Principles and Policies

This document reflects what I believe about massage.  It’s why and how I do what I do.

Definitions

I believe a combination of Medical Massage, Deep Tissue, Swedish, and Restorative Positioning can help the body approach a state of “coordinated fascial tensegrity" or an ideal state of alignment and function for the tissues and bones. 

Medical Massage

Medical Massage concentrates on a medical necessity. It is results-oriented and can address different health issues, manage pain, lower inflammation, boost circulation, alleviate nerve compression, enhance flexibility, and promote digestion.

Deep Tissue

Deep Tissue Massage techniques target deeper muscles, tendons and fascia. “Deep” is an anatomical term describing the location of tissues in the body relative to more superficial tissues, and “deep” can also refer to pressure.

Swedish Massage

Swedish Massage is a general massage for relaxation and circulation. Swedish massage features the repetition of traditional Swedish massage techniques, such as effleurage and petrissage. Repetition is soothing for the nervous system.

Restorative Positioning

Restorative Positioning is a form of Passive Release in which the body is placed in supported positions that allow joints and tissues to naturally relax. Restorative Positioning assists with the rehabilitation of tissues by giving the body and brain a comfortable pain-free or pain-reduced sensation.

Principles of Practice

This is a brief description of some Principles I use to guide my work. 

1. Treat where it hurts, then look everywhere else - 

up, down, diagonal, side-to-side, around, under, and through.

2. Work Locally and Globally

The body is 3-dimensional and layered, so I work 3-dimensionally and in layers.

3. Compression toward pain

In some situations, compression toward pain relieves pain, while stretching away from pain may worsen it

4. Stretching away from pain

  1. In some situations, stretching away from pain relieves pain, while compression toward pain may worsen it.

5. Include movement

Some situations require gentle movement in flexion, extension, rotation, etc.

6. Varying pressure & speed

Varying levels of pressure address superficial-to-deep layers of tissue and stimulate nerve endings that respond to different speeds and levels of pressure.

7. Posture

Posture is observed objectively as tilts, bends, rotations, and shifts.

Scope of Practice

Scope of practice is everything a licensed massage therapist is legally able to do.

Nature of work

1. It is within the scope of practice of Massage to help release tension and restore function in soft tissues.

2. It is outside the scope of practice of Massage to align the bones manually such as in Chiropractic or Osteopathy.

Observations and assessments

3. It is within the scope of practice of Massage to make observations and assessments regarding the relationships and positions of structures in the body, at rest and during movement.  

4. It is outside the scope of practice to diagnose conditions.

Recommendations

5. It is within the scope of practice of Massage to give recommendations for post-massage care at home.  Recommendations are not prescriptive and can be declined.

6. It is outside the scope of practice to prescribe treatment plans or at-home care.

Post-massage Recommendations

  1. Always be gentle with yourself.
  2. After a massage you might experience increased movement or sensation in areas that have been immobile or numb. You may also experience some soreness in areas where deep tissues were worked.
  3. Recommendations are not requirements or prescriptions, but are ideas from personal and professional experience that may facilitate rehabilitation, relaxation and healing.
  4. Recommendations are holistic for the best results and may include:
    1. Restorative positions
    2. Self-massage
    3. Environmental adjustments
    4. Activities to start, adjust, or temporarily stop
    5. Gentle movements
    6. Breathing exercises
    7. Areas to have assessed by another skilled practitioner

Observation and Clinical Reasoning

1. Determining how/where to work

I use my observations (both what I see and touch), your observations (including date of onset, order of impact, areas of pain and restriction, etc.), and clinical reasoning to determine which areas to work that will provide the most support and release for areas of pain.

2. What is observed

The condition of the tissues (sticky, hard, puckering, crunchy, taut, tight, etc.), relationship of bones as they come together to form joints, relationships of joints with other joints, and how joints move.

3. Documentation

I may pause during a massage to note observations.  I write detailed notes after each session. 

Episodes of Care

  1. A typical episode of care for Medical Massage or Deep Tissue Massage may be 3-12 appointments.
  2. Acute conditions may take fewer sessions to treat.
  3. Chronic conditions may benefit from regular massage.

Acute and Chronic Conditions

  1. Acute conditions, like recent injuries, may take less time to treat, as tissues haven't had time to settle into dysfunctional patterns for months, years, or decades, and pain patterns are new. Work can be done to reduce healing time, restore the tissues to function, and minimize long term effects.
  2. Chronic conditions, like long time pain or overuse injuries, may take more time to treat, as underlying dysfunctional movement patterns or pain patterns are typically more developed and habitual. There may be misalignment of bones, causing joints to move and load improperly.
  3. Massage can help with chronic pain, but does not correct movement habits or muscle weakness. Those issues may need to be addressed with corrective exercises and stretches prescribed by a skilled movement specialist (PT, kinesiologist, Feldenkreis practitioner).
  4. Both Acute and Chronic conditions may reach a point of maximum medical improvement (MMI), after which massage treatments can help maintain results but may not improve results further.

Measuring Progress with Scales and Functional Outcomes

  1. Pain intensity is self-reported and measured with the Verbal or Visual Analogue Scale, a common pain scale that rates intensity on a scale from 0 to 10.
  2. Pain frequency is self-reported and noted as Never (0), Seldom (1-25% of time), Intermittent (26-50% of time), Frequent (51-75% of time) or Constant (76-100% of time).
  3. Range of Motion may be measured with a Goniometer, which measures angles, and by observation.
  4. Posture and movement may be observed and noted.
  5. Progress in a massage treatment or episode of care can be measured by Functional Outcomes, or improvements in activities of daily life, return to work, decreased use of medications or decreased need for other interventions for the condition being treated.
  6. Meaningful goals for massage treatments are created by each individual.

Cautions

  1. I exercise caution in areas that are painful, swollen, in an active spasm, or injured to prevent increased swelling or injury to the area.
  2. I use discernment, as well as your feedback, regarding how much to do and how much pressure to use.
  3. In areas that are swollen, I may use light lymphatic techniques to help the area drain.
  4. I may decline to work in an area that is excessively swollen, hot, bruised, or showing other signs of injury or inflammation not treatable by massage.

Declining Care

  1. After a thorough health history intake, and visual and palpation assessment of your condition or conditions, I may decline to provide Deep Tissue or Medical Massage if your condition requires a different practitioner and/or modality, or if Massage is not appropriate.
  2. If it is not safe or wise to work in areas you are requesting, I may decline to provide or continue providing Deep Tissue or Medical Massage.

Release of Medical Documents

  1. With your consent and permission, If I believe you may benefit from an evaluation by a skilled professional, such as a PT, Chiropractor, or other practitioner who can assess your condition, I will write a detailed letter with my observations and offer copies of my notes to your preferred Health Care Provider to assist in getting a referral for appropriate care.