These essays on the evolution of bodywork techniques, education and certification are written by the people who developed and advanced these areas of your profession.
Throughout 2020 we have published many essays on the evolution of the massage therapy field, touching on such topics as education, business, ethics and COVID-19—and as the year comes to a close, so too does MASSAGE Magazine’s 35th-anniversary celebration.
This selection of essays is on bodywork techniques, written by: Elaine Stillerman on pregnancy massage: Don McCann on myofascial body restructuring; Irene Smith on hospice massage; Drew Freedman on evidence-based practice; Susan Salvo on education; Portia B. Resnick on massage regulation and certification; and John F. Barnes, PT, on myofascial release.
There was a question on the 1978 New York State Board exam that went something like this: “Is it ever safe to massage the lower back of a pregnant woman?” If you wanted to get the answer right, you responded with no. If you have ever been pregnant, around pregnant women, or massaged pregnant women, you know a leading source of pain is lumbar compression – a backache. So this question, and its misguided answer, was inaccurate.
But there were no guidelines 42 years ago. There was no one working with pregnant women to consult with. As a matter of fact, the conventional wisdom at that time was when a client became pregnant, she stopped having her massages and returned after her baby was born.
Thankfully, that attitude has changed. And the benefits of massage to both mother and her baby during pregnancy, labor and postpartum recovery are well documented.
But in 1980, when I started my prenatal massage practice, it was an upward battle to change the minds of medical professionals, the community at large—and, yes, even expectant women.
I found my niche by happenstance. One of my clients became pregnant and didn’t want to stop her treatments. Word got out that I was a “rogue massage therapist who was not afraid to touch pregnant women.” Soon, other massage therapists were sending me their pregnant clients and word spread quickly.
I realized I was lacking a lot of information about pregnancy, so I poured over sociological texts to learn that in indigenous societies, massage accompanied pregnancy as a major source of prenatal care. Obstetric and midwifery texts taught me about anatomy and physiology, which is the basis of my professional course.
After working with this deserving population for 10 years, I was approached to teach a continuing education class and MotherMassage: Massage during Pregnancy was born. Since 1990, I have taught this 24-CE class to massage therapists, midwives, doulas, nurses and childbirth educators at massage schools, spas and resorts across the country and in Europe. Prenatal massage has become a very popular continuing education class.
I have written extensively on the subject. Many of my articles have appeared in MASSAGE Magazine. But I have also written two books (out of four) on the topic: “MotherMassage: A Handbook for Relieving the Common Discomforts of Pregnancy,” (Dell, 1992) which was written for the expectant couple, and “Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork,” (Mosby, 2008) which is a leading text in many massage schools.
I will never forget the first time I felt a baby move inside of his mother’s womb. My eyes filled and I my hands froze on her belly in wonderment and awe. It is an honor and a privilege to work with this deserving population. And it is also a responsibility that should be taken with great seriousness and good intentions. Getting appropriate, hands-on training in a live class is an essential part of this work. We are reducing aches and pains, and alleviating stress, which makes mother’s journey easier and more comfortable. And when mom is calm, baby is calm.
Our ministrations can make a difference between a stressed-out mother and baby, or a calm mother and a baby developing in a sea of oxytocin and endorphins. We are changing lives with this work, and I couldn’t be happier.
Elaine Stillerman, LMT, licensed in New York in 1978, began working with pregnant women in 1980. She developed the award-winning course “MotherMassage: Massage during Pregnancy” in 1990 and continues to teach at massage schools here and in Europe. She is the author of four books, including “Prenatal Massage: A Textbook of Pregnancy, Labor, and Postpartum Bodywork,” (Mosby, 2008), and “Modalities for Massage and Bodywork,” (Mosby, second edition, 2016). In 2013, she won the inaugural AFMTE’s Educator of the Year award and was inducted into the World Massage Festival’s Massage Therapy Hall of Fame.
Read “7 Ways to Market a Prenatal Massage Practice,” by Elaine Stillerman.
Myofascial Body Restructuring
When I entered the field 44 years ago as a young. excited practitioner, I focused on myofascial body restructuring. The following are my observations of its evolution.
Working with the mind-body connection makes sense now after more than four decades of working with people and their bodies. My clients presented with many different conditions and diagnoses including the emotional aspect that related directly to structure.
The first development that led to the expansion of this original body of knowledge was to see how a diagnosis or condition in a client’s body related directly to structure. If a relationship could be determined, then applying structural change to help rehabilitate the condition made total sense.
Once this was determined, the order of treatment evolved into meeting the client’s emotional and physical needs by focusing on the structure directly related to their condition or complaint. When improvement was noted working with the rest of the structure would support the positive changes. This again was an evolution from the three stages of myofascial work that had originally been taught.
