Posted: February 27th, 2012 | Author: admin | Filed under: massage | Tags: education | No Comments »
Here at the Foundation we’re very excited about case reports, and empowering folks to write and submit them. They are the number-one way (along with donating to the MTF!) for regular therapists to transform the research landscape of massage therapy.
What is a case report, anyway? It’s simple: a case report is a story from your clinical practice, translated into a common format (Intro/Methods/Results/Discussion), and then shared with your colleagues out in the world. The reasons to write a case report are many, but the biggest reason is this: it’s what you should do when you have something to share. It’s part of our responsibility as clinicians to occasionally open a window into our practice, so that others may benefit.
When I say clinician, I’m talking about you. The person reading these words. Someone who gets paid to help people feel better, function more fully, and awaken more fully into themselves. What happens in your practice? What do you wish could be seen by physicians or researchers? What is common but undocumented? What is vexing or mysterious? I want to know.
I can tell you one mystery that has thoroughly disappeared: “How does one even get started with a case report?” If you’ve done the work of becoming licensed in massage therapy, you have the necessary skills to begin. Getting done is a bigger challenge, but we’ve got your back there, too:
Want to know how case reports are put together? Check out the Massage Therapy Foundation’s case report contests for step-by-step guidelines, outside resources, and examples from past contest winners. Do you feel rusty with finding or understanding research articles? Enroll in our excellent new online course – Basics of Research Literacy. Are you looking for inspiration or indignation? Just type the words “massage therapy case report” into Pubmed.gov and click on the first thing that looks interesting.
The most important thing is begin the story. Everything else is grounded in that act. Your first draft doesn’t need to be fancy — just write as if you were speaking to a colleague.
Here, I’ll start:
Case Report. A 30 year-old male patient hands me a self-typed letter that carefully conveys his medical history: a rare form of leukemia that took him down fast but somehow decided not to kill him.
He was eighteen when the cancer announced itself and confined him for years to a hospital bed. It was surreal for him to be suddenly so infirm, but by that time he had already accrued a lifetime of random calamity: A freak car accident at age two. A wicked bike fall at twelve. Broken bones and open wounds. Avascular necroses in his hips and knees. Thyroid and pancreatic swings. His eyes meet me briefly and then return to some distant horizon. He speaks quietly, as if sharing a secret, not entirely believing his own presence in the room.
His reason for visiting me is symptoms relating to the most recent diagnosis: Graft-versus host disease (GVHD). It’s an auto-immune reaction instigated by some donated bone marrow. His immune system, stimulated by an intermittent sense of invasion, had proliferated its inflammations and fibroses in a variety of ways. GVHD is a trickster disease, able to mimic a number of other autoimmune disorders and then morph into new modes. In recent years, the condition had manifested like a patchy, regional scleroderma. The skin on his left ribcage, left shoulder, left neck and left arm contains a number of quarter-sized skin adhesions, where the superficial fascia had spontaneously scarred and grabbed hold of the overlying epidermis. Each adhesion is colored a little pale, depleted of its melanin, and his normally mobile skin is like stiff leather under my fingertips.
He says his left shoulder felt glued down, stuck, tight and sore. The drape of his t-shirt and the taut meat below conveys a sense that his left upper trapezius has been suffering under heavy downward opposition. His knees and shoulder sockets ache “occaisionally” but he said they feel “OK” today. His low back ached more or less all the time, and he described his neck as “stiff but not usually painful”. I asked about headaches, and he said “Not usually. Not for long, anyway.”
He says that he wants freedom in the left shoulder, some reduction in back pain, and maybe some better sleep. I have him remove the t-shirt, and I notice that several of his adhesions lie along the path of cutaneous nerve roots (C6 through T4 dorsal rami on the left side) and the radial and axillary nerves of the arm. The overall effect is one of strapping the scapula close to the upper ribs, and the trapezius, serratus anterior, levator scapulae, and rhomboid muscles all seem to struggle mightily during scapulo-humeral abduction. The arm feels to me like it wears a tight stocking, and every motion seems oppressed by this constrictive garmet. He works as a carpenter-contractor, is two years married, and had recently recovered enough to finish his GED.
