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Issue 109 2020
www.massageworld.co.uk
A New Way of Working in CAM Treatments Following COVID-19 Remote Business Opportunities Understanding Research for the Massage Therapist £5.00
NEW! Susan Findlay Massage Mentor
MASSAGE THERAPY | REFLEXOLOGY | BUSINESS TOOLS
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welcome editorial by Wendy Kavanagh
EDITOR
Wendy Kavanagh
FEATURES
Earle Abrahamson Pauline Baxter Kate Browne Ruth Duncan Rachel Fairweather Susan Findlay Emma Gilmore Jane Langston Meghan Mari Nana Mensah Greg Morning Giacomo Sandri Sarah Jane Tepper Ian Tennant Madelaine Winzer Mark Woollard Marina Young
GRAPHIC DESIGN
Victoria Osborne
MEDIA COMMUNICATION
C J Newbury
PUBLISHERS
NK Publishing
illions of people have been staying inside and working from home, highlighting the huge impact our living space has on our lives as we interact with clients, friends, and families through the likes of Zoom and Skype. COVID-19 has caused a mass of anxiety throughout the world, especially for massage therapists as caring touch is integral to our industry.
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Massage therapists have had to think outside the box when it has come to remote working. Emma Gilmore talks about the different ways you can work from home as a massage therapist and what you need to take in consideration when doing so. Some massage therapists have taken this time to improve their websites and social media platforms, while others have taken this time to expand their knowledge through research and online courses. In this issue Greg Morling gives some new perspectives on research designs that might truly reflect the way we work and the wellbeing we hope to foster in out clients, while Kate Browne explains the ways in which art can be used to learn anatomical terms. It is an uncertain time so try to stay positive and enjoy the summer!
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contents
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issue 109 2020 Features 8 Massage World Mentor
If you have been subscribing to MW for a while you will know that Susan Findlay has been our Sports Massage writer for many years and we thank her for that. Susan has now adopted a new and exciting role, that of our readers Massage Mentor. Please feel free to send any questions into MW that you would like Susan to discuss.
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12 Exceeding the Limits We are all individual. What is right for one person is not necessarily right for another. In this article Pauline Baxter talks us through what factors we need to consider when we are working to make sure we stay within our limits.
16 Understanding Research for the Massage Therapist Greg Morling offers therapists and those who aim to engage in research in our tactile garden, some new perspectives on research designs that might truly reflect the way we work and the wellbeing we hope to foster in our clients.
20 Body Within the Mind Giacomo Sandri presents and discusses the evidence for the existence of the mindbody network, from a Western science perspective.
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24 Bringing Anatomy to Life Anatomy and physiology are the very foundation of what we practice. However, for some of us learning anatomical terms can be challenging, which is why Kate Browne believes in bringing anatomy to life through body painting. She explains how art can be used to learn anatomical terms and also connect with other therapists in your local area.
34 Remote Business Opportunity 2020 has shown us that if you think outside the box, almost anything is possible. Would you like to work remotely to support your clients but lack confidence or simply don’t know where to start? Emma Gilmore provides an introductory guide and some ideas to help you to develop your skills and communicate clearly with your existing and potential clients.
44 Resuming Treatments Following COVID-19 Positive touch is instrumental in our basic human need for connection and belonging. Therapists provide this for their clients, and the inability o connect at this level has had a profound effect amid the COVID-19 crisis. Sarah-Jane Tepper explains how the industry has changed since lockdown and what aspects we will need to consider when resuming treatments.
