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Intention of Practice
talk about touch

By Mary Kathleen Rose and Mary Ann Foster

Originally published in Massage Bodywork magazine, May/June 2010. Associated Bodywork and Massage Professionals. All rights reserved.

Mary Ann Foster: Students often ask me why they have to learn orthopedic tests as part of their massage practice. They are not sure what they are supposed to know, wondering how to run muscle and joint tests, while still leaving time for a full-body massage. They also get confused about where evaluation fits into the legal scope of massage.

Mary Kathleen Rose: This is part of a much bigger question regarding the overall range of the massage and bodywork profession. In late 2008, a number of key stakeholders from professional organizations convened to begin a process of defining massage therapy and entry-level competencies. The draft of their work is compiled in a document called the "Massage Therapy Body of Knowledge" (www.mtbok.org).

MAF: The students' persistent questions sent me on a search for answers. I found the most helpful information about the scope of massage and bodywork by reading state laws. They each define massage in two or three categories: the range of techniques and methods that massage includes; the intention and purpose of massage; and what massage does not include.

MKR: How is massage defined?

MAF: It is generally defined as a manipulation of soft tissues using a range of conventional massage strokes and techniques. The laws are also remarkably consistent in describing what massage practice excludes: medical diagnosis and treatment, spinal manipulations, and sexually related touch.

MKR: How do they define the intention or purpose of the massage?

MAF: This was the most interesting part of the statutes. I was surprised that 25 percent of the state laws do not even mention the intention and purpose of massage. But in the remaining statutes, there is a definite theme. Most of them describe massage therapy as a wellness practice for the purpose of "providing muscle relaxation," "alleviating general stress and pain," and "enhancing and restoring physical and mental health and well-being."

MKR: How did your study of the laws help you guide your students?

MAF: First of all, I tell students there is no right or wrong answer to the question about orthopedic testing. It's all a matter of context. If they are using the test within the wellness paradigm defined by the statues, then they are working within our scope of practice. A massage therapist is expected to make general assessments to develop a course of action for the session that meets the client's goals. Also, general joint and muscle tests can be helpful in identifying contraindications and developing an overall treatment plan. But running specific tests to evaluate a specific condition for treatment is questionable.

MKR: While working in a medical setting, and with other health-care professionals, it has been my practice to work to address the needs of the given medical diagnosis of the patient.

MAF: Combining conventional medicine and complementary therapies is what the National Center for Alternative and Complementary Medicine classifies as integrative medicine. The benefit of this collaboration is that massage therapists can draw on the diagnostic and evaluative expertise of medical practitioners, and the medical client can receive the general healing effects of therapeutic massage, such as relaxation and the release of muscle tension.

MKR: These benefits are what we provide the best. And that endears us to our clients and the other health-care professionals. With this intention of the profession in mind, I am able to define the intention in my own work.

MAF: In the classroom, we practice resisted muscle tests and joint range-of-motion tests as a way to learn more about the human body and to make general assessments about what would improve the condition of the client. When I tell my students that they are not responsible for testing to figure out clients' orthopedic problems, they sigh with relief.

MKR: Understanding the legal scope of practice and working with a clear intention makes it easier to work with confidence and meet our clients' needs.

MAF: Perhaps we can challenge our readers to check their own state laws and write their own definitions of massage therapy, its intention and purpose, and what it excludes. Our clarity of intention in practice will help us build bridges with other health-care professions, fostering mutual respect and understanding.

Mary Kathleen Rose, BA, CMT, has been practicing shiatsu and integrative massage since 1985. She is the author of Comfort Touch: Massage for the Elderly and the Ill (Lippincott Williams Wilkins, 2009). www.comforttouch.com.

Mary Ann Foster, BA, CMT, specializes in movement education for massage and is the author of Somatic Patterning: How to Improve Posture and Movement and Ease Pain (Educational Movement Systems Press, 2004). www.emspress.com.




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