I figure that some careful fascial release might be able to improve his shoulder mobility, and to the degree that cutaneous nerves were entrapped, it would be worth trying to free them. However, I’m concerned about inflaming the tissue, especially with a mysterious autoimmune process going on. I will have to cover ground slowly, and ask for communication as we do the work. And what about his pain perception, given the gnarly history of accidents and hospital care?
“I… don’t have a normal relationship to pain”, he says.
“In what way?”
“If a pain is really bad, I feel it for a second, and then I kind of turn it off.”
His leukemia treatment ten years prior had involved a thick stream of pain medications, but he didn’t like the mental haze or the digestive side effects. “I hated the painkillers, so I started not taking them. I just learned how to change what I’m feeling.” The doctors were dumbstruck, he says.
I could respond in any number of ways, but our intake time is already lengthy. “Can you feel this pressure?” I ask, pressing my thumb with medium force into his forearm.
“Ow, yes” he replies.
“That’s what I don’t want to exceed in our work. So let me know, ok?”
“OK.”
Fast forward three months. So far we’ve had 8 hour-long sessions. Our results have been mixed: In terms of shoulder mobility, we’ve had some good success. The first 3 sessions, especially, saw him go from severe limitation to only mild restriction (e.g. He went from a labored 70 degrees scapulo-humeral abduction to a comfortable 120.) “I’ve never gotten that kind of relief with massage” he reports with a sigh. The cutaneous adhesions have also reduced in size and number, although the skin remains discolored in the previously adhered spots.
His back pain has been fluctuant, but overall I don’t think it’s improved. There is still generalized ROM limitation, point tendernes, and muscular hypertonicity throughout his thoracic and lumbar spine. It has admittedly been a secondary focus. It’s also possible that a reduction in exercise is to blame: He’s been sitting in college classrooms recently, and running less.
His sleep disturbance had some early improvement, but then did not seem correlated with receiving massage. He tells me halfway through that his thyroid medication is “messed up” again, and that he’s waiting to adjust it with the doc. Two sessions later he says the sleep has normalized since reducing his thyroid medication.
Our current plan is to re-focus on the back pain, and leave the shoulder complex as a secondary focus. He seems quite grateful for the work, and seems less focused on his symptoms and more on the day-to-day frustrations of a carpenter and a 30-year-old college student. I take this as a good sign: perhaps he his comfortable enough most of the time to indulge in more pedestrian complaints.
I have to admit that as the sessions progressed, I became less focused on the tissue-level pathology, and more aware that his definition of “health” was expanding along with his range of motion. As I gained familiarity with his body, my clinical intent shifted to include not just fascial release, but kindness and embodiment.
My early tendencies as a massage therapist were to become so enthralled with dramatic conditions that they made opaque the person suffering in front of me. My role, I thought, was to understand, and in the absence of understanding, I could not really treat. My tools were few, but my curiosity was relentless, and this mostly worked well. The trigger points were found and muscles made loose. Scars were frictioned and ranges of motion increased. Except that this constant striving made me unable to arrive. Their healing would be a victory in my mind, their stasis a defeat, and I would sacrifice their sense of independence for my sense of accomplishment.
I wonder now if my early patients left feeling well-examined but never truly heard. It’s a constant balancing act when you’re asked to deploy a compassionate art within the constraints of a complex medical condition. The best sessions — from my perspective — seem to be those where love for the work and love for the patient seem to be one and the same.
I’m curious how other massage therapists have dealt with similar situations, and I’m looking forward to the day when we have better evidence around the efficacy and contraindications of massage for autoimmune conditions like GVHD.
The Massage Therapy Foundation offers two Case Report Contests each year: one contest is for Practitioners (submission deadline is October 1 annually), and another contest for Students (submission deadline is March 1 annually). Learn more by visiting the Case Report Contest section of our website.
Mike Hamm teaches anatomy, technique, and research literacy at Cortiva Institute Seattle, and maintains a full time bodywork practice focused on orthopedic injury and trauma recovery. He was the winner of the Massage Therapy Foundation’s 2005 Student Case Report Contest, and presently serves as a reviewer for the Foundation’s Professional Case Report Contest. He has published articles in various research journals and trade magazines on subjects including nerve entrapment and research literacy education. When not teaching or doing bodywork, Mike plays music in a Seattle band.
Posted: February 22nd, 2012 | Author: admin | Filed under: massage | No Comments »
We are pleased to announce the conference themes for our 2013 International Massage Therapy Research Conference – Presented by the Massage Therapy Foundation (IMTRC). We are excited to release the Call for Abstracts for the IMTRC as well!
