There are numerous advocates for many differing schools of thought concerning our purpose as manual therapists and our role in the well-being of a person and a community. We are a profession currently undergoing great changes. Some of what drives this accelerating change is the move to gain legislative recognition of our place in the health-care system across this nation. This need for recognition, in turn, has given rise to a sense of urgency to define the practice of massage therapy.
The danger of defining ourselves within a strictly evidenced-based model of practice is that, ultimately, we will become confined to orthopaedic issues. This is happening because such an approach easily lends itself to current medical research models of investigation. My fear is that many in our profession believe that we can only claim legitimacy as health-care providers by seeking approval from the general medical community by adopting that model’s view of health and what it considers acceptable practices.
But within such model what can we possibly be, for example, other than baby-physiotherapists?
Given the relatively short time we spend in educating our profession – compared to others in the various medical professions – how can we not be seen as less well-trained therapists within the field of orthopaedic issues (with a side-line in stress-reduction)? When all comparable professionals are university graduates, those of us with college diplomas will have difficulty being taken seriously on an otherwise level playing field.
One thing is for sure: any definition of massage therapy will not be done well by abandoning our historical roots. If we do so, we will inevitably be molded into something else, something that comes from another profession’s view of health and well-being, rather than from our own. Our fate will be taken out of our hands. If that happens, much of what has been part of massage therapy will be amputated in such a process. That is certainly not something I want to see happen. It’s not what I signed up for twenty years ago.
We need to turn our attention squarely onto the issue of who and what we are. This will be difficult because it is such an enormous issue and elicits such divergent answers. But it is necessary to ask the question and essential to seek an answer if we are to maintain a place as independent registered professionals. We need to accept this task and in doing so accept ourselves and our ancient heritage. This means it is time for us to celebrate our history, our diversity, and begin the discussion on what massage therapy has been, where it is now and what we want it to be in the future. Yes, we will butt heads over this. But we can also take the time to respect and celebrate each other’s uniqueness, celebrate our diverse goals and passions for this, our chosen profession.
Training in orthopaedic testing is a necessary component of our curriculum, for both schools of massage therapy and for continuing education. Learning the skills involved in orthopaedic assessment, from classic case history taking and range of motion testing to the special tests, provides us with essential knowledge, skills and understanding of those clients who see us for all manner of complaints. Equally important is the fact that it provides us with a common language with which we can both understand and communicate with each other and with other health-care practioners. Further, orthopaedics provides us with a window not only to many aspects of our own profession, but to help us understand and appreciate other health-care providers who also work within the orthopaedic scope.
Historically, however, assessment skills for massage therapy are not just about orthopaedic testing nor, for that matter, are massage treatments only about orthopaedic issues. Assessment in massage therapy has traditionally been about how the body works together as a whole, biopsychosocially, as a totality. Unfortunately, many therapists and many schools of massage therapy have forgotten or abandoned this perspective.
Our attempt to be accepted by the popular kids has resulted, in some circumstances, in a reliance on orthopaedic testing and treatment plans based exclusively upon them.
No one was more guilty of this than I was. Early on in my career as a therapist and as an instructor of clinical assessment I was obsessed with orthopaedics. As a result, my treatments became very specific and limited to the tissues directly involved in the specific complaint or a region of the body. My focus became smaller and narrower.
It seems many massage therapists have ended up fragmenting the body into separate biomechanical structures or regions. In a way, that results in ignoring the interdependence of all structures, systems and functions and fails to recognize the existence of a complete living organism. Assessment often becomes reduced to performing one or two tests to confirm the diagnosis already given by a more recognized professional. It leaves us as second-class professionals with no role to play other than performing a prescribed treatment protocol handed down to us by someone higher up in the food chain.
I was saved from my limited focus when I started to use an impairment-based model of assessment that avoided honing in on conditions and syndromes. I again started looking at an ever-widening area in order to draw a more complete picture of what brought the client in to see me. Also, I was looking for a way to figure out what could be interfering with, for example, a specific client’s healing, or to explain why a treatment, that should be addressing a specific dysfunction, all too often fail to produce the expected results.
A thorough regional exam would go a long way to answering some of these questions. I came to appreciate that the source for all those answers lies within the context of the whole person. Slowly, but surely, I came back to a much more holistic approach. In a way, I have come back to the view of massage therapy that attracted me to the profession in the first place.
I see my profession continuing to move toward, and begin to define itself as, a profession that is evidenced-based. Research is essential for our profession. Evidenced-based treatments are an invaluable component in the education of new therapists and for assisting practicing therapist to re-appraise their current practices. This can only elevate our profession in the eyes of other health professionals. So I am right there in the cheering section for research.
It is the defining part that concerns me.
Massage therapy does not just treat injuries. We do not just treat muscles, joints or soft tissue; we treat people. We treat the whole body with all its compensations and complexities. We treat it without relying on machinery; we treat it with touch. We treat it ourselves, without an assistant, medication or technology. And we are the last medical profession to do so. We have not changed our principles of treatment all that much since Hippocrates (with whom, I would argue, we have more in common than any other current field of medicine).
Though many in our profession seem to be acting like we are the new kid on the block, it is the current medical institution that is, in historical terms, new. We have, in one form or another, been around for a long time. We need to start acting as such, take the long view and teach our history and principles with pride.
So, to begin the discussion of what I would say massage therapy is. Very similar to what it was when Hippocrates talked about it: a profession that does no harm. I want it to be a profession that treats the whole person. I want it to be a profession that values, not just the similarities of each human body, but also the uniqueness of each person. I want it to be a profession that values the potential and the actual healing value of human touch.
It’s time we started learning about who and what we are.