|Sport massage is increasingly becoming a regular phenomenon in sporting events.
Collaboration/integration is certainly a strong overarching current trend across the board in Canadian health care, and George Fraser believes the inclusion of massage therapists on integrated health-care teams will increase. The executive director of the Massage Therapy Association of Manitoba (MTAM) says leadership within the profession has been very active over the last few years, with professional dialogue and outstanding results – first producing national competencies, and more recently, a plan for national educational accreditation.
A critically needed national examination will follow, which “will establish confidence at ‘entry to practice’ for massage therapists in the future, allowing them to proudly assume a larger role in integrated health-care teams and to meet labour mobility requirements across the country,” says Fraser.
Don Dillon, Toronto-based RMT, author and speaker, suggests that without a higher level of education, evidence-based practice and more political clout, RMTs may continue to face barriers to integration and provincially-funded health care. In addition, he says that in a recessive economy with a surplus of skilled workers to jobs, employee benefit plans and discretionary income suffer, negatively affecting the massage therapy profession.
In Dillon’s view, with the costs of business start-up and increasing competition, more practitioners will be shifting from self-employment to employment in well-capitalized spas and rehab centres.
In the arena of insurance claims, Fraser points out that as the public continues to turn in greater numbers towards massage therapy for treatment of the spectrum of pain management issues, this makes the future for claims bright – at least in Manitoba.
“A vocal few in the profession are concerned about the future relationship of RMTs and third-insurers,” he notes. “The MTAM experience is that insurance claims are trending upward and onward for massage therapists.”
Fraser points out that massage therapy now clearly represents the largest proportion of claims within the “paramedic” section of most benefit plans (chiropractic, physiotherapy and massage therapy).
“Massage therapy has a strong and positive position in the day-to-day approval of claims,” he explains. “Some still continue to say the ‘sky is falling’ regarding insurance claims. It is not, and RMTs who remain professional in their practices will not see claims being denied – this is just a scare tactic from some who do not do their research properly.”
In Ontario, however, Dillon says frontline practitioner accounts in social media and workshops he’s conducted suggest RMTs face more obstacles to billing auto insurance, worker’s compensation and even employee health benefit plans. Dillon also points to Newfoundland and Labrador, where claims for the Workplace Health and Safety and Compensation Commission have been dramatically limited for massage therapists.
“When auto-insurance changed in Ontario in 2010, RMTs reported they are facing more claim denials,” Dillon says. “With insurance companies adamant about addressing fraud, more RMTs report claims being denied or reduced, and employee health benefit coverage clawed back,” as in the case of General Motors where benefit caps for chiropractic, physiotherapy and massage therapy were merged.
“We need more information from frontline practitioners to learn how access to funding has changed in the last five years for them,” Dillon says.
In order to be included in health-care policy and funding, Dillon believes RMTs would do well to collaborate with primary CAM (complementary and alternative medicine) professions (chiropractic, naturopathic, traditional Chinese medicine/acupuncture) in areas of training and education, research and evidence-based practice, relations with insurers, gatekeeper health disciplines and public/media, and lobbying of government for favourable inclusion in health care.
“Working together, these professions can accomplish far more than on their own,” Dillon says.
Dillon also suggests another market force – baby boomers – will finance health/wellness not only for themselves, but also for their less advantaged children and grandchildren. “The public embraces CAM, so popularity is on our side,” he says.
Complementary health care and use of technologY
Many massage therapists are already adding complementary modalities to their practice, such as acupressure, acupuncture and laser therapy, according to the Canadian Massage Therapist Alliance (CMTA), a national alliance of provincial massage therapy professional associations. However, the alliance cautions while some of these modalities are considered in the scope of practice of massage therapy, others are not.
In an e-mail response to this writer’s query, the CMTA explains: “Even the consideration of ‘complementary and alternative health care’ is not a philosophy that is shared amongst all provincial jurisdictions. For example, in British Columbia registered massage therapy is not considered CAM.”
The CMTA says expanding the education of massage therapists is something the profession maybe moving towards in the future. “Certainly moving to a degree is something that we foresee as the future of the profession.”
“Like with all other health-care practitioners we must advance our skills to deliver the level of patient care that is required to meet a more educated and now more acute patient demographic. Specialization in specific patient populations will also become more of a demand in areas such as geriatric, oncology, womens’ health and, of course, sports.”
