach about it. I believe this is true, and it’s not just the research to teach a topic! I learn so much from people asking me questions, or asking me to further clarify something I’ve said. None of us know everything, so instructors who rely on people just following instruction are actually just looking for followers. Which takes us to the next point…

3. Question what you’re doing and why!

  • Sometimes it pays to act like a three year old: ask why, a lot. To yourself or out loud. Or a slightly more mature approach that I learned from Sandy Hilton is, “can you walk me through that?”. There should be answers as to why people do what they do. There can be discussions as to why what they are doing may work. You should be able to discuss, defend or explain what you’re doing.

4. Choose courses that challenge your beliefs.

  • Having people agree with you can feel fantastic! But if you constantly surround yourself with people who agree with you, it’s not likely you’ll come to have a deeper or broader understanding of much. Move out of that comfort zone, and at least consider alternatives to your usual way of doing things.

 

Photo by: qimono

A New Perspective

Any class or lecture I was attending was no longer a quest for an answer, but rather gathering more information to review and question my current practice.  

I embraced that I could walk out of a class and think ‘Nope, I’m not going to do that’. The most wonderful part about realizing I was allowed to critically think about why I was choosing to do (or not do) things in the clinic. I realized I was allowed to respectfully disagree and question ideas. I finally realized that there were no magic answers, and the best we can do is strive to be less wrong.

It was so freeing to say ‘I don’t know’! To embrace the unknown, to acknowledge that I would have to actively work to know more, and even then I would get it wrong.

One thing these realizations did was make me start to question the people I was learning from.

What’s interesting, is that some people embraced my questions and my challenges! And that’s when it hit me:  I didn’t need to learn any specific technique! I needed to be a better critical thinker!

A large majority of the continuing education for Physical Therapists (at least in the United States) seems to focus on specific techniques, some involving expensive trademarked tools. Some ‘techniques’ require several levels of training to become ‘competent’. Other courses seem to promise the impossible (or at lease biologically implausible).

The purpose of this post is not to discourage any technique or school of thought.  It is to encourage questioning!  And thinking!  And discussion!  And to challenge your biases. (Because we all have them!)

Now when I go  to courses, I don’t plan on learning anything to actually do. I plan on listening with an open mind, gathering information, and looking at my entire practice. I’m much more vocal asking questions when points don’t seem to be supported by science or seem to contradict what is commonly accepted. As healthcare providers,  we feel a need to do things, to help our patients or clients feel better and be healthier.  So on the quest to be better (and we can all be better), acknowledge that the next technique you learn won’t be any more magical than the last one you learned.  However, if you reflect and think critically, you may just be able to use what you already know to be better.

What Do Massage Therapy Associations Do For You?

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“What do massage therapy associations even do?” I get this question all the time.

We’re not an insurance company, although we do offer insurance, and we’re not a union, although we do represent Massage Therapists. We’re not lobbyists, although we do promote massage therapy to government and stakeholders, and we’re not a money grab because we put every single penny back towards working for you.

We’re an association.

We’re a group of like-minded individuals with a common goal.

So why would you want to give your hard earned money to your professional association? What’s the benefit for you? What do you get for your money? In addition to the obvious benefits like preferred rates for insurance, continuing education opportunities, networking opportunities, access to research, and referral services, we provide insight and guidance, programs and services, tools and resources. But there is a much larger long-term benefit.

We Advocate For You

Advocacy, in its most basic form, means to speak in favour of something.

So, your association speaks in favour of the profession of massage therapy. We promote massage therapy as a part of primary health care to government, the insurance industry, the general public, and other stakeholders. We make people aware of what it is that massage therapists can do, how well you do it, and why it works. We make sure that massage therapy is an important part of the healthcare landscape.

We work for you.

Advocacy is often seen as “big picture work”. Sometimes it’s complicated and often takes a long time, but it also has a direct and practical impact on your career as an RMT. It impacts how you practice, how patients find you, and how you’re viewed. It’s not only your professional association that can make a difference – you can too.

There are really two ‘yous’ when it comes to advocacy. There is the ‘smaller you’ and the ‘larger you’. The ‘smaller you’ is each individual health professional (that’s you!). You demonstrate a commitment to professional practice, ongoing education and continuous improvement. You are the health professional that people point to and say “they are the reason that massage therapy is a valuable health care profession”. You are dedicated to your profession and are able to easily articulate why you have chosen massage therapy and why it works.

