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Essentials of Assessment: Spring 2007

Very few massage therapists, who have gone through a 2200+ hour program, would feel as though they were given too little information to learn while in school. Yet, many massage therapists do not have the knowledge and skills to comprehensively treat the soft tissue and joints of the body. What is missing?


September 28, 2009
By David Zulak


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Very few massage therapists, who have gone through a 2200+ hour program, would feel as though they were given too little information to learn while in school. Yet, many massage therapists do not have the knowledge and skills to comprehensively treat the soft tissue and joints of the body. What is missing?

From my perspective, an important omission in the education of a large number of therapists is the lack of training they receive in assessing the synovial joints of the spine and the sacroiliac joints. Without these skills, how are we expected to treat neck, upper- mid- and low-back pain and restrictions in motion?

After all, three quarters of people who come to us for treatment, do so for neck or back pain. If we do not understand how the spine and sacrum works, and also how those structures become impaired, then I believe we are left lacking as therapists. Without this knowledge, how can we use the techniques we spent so much time honing to help rebalance a spine with a functional scoliosis – to restore motion to a painful and locked sacrum?

Further, as massage therapists we see the body as an inter-dependent dynamic whole. We recognize that any change or dysfunction in any part of the body will, in a short time, be seen to affect other nearby structures and, if not resolved, will eventually affect the whole body.

Yet, without this understanding of spinal motion and dysfunction, how can we adequately and completely treat impairments and dysfunctions that may affect the arms and legs if we are unable to affect significant changes to the trunk of the body?

Now, I know that what I have said is not true of all massage therapists, nor are all schools of massage remiss in teaching the basic principles of spinal or sacral motion. However, there are many schools, probably the majority of schools, which do not provide this knowledge and training. Why is that?

One reason, I suspect, is historical. In many provinces, the length of time given to the training and education of massage therapists, the modification to curriculum and even the methods of education have changed and evolved over many decades. The spine and sacrum was seen as the territory of chiropractic and physiotherapy and it was too complicated for a massage therapist to safely treat.

Why would those professions, especially chiropractors, who were recruited to teach the expanding courses in anatomy, neurology, pathology and clinical assessment, teach us to assess and treat an area of the body that they considered to be their specialty? 

Why would they contribute to making us into their competitors in the field of manual therapy?

It appears that historically the assessment and treatment of the spine and sacrum was just considered not to be part of the set of skills belonging to massage therapists.

In fact, at times it was even considered by some instructors of massage as an area of the body to be avoided when treating. I have even heard from a few educators that they feel it is not practical to teach massage students assessment of the spine to this extent, that there is so much information already being given and schools are overloading students, as it is.

I have even heard it said that “the students may not be able to absorb or understand such a ‘complex topic’ on top of everything else the student has to learn.” This latter point is why I called this article: “When is learning too much not enough?”

My belief and experience as a teacher is that when a student feels overwhelmed with the volume of knowledge being taught, it is because they have not been shown how the information fits together. They have not been given various “hooks” on which to hang the reams of facts and information in anatomy and physiology that they are getting. The student has not learned to use the knowledge and, therefore, cannot retain it for long.

If the student is not shown (using the topic of this article as an example), how to assess and treat the spine, why and how would they retain the otherwise disparate facts about the spine, its musculature and its pathologies?

I often tell students, especially practicing massage therapists, that they have already learned 95 per cent of what is needed to assess the spine and sacrum while in school; all those “facts” about the spine’s anatomy. But that last 5 per cent that would speak to how it all fits together, how the spine works and how it becomes dysfunctional, was held back from them as students.

So, of course, therapists forget “the facts” as soon as they graduate, because so much of the information, the anatomical, physiological, and pathological “facts” cannot be applied in their treatments. To coin a phrase, if we do not use it, we lose it.

This crucial information, the “missing links,” the knowledge of how the spine works and how to assess it, is unfortunately withheld from a large number of students of massage. This relatively small amount of information is not the “final straw” that will break the proverbial camel’s back, which will leave the student crushed under the burden of all those “facts.” Rather, I believe that when the student understands how something about the body works and how they can see it, feel it and how to affect that aspect of the body in their practice, they have little trouble remembering the details.

Do we have the techniques to treat spinal dysfunction?
It may be true that the reason some educators feel it best not to learn to fully assess the spine and sacrum, is that they believe that we do not have the techniques to treat spinal dysfunctions. This could not be further from the truth.

Many dysfunctions of the spine and/or sacrum can be addressed through Swedish massage itself. They may also be treated through the application of stretching techniques such as Post Isometric Relaxation (PIR), or with simple joint play oscillations as learned in school – once the therapist understands how the structures and tissue work and how they dysfunction.

Yes, there are some flashy special techniques that can be used to treat the spine, and certainly there are some that are out of our scope of practice. But, the techniques learned in massage schools across this country can be used effectively to treat many dysfunctions of the spine and sacrum. Yes we do possess the necessary skills!

Massage therapy is a still-evolving profession. Therefore, the more comprehensive our knowledge, understanding and assessment skills are with respect to spinal and sacral dysfunctions, the more likely it is that massage therapy will develop new and innovative ways of addressing these dysfunctions using techniques that remain within our scope.


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