Structural body reading revealed a spiral twist that went from the head to the feet in every client. This spiral twist was not mentioned in rehabilitation and was not named. What became clear was that within the spiral twist there were additional degrees of distortion and that was where people were developing their problems.
This spiral twist (the core distortion) is becoming recognized as the principle goal of rehabilitation for treating musculoskeletal issues. The most troublesome aspect of the core distortion is the lack of weight bearing support between the sacrum and ilium which is almost impossible to correct. Physical therapists call it the hip complex and did not have a solution to bring it back into weight bearing support.
Chiropractic recognized the problem but only had limited success bringing it into long term support. The sacral occipital technique chiropractors used blocks to minimize the rotation of the iliums and support the weight-bearing separation that actually gave support to the entire spine and helped to balance leg length.
The problem was keeping the SI joint in weight bearing support through life experiences. Applying the sacral occipital technique concept to soft tissue body restructuring gave a balanced pattern that was more effective than techniques previously applied.
The osteopaths had known that mobilizing and working with cranial motion affected the structure. The big breakthrough happened when the relationship of the cranial bones and the structural distortion of the pelvis was recognized.
Another important step was recognizing that soft tissue organized and governed the cranial motion. By combining soft tissue myofascial release with balancing and mobilizing the cranial motion it was found that the weight bearing separation between the sacrum and the ilium could be brought into long term weight bearing support.
Thus, by using cranial therapy that related directly to structural support, improvements in clients’ musculoskeletal issues expanded beyond the limitations of the old collapse of the core distortion. Additionally, the weaknesses from being in the core distortion, which has approximately 50% of the muscles operating at 50% or less strength and function verifiable using kinesiology, were increased to 80% or greater strength and function.
This unlocks not only the potential for long term rehabilitation of clients’ musculoskeletal issues but also the potential for client’s physical activities. This shows athletes’ potential being unlocked and their performance exceeding previous limitations. There is also a rapid increase in rehabilitation from injuries.
The potential of body restructuring has expanded exponentially.
Don McCann, LMHC, LMT, CSETT, developed Structural Energetic Therapy, integrating cranial/structural, myofascial soft tissue, and emotional energy release techniques. He holds a master’s in counseling education, is a licensed mental health counselor and a licensed massage therapist for 44 years. He is also the author of five books, a columnist, lecturer, instructor, and an inductee in Massage Therapy Hall of Fame.
Read “Is Structural Energetic Therapy Right for You? It Depends,” by Don McCann.
Although certified in massage in 1974, it was only after meeting Elisabeth Kubler-Ross, MD, in 1978 that I was inspired to pursue my chosen field. Inspired by Elisabeth and her compassion for those who were ill and dying, I became a hospice massage volunteer. I saw my first hospice client in 1982. I worked with cancer patients—and then the AIDS epidemic was birthed.
The need to incorporate other therapists resulted in the creation of the nonprofit organization Service Through Touch, with massage volunteers serving hospitals, nursing homes, and residences for persons with AIDS. By 1984, massage volunteers were in the trenches where others would not serve. I was so inspired.
Wanting the world to see the healing power of touch and the exposed heart, I authored an article with stories and beautifully sensitive photographs for the primary magazine for massage therapists. I waited for a response. The letter from the editors simply stated, “Thank you; however, our readers are not interested in reading about this work.
I didn’t understand the response or the massage community’s limited vision of contribution. The next 15 years were about understanding the limitations of the massage profession and its educational institutions while continuing to serve marginal populations—many times, outside the usual contraindications.
Then, throughout the 1990s massage therapists all over the country started volunteering to serve the dying. As the massage community matured, learned its value in the wider world outside the spa, strengthening its esteem, massage for people with cancer became widely accepted as a modality of care. Everything changed.
Educational institutions realized information and education on providing massage for medically fragile populations was needed for the maturity of the industry’s practitioners.
During this time of change, hospices let go of massage volunteer programs and created paying models. Today no one can dispute the demand for massage for people with cancer or deny that massage in hospice care is a valuable and sought-after modality of care for the dying.
To have seen this level of growth and maturity in this profession in my professional lifetime is a treasure that’s almost too beautiful to hold.
Now with COVID-19, hospice massage is on lock down. Some practitioners are unable to serve their clients tactically. We are being called to reorganize and change yet again. This is when we become touch educators and step into assisting health care sites with creating environments that nurture the senses.
It’s time to develop strategies to educate health care providers in skillful touch. They are the practitioners in this time. Let’s teach them touch awareness with what they are already providing. Feeding, dressing, transferring and bathing are intimate touch sessions that when provided with skill can sooth and comfort.
Let’s teach the care providers how to touch and the importance of staying grounded, staying mindful and conscious, and how to incorporate aromas that sooth and assist with easing anxiety. Educate in the use of soft textures for beds that please and comfort the skin and how to apply lotion to the skin in a way that nourishes and sooths.