The day-to-day interactions with patients and the way you present yourself professionally are ways that you advocate for the profession – perhaps without even knowing you’re doing it. This is advocacy on an individual level and is incredibly important.

It is, in fact, the basis of all advocacy.

The ‘larger you’ is all Massage Therapists combined. It is a “coming together” as an association with a common purpose. It is team work, co-operation and collaboration combined, and that team work has the power to make a real difference. A large group with a common goal can do things that individuals can’t. Doors are open for associations that are not open for individuals. Together, the ‘larger you’ has a louder voice.

The “larger you”, the association, amplifies that voice and directs it towards the appropriate people and organizations. We get the right message to the people who are in a position to make change happen. There’s power in numbers, and numbers get people in a position of power to take notice.

A rising tide lifts all boats. Whatever the association achieves for Massage Therapists will affect you whether you’re a member of the association or not. I get it – it’s easier to save your money, put your head down, and do your job. But as part of the association, you get a say in the way the wind is blowing and how the boat is steered. When you’re not a part of the association, you’re along for the ride whether you like it or not.

Associations reach out to their members to get feedback. We want to know what you need, when you need it and how we can make it happen.

Most, if not all, RMTs think we should have access to extended healthcare benefits. They want to be respected as a primary health care provider. They expect and deserve to earn a suitable income.

Massage therapy associations are the groups that make sure massage therapy is a viable, respected and accessible profession. We want to make it easier for Massage Therapists to do their jobs. You already know how to get a patient back to optimal health. Our job is to make sure that you can provide your professional healthcare services and earn a living so that you can continue to do so.

Photo by: RMTBC

Increasing Credibility Of Our Profession

Massage therapy associations are run by a board of your peers, chosen by you, who identify the issues and trends that will impact the profession and what we should do about it.

The board does extensive research to ensure they are representing the profession and the issues that are current to the day. They talk with members – the people these decisions will directly affect – and determine the way to position the profession for maximum success and the steps that should be taken in order to achieve the vision for the profession.

Massage therapy associations are run by Massage Therapists, for Massage Therapists. We keep a finger on the pulse of the profession and the landscape in which it operates.

Massage therapy associations work for the profession, and massage therapy regulatory bodies are primarily concerned with the public interest. Although these two groups may seem to be opposites, they are really two sides of the same coin. We both work in the best interest of the patient by making sure they are able to access massage therapy receive proper and appropriate care from Massage Therapists.

Both the association and the college must communicate with each other to work towards our separate mandates and our common goals. We both want Massage Therapists to be able to positively contribute to the health of Canadians.

RMTs are working with doctors, physiotherapists and chiropractors, in palliative care, and in hospitals – situations that may not have seemed possible in the early years of the profession. Massage therapy is now seen more often as a valuable healthcare option, which was made possible through years of advocacy undertaken by associations.

I suppose that provides an example of the answer to that frequently asked question ‘what do massage therapy associations even do?’ Associations determine the direction this profession should be heading, determine what we need to do to get it there, and then we actually do it.

The credibility of the profession has increased dramatically over the past few decades, thanks in part to the work of associations. Massage therapy remains the most utilized paramedical benefit in Canada behind drugs and vision care.

But we still have work to do.

Advocacy takes time. To make a significant change takes time. Developing the argument with the inescapable conclusion that massage therapy is an effective and critical piece of the healthcare puzzle is how we spend a large part of our time.

But this is time well spent.

It will ensure that massage therapy is and remains a solid and respected part of the health care landscape. It will ensure that you are appropriately rewarded for your time and effort. It will bring new patients to you because they will be aware of what massage therapy is and how it can help them, and it will ensure that you remain valued as a healthcare professional.

Canada is searching for solutions to the impending healthcare crisis. Massage Therapists are a part of that solution. It is the dedication and passion of Massage Therapists, which can be amplified by professional associations, which ensures massage therapy can remain an important part of health care. In your own community, and through your day-to-day professional life, you can advocate for the profession by the way you practice and the way you communicate that practice.As the larger you, your professional association is part of the important conversations, the important decisions, and the necessary actions now and in the future. Check out what your association is doing about the issues that affect you and your profession. It’s your profession and your association.

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