The 2013 IMTRC will:
- Present research findings that help explain how massage therapy works through physiological, psychological, and neurological mechanisms;
- Emphasize the potential for community outreach programs to provide research data through evaluation, and discuss program implementation strategies;
- Explore the current status of massage research in preparation for updating and advancing the Massage Therapy Research Agenda.
Call for Abstracts
The MTF is now requesting abstracts for all oral and poster presentations that focus on the above themes. Submissions are welcome of original research, reviews, basic and applied research, translational, participatory and community-based research, case reports and quantitative, qualitative and mixed methodologies. Accepted abstracts will be published in our open-access research journal, the International Journal of Therapeutic Massage and Bodywork (IJTMB). The abstract submission deadline is September 15, 2012.
Download the full call for abstracts with submission guidelines [PDF].
Download the Abstract Submission Template [Doc].
This is the third research conference hosted by the Massage Therapy Foundation, bringing together massage and manual therapy practitioners, educators, CIM researchers, allied health professionals, and others interested in massage research. Registration for the conference will open in October 2012. Learn more about the 2013 IMTRC.
Posted: February 6th, 2012 | Author: admin | Filed under: massage | No Comments »
Much of Massage/Manual Therapy tends to focus on the soft-tissues and under the soft-tissue ‘umbrella’ is FASCIA. Therefore is seems clear that fascia must be considered in all aspects of soft-tissue assessment, treatment and pre/rehabilitation. But, how can we develop a sound understanding of fascia when it has been largely research-ignored and therefore not comprehensively included in commonly used health science educational materials?
The International Fascia Research Congress, a continuing series of conferences dedicated to the emerging field of fascia studies, is making great strides to amend this oversight.
As a Silver Sponsor of the upcoming 3rd International Fascia Research Congress (FRC 2012), the Massage Therapy Foundation again steps up to honour its commitment to advancing the knowledge and practice of massage therapy by supporting scientific research and education.
Considering fascia in the mix calls us to reconsider much of what was and, for the most part, is still being taught within the realm of soft-tissue related health sciences.
In an article featured in Massage Today, Whitney Lowe LMT poses the question: Does Fascial Research Alter Assessment?
Lowe explores this question citing the following example: certain orthopaedic assessment procedures operate from the premise that contractile soft-tissues (e.g. muscle/tendon) can be isolated from non-contractile soft-tissues (e.g. ligament), thereby providing a clear indication of the involved/injured tissue which in turn dictates the selection and delivery of treatment and rehabilitation measures.
Now, consider the work of Jaap van der Wal (featured at the 2nd FRC – 2009), which challenges the classical understanding that most ligaments are only (passively) lengthened or shortened during movement of associated joints and substantiates the presence of direct fascial connections that link ligaments and muscles together in series. An in-series/fascial link demonstrates that ligaments will have tensile loads applied to them when muscles contract – with or without joint movement. Therefore, isolation of contractile/non-contractile tissue via currently taught assessment procedures no longer seems plausible.
Van der Wal’s work is only one (albeit fantastic) example of the need for an extreme make over: soft-tissue edition – one that includes the dynamic nature of fascia.
Current fascia research not only insists on the alteration of assessment procedures, which in turn impacts the selection of treatment measures, but also calls us to reconsider much of soft-tissue anatomy and physiology as we knew it!
It is essential for any one engaged in a soft-tissue modality to more fully understand fascia’s neurobiology, response to stimuli, trauma, demand, contractile capabilities, significant anatomy features (e.g. normal/abnormal presentations) and functions.
The Massage Therapists’ Association of British Columbia (the hosting sponsor) invites you to advance your fascial knowledge by attending the 3rd FRC.
Don’t let all this great fascially-significant information sit idle collecting dust.
“Knows” cultivates knows how, which shifts into does, which then results in more effective outcomes – benefitting all stakeholders!
For more information go to www.fasciacongress.org.
Posted: January 6th, 2012 | Author: admin | Filed under: massage | Tags: inspiration | No Comments »
In 2010, Heidi Pannke, a massage therapist and Alternative Medicine Coordinator at Outside In in Portland, Oregon, was awarded an MTF Community Service grant for $5,000. Through the MTF grant, 200 homeless and severely mentally disabled Portland residents were provided with massage over the course of the year. The grant provided funding in the first year of this program, and allowed the program to continue to grow in subsequent years. We asked Heidi to discuss what led her to apply for an MTF Community Service grant and how receiving the grant impacted Outside I. Below is her story.