We have these skills. We are the face of the new health care facility. The time is prime for us to teach the broader application of our sense of touch. Our esteem is high, and our hearts are exposed. There is strength in vulnerability. Pause, breathe and move forward!
Irene Smith is an internationally respected author and educator certified in massage since 1974. She is a member of the ABMP, holds a CAMTC license, and is an NCBTMB Ce provider. Through her organization, Everflowing, Smith provides live, online, and home study CE programs in hospice massage.
Read “Massage Therapy’s Role in the Growing Hospice Movement,” by Irene Smith.
A career in massage requires a daily commitment to both yourself and your clients to continuously grow from yesterday’s understanding and tomorrow’s new evidence of massage therapy. As someone who entered this field with a strong foundation in health, by far the most challenging aspect of my work has always been staying current with the most effective approach to care.
The science of massage is still a new frontier to us. Demonstrating what massage does is not always as simple as seeing or feeling the results we experience in our treatment rooms. We must be able to communicate to clients that the benefits of what we can provide them are greatly enhanced when they are partnered with other complimentary interventions such as nutrition, sleep and deep breathing.
This is why I impress upon my staff to operate from an evidence-based practice (EVP) model. The term EVP is often used but misinterpreted. Many think it means we should only use the information pulled from research to explain or dictate our approach to massage. This is where so many therapists get stuck, ethically and practically.
An EVP is comprised of three factors: scientific evidence, anecdotal evidence and individual client needs. Failure to consider all three in your approach, rather than leaning heavily toward one, is where many of us are mystified and confused. We know scientists are working to provide research, but most conclusions are that we ‘need more studies’ or the studies themselves are heavily flawed.
Many of us have taken our skills into the room and have witnessed, first-hand, positive outcomes from a massage, yet research can’t qualify it. Many of us have clients report outcomes that from science and our own practical experience, don’t make sense, yet the client states they feel better.
Combining all three schools of thinking in your work is the best way to be able to properly develop your treatment plan, goals and overall communication with your clients.
Drew Freedman is the principal and founder of The Boston Bodyworker & Learn2Tape. He has been a massage therapist for over 24 years. Freedman is Board Certified in Therapeutic Massage & Bodywork (BCTMB), a Certified Kinesiology Taping Specialist (CKTS) and an Approved CE Provider for the NCBTMB. He is a graduate from the University of South Florida’s Sports Medicine program where he also served as an athletic trainer and massage therapist to many professional and collegiate teams as well as Olympic athletes.
There are a lot of wonderful things happening in the massage profession right now. The changes I am most excited about are in massage education. Massage curriculum and instruction now include significant emphasis on evidence-based practice and cultural competence.
I have long been an advocate of research as a means to advance the massage profession. This is now a reality due to the combined efforts of the Massage Therapy Body of Knowledge, professional organizations such as the Massage Therapy Foundation, continuing education providers who use research in their courses, authors and journalists who write about research in textbooks and journals, instructors who share their passion for research with students, and practitioners who use evidence when formulating treatment plans for clients.
I am particularly interested in cultural competence, as this was the topic of my doctoral dissertation. Massage education now includes meaningful discussions on ways to reduce barriers for minorities and underserved populations, including the LGBTQ+ community. (Intake forms now, for example, feature questions such as gender assigned at birth, gender identity, preferred pronouns, and preferred names, as they may differ from a client’s legal name or the name on insurance policies.)
Cultural competence also includes working through clothing when a transgender client who chooses not to undergo sex reassignment surgery elects not to disrobe. We want all clients to have positive massage experiences.
By emphasizing research, evidence-informed practice, and cultural competence, we have strengthened our position in all massage settings, whether it’s health care, spa and wellness, or private practice. The best way to change the massage profession is to change massage education. And it has changed—for the better!
Susan Salvo, PhD, a native of Louisiana, has a doctorate in education and a master’s in instructional technology. She has been in active practice since in 1983 and authors two widely used textbooks, contributes scholarly articles for peer-reviewed journals, and conducts presentations at professional conferences across the country. She reviews case reports for the Massage Therapy Foundation and serves as an expert witness for legal cases involving massage therapy standards of care. Her primary modalities are massage integrated with Trager and neuromuscular techniques.
While there are various factors influencing our growth over the years, it boils down to three key factors: regulation, credentials, and research.
Certification was originally developed to differentiate a practitioner who attended a formal massage therapy training program—and understood anatomy, physiology, kinesiology, pathology, massage modalities, and ethics—from those who did not. From its early stages, Certification provided therapists with a credential backed by a national organization under the strict credentialing guidelines of an accrediting body.
As few states regulated massage in the early 90s, Certification quickly became the standard of excellence. As regulation increased over time, Certification was integrated into regulation requirements—blurring the lines between Certification and licensure. Board Certification was introduced in 2013 as a direct effort to restore Certification’s original intent of setting apart highly qualified therapists.