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Regulars 3 Editor’s Welcome 6 News & Views 32 Book Reviews 41 Reflexology 56 Course Listings Issue 109 2020
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news&viewsnews&viewsn Association of Physical & Natural Therapists’ stance on returning to practice During the closure of all practices due to CoVid-19, we have actively liaised with our affiliated bodies such as GCMT, and our lobbying body The Integrated Healthcare Collaborative as well as our own independent liaisons with the relevant government bodies. Some of the actions that have been taken was a collaborative letter from ourselves and several leading Professional Associations written to the Chancellor of the Exchequer, the Rt Hon Rishi Sunak MP, calling for action to limit financial hardship for this subsection of the self-employed who may have ‘fallen through the cracks’ to receive assistance. More information on that letter and work done within the IHC can be found, here: www.theihc.org.uk/news However, when it has come to producing ‘back to practice guidance’, we have unfortunately found that our industry has had a very incohesive front. While many PA’s rushed to put together guidance in very early days from internet searches, this approach did not resonate with us so we chose not to send this guidance to our members or to include ourselves in their development. We found PA’s were using government PPE guidance based on high-risk settings for frontline healthcare professionals and it only took a quick glance in massage forums to see that the guidance being produced was causing panic and anxiety within our industry. I want to highlight again that APNT’s aim is not to get Therapists back to work ‘as quickly as possible’ but instead ‘as safely as possible’. Our aim is protecting the industry, and we have taken a strong stance with other PA’s from the beginning that we would not support these guidelines OR our industry going back to work if the government required the same level of PPE required in high-risk frontline settings as the potential for damage is just too high for an unregulated and non-standardised industry.
found here: https://www.apnt.org/covid-19 . This guidance will be regularly updated, so please check back often for the most up-to-date advise. In terms of the question on EVERY Therapists mind, ‘When will be able to return to practice?’ – It must be understood that the answer to that question varies across regions as they are all following their own individual Roadmap. Some of our government sources have hinted the possibility that ‘massage’ in particular may not be able to return until social distancing measures have been lifted; however, we cannot confirm this is the case. We will update you accordingly.
Instead, in the last weeks, we have utilised our government contacts to help us design our own guidelines based on a low-risk non-frontline setting, both under the circumstances of social distancing still being in place as well as being lifted. This Guidance as well as answers to many FAQ’s can be
Britney Spence APNT Chair www.apnt.org
GCMT Statement on COVID 19 As a Council tasked with the protection of our professional associations and the public, and in light of the developing situation with the recent outbreak of coronavirus (COVID-19), we refer organisations and individuals to the following guidance. The information and guidance is being updated regularly by the Department of Health and Social Care as well as Public Health England as the situation develops, so please remain alert for any updates.
Guidance can be found here: www.gcmt.org.uk
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snews&viewsnews&views Kneader Chair Massage Kneader Chair Massage mixes holistic massage, acupressure/trigger points and passive stretching in an award-winning routine that’s done with two Kneader massage tools. This technique is also an attractive choice for both therapist and client because it’s over clothes and done with two massage tools that are easily washable, which may be a more convenient option in these post-lockdown times. Kneads Must’s new, online course is for qualified level 3 (or above) massage therapists to learn the Kneader Chair Massage routine in their own space and at their own pace. This short course is accredited for 15 CPD points and is insurable with several top industry providers. Course participants will have all online material for 6 months and will have unlimited access to (even as alumni) to our closed Kneader Chair Massage Facebook group, where there will be weekly Q&As, videos and information sharing.
Check out the course page at kneadsmust.thinkific.com/courses/chair-massage (or via the Kneads Must website) and take advantage of our half-price introductory offer to help you earn CPD points, protect your hands and grow your business.
Think tree Hub Free Covid-19 Online Course As we await Governmental instructions on when and how we can return to work we need to do some serious thinking about how we will protect both our clients and our clinics when we do. As diverse as our industry is, it is generally one where we cannot make our businesses “Covid Secure”, working at a 2 metre distance is impractical, if not impossible. However at some point, once the risk subsides further, this ruling will be relaxed and we will need to be ready to work in a world where Covid-19 is both a risk and a reality. We need to be thinking ahead as to how we can make this work while protecting ourselves and our clients. This course is designed to take you through that thinking to check that you have done everything possible and to be able to display certification so that your clients know that you are taking their welfare seriously. Massage World advises therapist that if you can sign up and complete this course we have had some fantastic feedback from therapists who have already completed it.