It had always been my dream to have more massage at the Outside In Clinic. We’d had acupuncture students coming in, as well as a volunteer chiropractor, but there was hardly ever any massage therapy. I thought, “if only we could have massage therapy here more often, great things could happen.”
Heidi Pannke administering a massage to a client at Outside In
The Outside In Clinic primarily serves homeless youth, (although other marginalized people are included as well) addressing their various needs, through case management, housing, education, employment, and medical services. Many of the youth that Outside In serves had never had a massage before I worked on them. I would always wonder if any of them had ever received any positive healing touch at all in their lives.
In early 2009, the clinic staff was at a retreat and we did an exercise where we all wrote down what our dreams were – I wrote down that my dream would be to someday offer massage at Outside In. I began working at Outside In before I got into massage school. I was hired because of my Spanish speaking abilities, and worked in the medical clinic as an interpreter. It was from working with these clients that I began to feel that I would like to do something more to help out, and after receiving a lot of massage myself one summer, I felt called to enroll in massage school.
I started my massage classes, all the while still working part time interpreting at the clinic. Once I graduated and became a licensed massage therapist, I worked part time at a chiropractor’s office, but this wasn’t fulfilling to me. I wanted to do something more with my massage license; I wanted to be able to offer massage to our clients at Outside In.
John Duke, the director of the clinic, came to me after that retreat, and let me know if I could find a massage grant, he would help write it. I did find a grant, the Community Service Grant from the Massage Therapy Foundation. The grant was written, and a few months later, we were informed that we got it.
It was a bit of a slow start as we were figuring out how best to incorporate massage therapy into our clinic services, but once we got going, it became one of the most popular services for our clients. Some of the feedback I got from our clients was amazing. One young man who had been in and out of mental institutions his whole life, told me if he could get a massage every week, he wouldn’t need to take so many of his medications, and that for once in his life, he felt good and didn’t feel so depressed anymore. Another young lady who was struggling to get off heroin told me that the massage helped her body feel relaxed during the detoxification process. I consistently heard so much gratitude from our clients, with them telling me it was the highlight of their day, their week, their month, their year.
The grant ended in August of 2011, and since then, we have consistently had massage at the clinic four times a week. We are going to be renovating the CAM space soon, and there will be a spot for four massage tables. We are in talks with a local massage therapy training program about the possibility of bringing their students to our clinic for their clinical rotations. None of this would have been possible without the MTF grant.For about 6 months of the grant, I would take my massage table out every week to one of the clinic’s outreach sites, a social service agency that helped older homeless folks find housing. Some of these clients had not seen any sort of medical providers for sometimes upward of 20 years. But once they heard a massage therapist was there, they were eager to sign up. Sometimes clients would reveal very serious things about their medical history, and I would encourage them to follow up with one of our doctor’s. Several of my clients did, and are now receiving primary care through our clinic. One client told me he didn’t think anybody cared about him before the massage, and he was so appreciative that I came out to do this.
Heidi Pannke
Massage Therapist / Alternative Medicine Coordinator / Records Fairy
Outside In – www.outsidein.org
About Outside In
The mission of Outside In is to assist homeless youth and other low-income and marginalized people move toward improved health and self-sufficiency. Outside In, established in 1968, has continually revised services to respond to changing client needs. Current programs include a Clinic and Homeless Youth Department. The clinic is a cutting-edge blend of western and alternative medicine. It is a teaching site for Oregon Health Sciences University, and the National College of Naturopathic Medicine, providing western medicine, naturopathic, acupuncture, Chinese herbal, chiropractic, massage and dental care. The clinic provides over 17,000 visits annually for homeless youth and homeless and low income adults. In addition to the on-site clinic, our mobile medical outreach program uses a 38-foot medical van with 3 exam rooms, a lab and electronic medical records to take medical care to isolated populations who lack access to care. You can learn more about Outside In by visiting their website at www.outsidein.org.
To read about all of the Community Service grants that were awarded by the MTF in 2010, read our annual report: massagetherapyfoundation.org/2010annualreport/
