The Saber-Tooth Curriculum article by Abner Peddiwell exemplifies the current state of affairs within the massage therapy profession in British Columbia with intra-professional tensions perhaps at the highest in the last twenty years.
There
are many ‘tensions’ within the profession for example:
- education requirements that’s based on competencies instead of number of hours
- the notion of the effectiveness of a clinical, regional or specific treatment verses one that is a full body integrative relaxation session
- the need to practice from an evidence/ informed based practice that borders on a western allopathic orthopedic model of therapy, verses an eastern, holistic, mind-body treatment approach and
- jurisdictional requirements and acceptance of out of province trained therapists
This post will explore one area of tension I manage daily, namely the
treatment request from the client verses the treatment approach based on my
assessment and clinical experience, that would best suit the client at the time of their visit. An
additional layer of ‘tension’ is added when the client is referred by another
health care professional with a specific request, as will be explained later
on. The questions I will address are: why this tension exists? how it came to be?, and what I learn
from the experience.
In
answering ‘Why this tension exist?’ I realized it exist because I create it. It
became very apparent that my beliefs, experiences, attitudes and surroundings
have an immense impact on the clinical situations and client presentations I am
faced with, the methods, and thoughts I refer too when developing a treatment
approach, and how I contribute to creating a clinical situation – tension
relationship.
When clients present their health narratives and
concerns, and, they share the advice received from other health care
practitioners, it’s easy to imagine how they can at times interpret these
well-meaning words of advice as the authoritative word. I am acutely aware of
censoring what I say to them and not add to the deluge of information, and in
doing so hope my words of advice direct them towards a more meaningful and
healthier lifestyle.
How these tensions came to be
Clients today are more educated about various
health care disciplines and have access to a far greater number and diversity of
health care professionals than ever before. Some professions are provincially
and nationally regulated such as massage therapy, nursing, physiotherapy,
medicine, naturopathy and traditional chinese medicine, while other professions
are not (they may be in other areas of the world) including aromatherapy,
shatisu, nutrition and ayurveda. It’s becoming increasingly important during
initial (and ongoing) assessments to explore what other therapies clients have
experienced and why, and then ensure that the approach to treatment I adopt
with the client is professionally appropriate and complimentary and, meet the
needs of the client. Below is a description of a scenario when a ‘tension’ developed
between what I believed the client needed, and what their request was.
The general history of the client: 30 + year old
female nurse, eight months ago had a brain aneurysm rupture while at work. She
is an emergency nurse so was very fortunate to be at work when this incident
occurred and was able to get prompt medical care with immediate surgery. With her
current rehabilitation program, her prognosis is very good, there is however
some residual cognitive challenges that she still experiences and is currently
receiving medical attention for it. This client was referred to me by her
physiotherapist for treatment of her ‘tight, sore, back and leg’ muscles. She
is an avid and active runner, and is engaged in several other activities. During
our initial assessment I did find an increased degree of muscular tension in
her hamstrings and calves, and her upper trapezius muscles presented with
several hypersensitive nodular areas typical of trigger points with their
accompanying pain referral patterns. This client said she had a renewed feeling
about life, she is enjoying fitness, (runs as often as she can) has a schedule
of her daily activities, takes time out to relax, and eats relatively healthy
since the incident, as she is aware of how diet can influence cardiovascular
health. When asked her if she can quiet the mind her answer was ‘not as much as
I want too’.
When assessing her breathing and breath habits she demonstrated a
rapid respiration rate, breathe through the mouth and her cervical muscles were
hyper-toned. Her respiratory presentation and characteristics presented as what
hyperventilation might present as, a respiratory condition characterized by
rapid breathing that affects the ratio of carbon dioxide to oxygen in the
blood. A change in this blood gaseous ratio influences various physiologic
processes, such as blood pressure, muscular tension and nerve irritation, all
of which can be risky for an individual with a cardiovascular health concern. I
spent several minutes explaining to her how her breathing may be
influencing/contributing to the muscular aches and pain she is experiencing,
and the potential effects on cardiovascular health. I then suggested spending
the remaining session time on developing skills of breath awareness and breathing
practice, and on reducing the muscular
tension around the neck and shoulders
with massage and other types of soft tissue treatment modalities.
After a short
deliberation, the client politely declined the treatment approach I suggested
and indicated that she was referred by her physiotherapist to see me
specifically for massage therapy to address her sore muscles and not for
breathing lessons, and she asked to have her legs, back and shoulders attended
too. I proceeded with her request and focused the treatment on reducing the
muscular tension in her legs, back and shoulders. Post treatment the client
reported feeling relaxed and with less tension in the areas where I treated.
Why did this experience create a ‘tension’ for me
and what was /were the lessons for me
During the process of ‘unpacking’ this feeling of
tension, what immediately surfaced was my assumption, and therefore the
‘tension’ I experienced, that the client, with her nursing background knowledge
would have acknowledged the treatment approach I suggested. I wondered if this
client considered that her sore muscles may be MORE related to her
‘hyperventilation like breathing patterns’ rather than to her activity levels,
and more importantly, she was potentially increasing her risk of another
cardiovascular event if she continued with her current breathing habits. As her
care-giver at that moment, I experienced deep sadness as her decision did not
address her breathing patterns. I realized that working on her sore muscles
would bring some relief too her, and perhaps induce a deeper, slower balanced
breath, even though it would be for the few moments we had.
I learner that while I advise clients on how to
approach their health concerns as per within my scope of practice, they do not
have to adopt the advice. I liken myself to the analogy of a bus stop, I am
just one stop for them along their health and self-care journey. Some clients
may travel the route several times, stopping each time to visit, before moving
on, while for others it’s a single stop, single visit. For this particular
client, nurse, person, I suspect it was a single stop and she has since moved
on.
Following this experience, and now having to
reflect on and further ‘unpack’ it, the next steps I anticipate would be to ‘flesh
out’ how I situate myself as a practitioner within the massage therapy
profession. Perhaps I need to reframe my practice and have a focus on
respiratory health, or mind body interconnectedness so it’s clearer to all who
visit, and it is more reflective of how I’ve evolved as a person and practitioner.