Sign up here: https://thinktreehub.com/
Issue 109 2020
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Susan Findlay
Massage Mentor Mentor [noun]: a person with experience in a job who supports and advises someone with less experience to help them develop in their work
I have enjoyed my role as the feature sports massage writer for Massage World, but like you, I have evolved both personally and professionally over the past few years. Today I feel as though all of my professional experience has finally culminated into a solid direction in which I want to take both my career and my voice. I believe I am now in a position to be a Massage Mentor.
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massagementor susan findlay
found myself more and more interested in the medical side of soft tissue therapy. I therefore went on to train in many other areas of remedial soft tissue therapy that would give me the depth of understanding I so desired. I have been privileged enough to study with thought leaders and experts from groups that include: visceral massage, biotensegrity, fascia, as well as explore the benefits of massage therapy on pathologies such as cancer. Even my skills as a dancer have been woven into how I teach and work as a soft tissue therapist. As a dancer, I was taught to have an understanding of the need to move with a whole body connection, and to be light in those movements; otherwise you become a dead weight when a partner wants to lift you, or you cannot achieve the power needed to jump or pirouette. The whole basis of my body mechanics series, and elements within my book draw on this skill and knowledge that I formed while being a dancer. Whole body connection and lightness of movement are two key elements in being able to achieve depth and feel in your touch.
have learnt an awful lot during the last four months of lockdown. It has been, without doubt, one of the most stressful and frightening periods of time for all of us within the massage industry. With little to no notice, we were shut down, and for weeks if not months we were uncertain whether we would ever be able to resume again. Of course we can, but there will be a new normal, and we will all need to adapt in order to survive. I am however, a glass half full type of gal, and over the last week or two, I have been thinking about the positives I can take from this downtime, and how I can use them to inform my new career move. This article will examine my career history and track my journey from where I began to where I have come to, while looking at what I have been able to learn through this pandemic that has sealed my decision to make this move. Sports massage was my original massage qualification, but as I had previously enjoyed a career as a nurse, over time, I
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During the last few months, I have been observing the conversations that are taking place on various social media platforms, and I have found myself mentoring and supporting other therapists more and more. I suppose that was my eureka moment. I realised that mentoring those within our field to be the best therapists they can be, with long-lasting, sustainable careers, was where my skills and expertise were all taking me. Before lockdown, it was not unusual for me to hear that a therapist was suffering with multiple injuries as a result of the work they do. Many times I spoke with therapists who would tell me that they were so exhausted by the end of each day, that they were on the verge of burnout and leaving the profession. Too many massage therapists overuse their thumbs, have tight and sore shoulders, lower back complaints and can finish a working week feeling absolutely broken. I want to help therapists resolve these problems. I know that my career as a nurse, a soft tissue therapist and a massage
teacher means that I am equipped with the knowledge and techniques to help you all work smarter and more efficiently. During lockdown, one of the most important things I have learnt, is the importance of allowing yourself time. There is a quote by Leon Brown, which says: “The answers you seek never come when the mind is busy, they come when the mind is still, when silence speaks loudest.” This has been what I have found during the last three months. Allowing my mind some peace and quiet, has given me time to refocus, figure out what is and isn’t important, it has given me clarity of purpose. I have been able to strip away the distractions and revisit my ‘mission statement’. For many reasons, I found myself on another path, waylaid. I got caught up on another to do list rather than following the path I had originally planned. Another thing I have learned during this period is, embarrassingly, advice that I give to my clients all the time; you must find a balance in your work and home life. I thought I had this sussed, what a contrast it is in comparison to my new now pandemic lifestyle, I feel like a completely different person. I sleep better, I move more, I’m a healthier eater, I have learned to feel and appreciate the moment, I am happier. These lessons that I have learned are so important and will form the foundation of my mentor program. If you want to have a long lasting sustainable career, self-care needs to be your number one priority. Don’t get me wrong, as I mentioned earlier; lockdown has caused me a lot of stress and anxiety. It exposed things within my company and myself that I didn’t want to look at. But that’s the thing – when you are forced to look at your weak spots, where you are vulnerable, you then have the choice – ignore it and fail, or do something about it and move forward. In business in general we need to have the courage to look at what’s not working and ask ourselves why. If you bury your head in the sand every time your thumbs ache, and pretend that the pain will go away, you will likely lose your career. However, you can do something to protect yourself and ensure career longevity, and this is where I hope that I come in. Issue 109 2020
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massagementor Susan Findlay
Life is about growth... if we want to be successful in business we need to look at the good, the bad and the ugly, and be honest with ourselves, we have the power within ourselves to make changes in all that we do and affect.