The elevation to Board Certification by NCBTMB better-prepared therapists for working as part of a health care team. The Board exam was no longer for entry-level licensure—returning the credential to its original designation of separating therapists with a strong, research-based education and evidence-informed practice.
Like other professions, NCBTMB set strict eligibility requirements to achieve Board Certification, including the ability to pass a rigorous exam. The Board Certification Exam is clinically based, requiring advanced skills and knowledge in the areas of assessment, indications/contraindication pertaining to different pathologies, professional conduct and communication within a health care facility, ethical behavior, systems of the body, massage modalities for special populations, and business.
Furthermore, Board Certification is a credential that the health care industry understands and embraces—empowering massage therapists with a credential that speaks the same language.
As the body of research on massage continues to grow, our profession continues to evolve adopting evidence-based practices. As the Board Certification Exam is evidence-based, the research is closely monitored by NCBTMB and incorporated within routine exam reviews and evaluations to ensure content assesses the most accurate information.*
Beyond the benefit of a credential that speaks the language, the integration of research and evidence-based information within the BCETMB solidifies our role in health care; the health care profession also understands the value of research—especially when creating treatment protocols.
In short, the evolution of regulation, certification, and research are all reflected within the evolution of Board Certification. (NCBTMB provides a full BCETMB Outline/Study Guide for free on its website.)
By achieving today’s Board Certification, therapists demonstrate the necessary credential, authority, and expertise to further advocate for massage as a treatment of choice, as well as the importance of our role within an integrative health care team.
Portia B. Resnick, PhD, ATC, BCTMB, is a Board Certified and state licensed massage therapist and athletic trainer with over 20 years of experience in the sports medicine field. She pursued her massage education at Somerset School of Massage Therapy in 2003 and taught at the school until 2010. In 2017, she completed her PhD in kinesiology at the University of Hawaii at Manoa, where her research explored the use of heart rate variability as a clinical measure of recovery in NCAA Division I athletes.
I began the development of my Myofascial Release Approach in the late 1970s. Many changes have occurred in the massage and bodywork professions, including knowledge related to the benefits and advancements of myofascial release.
The following four phenomena are at the core of my Myofascial Release Approach. By understanding these principles and incorporating this approach into your bodywork and massage practices. you can greatly enhance your ability to help others.
Piezoelectricity is a Greek word, which means pressure electricity. It is a well-known fact that each of our cells are crystalline in nature. When you place pressure into a crystal it creates an electrical flow. The sustained pressure of my Approach to Myofascial Release coupled with the time element, 5 minutes or longer per restriction creates a bioelectrical flow in our body this leads to mechanotransducton.
Mechanotransduction; sustained mechanical pressure can also create biochemical changes within our bodies. Importantly, Myofascial Release produces interleukin 8, our bodies own natural anti- inflammatory agent.
Research has shown that inflammation is an important part of the healing process, however when inflammation has been thwarted it tends to solidify the ground substance of the fascial system which should be fluid. This then blocks healing and over time tends to continue to solidify in into crushing restrictions that produce the symptoms that many of your clients come to you for treatment. Returning to cause, it is not enough to just treat the effect or symptoms.
3. Phase Transition
These two occurrences, piezoelectricity and mechanotranduction dove tail together and then Phase Transition takes place. This is the phenomena of ice transforming into water. In our bodies a similar occurrence happens. The solidification of the ground substance becomes more fluid allowing the tissue to rehydrate and to glide taking crushing pressure off pain sensitive structures.
When one human touches another human their vibratory rates are quite different on the molecular level, however with sustained pressure at the fascial restriction, the vibratory rates will become identical creating resonance. Resonance is the very essence of my Approach to Myofascial Release. This is what I call a “Release.” Release occurs both in the cranial area and throughout the body.
Resonance unfortunately does not occur in other forms of therapy due to the sheer fact that these other forms of therapy are too quick, hence providing only temporary results. The good news is that Myofascial Release coupled with the various forms of therapy, massage, bodywork and energy techniques enhance your effectiveness.
Read research on resonance here.
John F. Barnes, PT, LMT, is the president of the Myofascial Release Treatment Centers, “Therapy on the Rocks” in Sedona, Arizona and ‘The Sanctuary’ in Suburban Phila., Pennsylvania, which is also the headquarters of his International Myofascial Release Seminars. He has trained over 100,000 therapists and physicians in his highly successful Myofascial Release Approach. In addition, John F. Barnes, PT has been a keynote speaker at the American Back Society Symposiums for over 25 years and presented myofascial release at their recent symposium whose theme was the most important advances in health care in the last century.
Read “The John F. Barnes Approach to Myofascial Release,” by John F. Barnes.