Certain modalities are also getting more uptake than others, such as acupuncture. Fraser says RMTs, particularly in regulated provinces, are embracing it into their practices.
“As a trend, this can only grow in use,” he says. “Also, the related ‘cupping’ education is producing significant positive results within treatment plans – even without acupuncture.”
He adds that RMTs will also continue to embrace new electro-modalities in their practices, such as low-intensity laser.
Dillon agrees. “RMTs have embraced acupuncture modalities and hand-tools because they experience how time and labour-intensive the work is, and realize they have to be innovative to earn more income and stave off overwork” he says.
Trends in sports massage therapy
Canada is among world leaders in sports massage therapy. “I am only aware of a sport massage association in the U.K., and as far as I know, no other country has a sport massage association,” says Trish Schiedel, president of the Canadian Sport Massage Therapy Association (CSMTA).
At least one of the current trends in health care – the team or multidisciplinary approach – has always been an aspect of sport massage but is accelerating at this point.
“Sports massage therapists have been doing this for eons,” Schiedel says. “In the arena of sports, you will find often an athletic therapist, sport physio, sport chiro, sport massage therapist, team doctor, coaches and possibly sport physiologists and sport psychologists.”
However, she notes that more multi-disciplinary teams than ever are present at events or with sports teams.
Schiedel also points to using corrective exercises as part of treatment as an ongoing trend, as well as corrective taping (e.g., elastic therapeutic taping, neuro-proprioceptive taping). There is also the trend of applying techniques such as fascial manipulation, Ligament Articular Strain, and Thai massage specifically to sport massage. It’s a matter of building knowledge and developing critical thinking skills so that sports massage therapists can determine how they might use a technique pre-event/post-event or during rehab, and consider the specific mechanics that cause common injuries in specific sports on an ongoing basis.
“There are common injuries seen in hockey, soccer or rowing, for example, so having a good understanding of body mechanics is essential for the sport massage therapist,” says Schiedel.
She notes that some courses in these areas are essential in becoming a certified sport massage therapist, but adds that “concussion has been a very hot topic for the last few years as we have had a lot more research coming out in this area.”
“For the last two to three years there have been concussion lectures at all of our conferences.”
In addition, the SCAT3 (Sport Concussion Assessment Tool), released in March 2013 in the British Medicine Journal, is essential for all medical staff working with a team or at an event. It has been an important aspect of the medical team working together with the athlete and coach in the diagnosis and rehab process, Schiedel explains.
Ongoing learning is also a significant current trend. The CSMTA recently started a mentorship program, Schiedel says.
“It is essential for a sport massage therapist to continue studying mechanics of the fascia, muscles and joints.” This builds on the CSMTA’s International Sport Massage Diploma Program, a distance learning, post-graduate, continuing education program of three courses developed in 2005.
“Sport massage therapists have to deal with a wide variety of injuries and medical conditions, and this requires more knowledge, skills and first aid application than is taught in massage therapy schools,” says Schiedel. “At least one massage college (in Alberta) has adapted these courses into their curriculum and we hope more schools will offer this option.”
The CMTA urges massage therapists to continue updating their education through hands-on courses, best practice and evidence-based massage.
“Massage therapists definitely have to realize that there is a new patient out there – an educated patient,” the CMTA said. “Education, not only to meet the trends of a more health-challenged or educated patient, but also to work within multi-disciplinary clinical environments.”
As RMTs are often required to address the complex care issues of some patients, critical thinking and research are important aspects of being a massage therapist, the alliance added.
Overall, Dillon sees the massage therapy profession as being at a crossroads.
“Maintain a multifaceted identity (spa, rehab, workplace wellness, holistic) or emulate physiotherapy’s trajectory (degree-level program, evidence-based practice and financed political clout); collaborate and support common national and interdisciplinary initiatives or continue (perhaps, ineffectively) to manage solely; clean up our relations with insurers, government, gatekeeper health disciplines and the public/media, or face the consequences of inaction.”
Treena Hein is a freelance writer and editor based in Eastern Ontario. Treena is the proud winner of two awards: the International Federation of Agricultural Journalists “Star Prize” and the Canadian Farm Writers Federation “Gold” feature award.