Life is about growth, sometimes it is uncomfortable but if we want to be successful in business we need to look at the good, the bad and the ugly, and be honest with ourselves, we have the power within ourselves to make changes in all that we do and affect. What I hope this new section in Massage World will offer, is a place to open up a dialogue expanding on the pain points and issues I see and hear every day among therapists. I am not going to be that person who advises you how to increase your email list, we have experts like Tor Davies from Co-Kinetics who I would highly recommend for most things business. Equally, I am not going to teach you new techniques, there are many great schools; a number of them even contribute to this magazine. What
I would advise if you are looking for a school is to look to those that invest in the industry, who are part of the conversation, and who obviously are looking out for your best interests. As I have already said, my new career goal, and therefore the aim of this section within Massage World, is to mentor fellow therapists. Impart the invaluable lessons that I have learned along the way. I will show you all the tricks of the trade that will increase your hands-on skills. I will engage you in discussion to help you learn how you can elongate your working hours, while staying in your comfort zone. If you want to learn how to apply techniques with ease, meet the needs of your client, no matter the depth, position or size that they are, and not burnout, I can help you! I am so looking forward to starting this new chapter and I hope you’ll join me.
Susan Findlay is the Director of NLSSM and Chair of GCMT Communications. She keeps her hands in as a Sport and Remedial Massage Therapist in north London. She is also the author of Sports Massage, a practical book for all massage professionals wanting to work more effectively as a sensitive and deep tissue therapist. Susan can be contacted at www.nlssm.com or email her at susan@nlssm.com
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Exceeding the Limits By Pauline Baxter re you going over the top? You have your chair, you have ensured you are ‘fit to massage’, and you’re off. It is always exciting when you get a new corporate contract. It gives you so much opportunity to show how effective massage can be and how good you are at delivering it. You love how grateful people are for how you make them feel after their massage. Life is good. What’s more, there is so much potential for additional business from referrals, particularly from your corporate clients. Fantastic! And so you push on to gain more corporate contracts, giving you the opportunity for more regular income (compared to individual clients). But you don’t want to neglect your private clients, so you fit their appointments around your corporate contracts. This may mean a day of corporate work followed by an evening of appointments. It makes for a long day, but think of
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the money. After all, there are no guarantees of income (as the current coronavirus situation confirms), so you have to take the appointments whenever you can. Sound familiar? I think most of us have, at some point, been in this position to varying degrees. This is usually, when either first starting out in your business, or when you add an additional skill to your repertoire. You know how beneficial massage can be and you really don’t want to disappoint your clients. So you find a way to ‘squeeze’ in their appointment. You tell yourself you will be fine and your massage will be just as good as always. Besides, the extra money will be useful. It will be fine. But will it? In this situation, you are going against all your training, code of ethics, qualifications, knowledge and even common sense. You are basically putting your own health at risk, and possible that of your client’s. Not to mention being unable to provide the best massage you can for all your clients.
massagefeature exceeding the limits
Clearly, this practitioner was not working within their knowledge, ability or limits. They were also potentially putting the health of the client at risk. Whilst this situation may be the exception to the rule, it highlights the need for practitioners to understand what information they need from their client and what questions to ask to get it.
Health You need to take into account your own health, both current and historical. This clearly applies physically, but don’t forget about the mental health aspects of providing massage. We are probably all aware that some clients have the potential to leave you feeling drained of energy. It is very likely you have already experienced this during the early days of your training and business. Not ideal for you as a massage practitioner! You have to learn how to protect yourself but still be able to provide the highest quality, safe, and effective massage you can.
But it will be fine. You are relatively fit and healthy. You know what you are doing. It will be fine…won’t it? We are all individual. We have our own level of health (current and historical), abilities, skills, lifestyles and personalities. What is right for one person is not necessarily right for another. You have to consider all aspects and work within your limits. Limits can be personal and environmental.
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Training provision There has been a definite increase in the number of online training courses and webinars in many industries. No doubt over recent weeks you will have been inundated with such courses and may have signed up to one or two, or several. I know I have, ranging from work to personal interest. This surge in online training has probably made you wonder what you can currently offer your clients? I would be very surprised if you haven’t. Some things may be more adaptable than others for online appointments. It is clearly easier to carry out an appointment with talking therapies than it is for hands-on massage. It may not be your preferred option, but it is an option. Some practitioners are providing short webinars/training for self-massage, use of essential oils etc. These can be beneficial to your clients and potential clients.
From a personal front, you need to consider a number of things: • Training/qualifications/ability • Health (physically/mentally/ emotionally)
Ability Just because you trained and qualified in a therapy, it does not necessarily mean you are capable of, nor comfortable with, every technique of that therapy. Something seen at an exhibition some time ago, a practitioner asked the client to complete a health questionnaire. The client duly completed the form. The practitioner took the form and placed it on the table without a mere glance. The massage went ahead. Only afterwards did the practitioner turn to a colleague and ask, ‘What’s diabetes?’ When the colleague managed to pick her jaw up from the floor, she enlightened the practitioner and suggested retraining or to attend a refresher course. Issue 109 2020
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massagefeature exceeding the limits
A word of caution If you are providing online information, there are a number of considerations: • Are you discussing, providing guidance or teaching? • If teaching, are you qualified to teach? • Does your insurance cover you to teach? • Does your insurance cover you to provide online training? • Are you qualified in the subject about which you are teaching? (you would be surprised!) • What platform will you use to present your training and is it GDPR compliant? • Will you be providing slides or downloadable handouts? The aim here is not to put you off from providing online guidance or training, but simply to point out some of the things you may need to consider.
Environmental This covers a number of things. The main equipment used by massage practitioners will be the massage chair or couch. Manufacturers of this equipment should provide safety guidelines which include a limit to the weight placed on the equipment. Although our main focus is the massage chair, I do want to briefly discuss your massage couch. On occasion, practitioners have been known to climb onto the couch (whilst the client is lying on it), to carry out some techniques. This raises a number of obvious safety issues, not least of which is the ability of the practitioner to safely balance on the couch. Perhaps one that isn’t quite so obvious is the weight-bearing limit of the couch itself. Should you decide to carry out techniques which involve you being on the couch at the same time as your client, you need to consider your combined weight. Then think about the pressure you are going to apply. Is it over a particularly vulnerable part of the couch? This is perhaps more significant with a fold-down, portable couch rather than a fixed couch.
The situation is slightly different for the massage chair as it is unlikely you are going to ‘climb onto’ the chair whilst your client is sitting there. However, there are many different makes/styles of chair, each with their own limitations. We talked in detail last time about what you need to consider when purchasing your first massage chair. This included the framework, weight, adjustability, maintenance, durability and manufacturer guidelines. The guidelines should indicate the maximum load for the chair as a weight-bearing piece of equipment. Providing the chair is used in the manner for which it was designed, of course. So far, so good. Now consider techniques used by some practitioners. It is not unknown for a practitioner to place their foot onto the arm rest, while simultaneously working on the extended arm of the client. This clearly adds a degree of additional downward pressure on the armrest. Very few chairs, if any, are designed to withstand this sort of pressure so you would be in danger of damaging the chair, your client and you. Any resulting damage or injury would likely mean your warranty and insurance are invalid, as the chair has been used in a way for which it was not designed. Another area that can be more vulnerable to weight/pressure is the headrest. Many chairs have adjustable parts which allow you to ensure the client is in a comfortable and safe position. These points of adjustment are susceptible to wear and tear through normal use. If you then add extra pressure to these vulnerable areas then you are likely to damage the chair and possibly injure your client. An example of extra pressure could be the practitioner leaning on the headrest, or applying downward, vertical pressure. Being able to work We currently find ourselves in a situation that we could have never imagined. Covid-19 has had a global impact and will continue to do so in the future. We have had to learn to adjust and adapt in so many ways. This has forced many of us to rethink our businesses and how we work. As the lockdown begins to ease, there is a shift towards business beginning to function. The way in which they function has changed for us all. Whether you choose to simply offer the same services you offered prior to Covid-19, develop a new ‘arm’ of your business to include some online training/appointments, or learn a new therapy/qualification, it is vital that you...
do not exceed the limits.
Pauline Baxter A 10 year background in Health & Fitness Club Management laid the foundation for Pauline’s venture into the world of complementary therapies. Over 22 years later, that journey has been, and continues to be exciting, rewarding and ever-evolving. Notable events include becoming a tutor for Academy of On Site Massage (AOSM) in 2000, director and owner of AOSM in 2006, a regular contributor to industry magazines since 2010, development and growth of additional On Site Massage training, and a judge at the National Massage Championships in 2018 & 2019. www.aosm.co.uk | 0118 391 4313
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Understanding Research for the Massage Therapist By Greg Morling
In his foreword to both Glenn M. Hymel’s book, ‘Research Methods for Massage and Holistic Therapies’ and Tiffany Field’s text, ‘Massage Therapy Research’, Leon Chaitow gives high praise to both books and outlines the two different imperatives that are the driving forces behind both; the need for ever-improving competencies in the application of massage and bodywork and the need for evidence that validates and supports the methods and techniques used in therapeutic massage. The ‘evidence’ could be found in many ways, and I have a bias in research design that will become evident as you progress through this article. This piece will outline the use of both qualitative and quantitative approaches to finding the evidence that Chaitow and others suggest is required to improve competencies in tactile therapy. I hope that this article will give the massage therapist and most importantly, those who aim to engage in research in our tactile garden, some new perspectives on research designs that might truly reflect the way we work and the wellbeing we hope to foster in our clients.
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therapistinsights understanding research for the massage therapist
esearch is defined as the creation of new knowledge and/or the use of existing knowledge in a new and creative way to generate new concepts, methodologies and understandings. This could include synthesis and analysis of previous research to the extent that it leads to new and creative outcomes. This definition of research is consistent with a broad notion of what research can be, including the different methodologies that may be used to reach fresh knowledge. Both qualitative and quantitative research methods have equal validity in seeking and uncovering these creative outcomes for the benefit of our clients and patients now and in the future.
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Qualitative and Quantitative research methods: the distinction There are unique characteristics between qualitative and quantitative approaches to research, and it is important that natural therapists understand the difference between them when reading scholarly articles on CATM. I now use CATM (Complementary, Alternative and Traditional Medicine), as opposed to just CAM to honour and recognize the traditional healing medicines from the indigenous and first nation peoples around the world or any other piece of writing related to health care. It must also be noted that qualitative research and quantitative research are in no way in opposition. A Hymel states, ‘they are an alternative to the other’. Reductionism can be an oversimplification of an idea when we are researching human experience, but it can be a very useful process to use in developing an aware global society by collecting and analysing information about our environment such as, ‘species diversity, global climate patterns, and ocean pollutants’. Mixed methods research is a third research process that involves the use of qualitative and quantitative data in a single research project. Mixed method research enquiry is certainly worthy of exploration in relation to CATM, but I have decided to focus on these separately in this article.
Quantitative research and the ‘dualist model’ When you see ‘quantitative,’ think; experimental and statistical. The goal here is to use tests, measures, statistics and predictions. Practical examples of this form of research underpin the book previously mentioned, written by Tiffany Field, Director of the Touch Research Institute in Miami, Florida. Her research on a broad range of conditions including positive outcomes in growth and development in pre-term and full-term infants, ADHD, depression, eating disorders, lower back pain, fibromyalgia, Parkinson’s Disease and breast cancer. Her book is a review of quantitative research studies from both her laboratory and others, which rely exclusively on quantitative research design which is used in the biomechanical model. The experimental quantitative research model may employ randomized controlled trials (RCT) which have long been held up as the ‘gold standard’ of clinical research. In a randomized controlled trial, participants are randomly assigned to receive either the treatment under investigation, or as a control, a placebo, or the current standard treatment. An RCT aims to be ‘impersonal, value-free, rational and reliable’. There is a very strong reliance on quantitative research methodology using a reductionist model in modern medicine. The original architect of this way of thinking (and research process) was René Descartes, the seventeenth-century philosopher who presented a dualist view that Mind and
Matter (which includes the brain) are two altogether different kinds of beings that occupy different realms with different rules, with no point in common. This ‘Cartesian dualism’ philosophy had, and still has, an enormous influence on how we view the world, including medicine, research and health care. Descartes believed that to understand a problem we needed to break it into small pieces of information (reduction) and his philosophy is the basis for our understanding of the ‘scientific method’, eliminating variables from research design as much as possible.
Qualitative research Qualitative research, (QR) on the other hand, can be used to ‘understand the complexity of social phenomena through a set of systematic and interpretive practices designed to seek answers to questions that stress how social experiences are created and sustained’. Qualitative research methods eliminate nothing in revealing answers to the human condition. All variables are welcome and well regarded! Commonly employed qualitative methods that may be used in researching CATM include ethnography, case studies, discourse analysis, and phenomenology, which I will address later in this article. An ethnographic question in massage therapy might be, ‘are there changes in my massage practice following engagement with other therapists in a Massage Conference?’ A case study might Issue 109 2020
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ask, ‘What are the effects of massage on chronic lowerback pain in a patient with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and degenerative disc disease?’ The qualitative methods that address the types of questions cited come from strong theoretical traditions. For further evidence of this, the reader might like to read the article, ‘How to locate and appraise qualitative research in complementary and alternative medicine’ which appeared in the BMC Complementary Journal. These type of research questions are positioned in the human sciences as opposed to quantitative studies that are situated in biological reductionist analyses, possibly using CRT. Specifically, qualitative research is not designed to test theory and has no relationship to CRT or the reductionist way of research enquiry. Instead, it questions broadly from an inductive approach rather than deductive. It is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the “why” rather than the “what” of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their everyday lives. This method of research is human science research and involves the study of lived, human experience. In our field of massage therapy and other CATM, a question could be, ‘how does a client feel when they are having massage?’ Another question might be, ‘what meaning does massage therapy hold for an individual client? ’This is an idiographic focus where we are interested in what the phenomenon holds for an individual, not a cohort or representative sample. We should acknowledge that human science operates with its own criteria for precision, exactness, and rigor. Research in the field of complementary, alternative and traditional medicine is underused and, ‘when used, done so defensively’. The development of medical research methodologies, has, at least in part been a result of concerns about the intrusion of CATM practices in health care which may explain why CATM has not always emerged from ‘scientific’ examination unscathed. CATM and the Randomized Control Trial (RCT) (mentioned previously as the preferred method of enquiry for biomedical research) are not a good fit due to the complexities of CATM interventions, the many variables in therapy (nonstandardization of treatment), the reasons for a client/ patient seeking CATM treatment, and placebo issues. The critical concern from the standpoint of the CATM practitioner is the importance of a holistic understanding of the individual patient. Objectivity in humanistic, qualitative research can be critical to the accuracy of this research process. The ‘pure science’ (reductionist) view is that measuring variations across a population has far more meaning than information about changes, feelings or the lived experience of the individual client/ patient, and subjectivity in research is essential. Qualitative research methods can encompass the complexities of CATM and identify richer and more appropriate veins for research exploration for both us as 18
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CATM therapists from a different research paradigm. The rigorous application of holistic research using qualitative research design, exercised non-defensively, can only benefit CATM and the knowledge base of science.
The CATM therapist’s pursuit of legitimacy The debate surrounding the politics of ‘evidence-based medicine’ and what value qualitative methods have in health research have led to some CATM practitioners compromising their professionalism by blindly attempting to legitimize their practice by pseudo-scientific claims. In my own CATM area, the field of tactile therapy, it seems nonsensical to attempt quantitative research where the interconnected variables of our practice make this type of research so difficult to assess; intensity and duration of massage, levels of tactile temperature, extent and style of massage. The list is extensive and obviously intimates that the qualitative research methods would provide would be be far more revealing and offer greater value. Qualitative methods may address ‘why a tactile intervention works’, ‘how a participant is experiencing the massage intervention’, and /or ‘how they give meaning to these experiences’. Ann Verhoef argues strongly in JACM that qualitative research methods should be added as another ‘Gold Standard’ and I hope this article, ‘contributes to your search in how we might research our tactile garden, to find therapeutic truth in our work. I hope this article has persuaded you to see the value of qualitative research methods to the practice of CATM and in particular, massage therapy.
The philosophy underpinning qualitative research Approaches to research have a philosophical base. For example, René Descartes, considered the father of modern philosophy, gave us one of the deepest and most lasting legacies; his
thesis that mind and body are quite distinct–a thesis now called “mind-body dualism.” This philosophy gave us empiricism, and of course, quantitative research methodology. However, some of the greatest minds of the 20th Century; Edmund Husserl, Jean– Paul Sartre and Merleau–Ponty strongly refuted Descartes philosophy and his way of looking at the world. Merleau-Ponty wrote that, ‘the Cartesian separation of emotion from behaviour radically misconstrues our experience of others’. He repudiates the idea of ‘mind-body dualism’ that pervaded the philosophy of Descartes. They would probably not explicitly state it as such (if they were alive today), but their writings and ideas enthral us with insights into the enigma of life as we experience it, and they have given us the underpinnings of qualitative research methodology by using phenomenology.
Phenomenology The study of phenomenology has its roots in philosophy. While it has been studied in various forms throughout history, I believe it has a certain relevance to us as CATM therapists currently practising in the existing permeating biomechanical, reductionist health environment. Phenomenologists are interested in the analytical and descriptive experience of phenomena by individuals (in our case, patients and clients) in their everyday world. For example, a phenomenological study on osteoarthritis may concentrate on the experience of what it is like to be someone with osteoarthritis from the individual’s point of view and try and describe how he or she interprets the everyday world. Phenomenological research would endeavour to capture the essence, rather than measure the number of osteoarthritic sufferers or define the causes of osteoarthritis. Phenomenologists are interested in all types of experience, which can include the mundane to dramatic experiences.
Phenomenologists perceive that human experience of the everyday world is a valid way to interpret the world and therefore reject the notion that the detached, scientific empirical tradition is the superior method of research. Phenomenological research differs from other modes of qualitative inquiry in that it attempts to understand the essence of a phenomenon from the perspective of someone who has experienced it. The great living phenomenologist, Max van Manen, wrote that, ‘(research) asks us to be forever attentive to the fascinating varieties and subtleties of primal, lived experience and consciousness in all its remarkable complexities, fathomless depths, rich detail, startling disturbances and luring charms.
References
1. Chaitow L, Research Method for Massage and Holistic Therapies (2006) Foreword Elsevier Press 2. Definition of Research-Australian Research Council, Stanford Encyclopedia of Philosophy, https://plato. stanford.edu/index.html accessed 6.03.20 3.Cockrane, Suzanne; Possami-Inesedy, Alphia. (2013) Complementary Therapies in Medicine; Kidlington Vol. 21, Iss. 1, 73-6 4. Klein D, Cathcart T, Heidegger and a Hippo Walk Through Those Pearly Gates (2009) p.130 Text Publishing 5. Cockrane, Suzanne; Possami-Inesedy, Alphia. (2013) Complementary Therapies in Medicine; Kidlington Vol. 21, Iss. 1, 73-6 6. Franzel et al BMC Complementary and Alternative Medicine2013, 13:125 7. Hammer, Carol Scheffner (ed.) American Journal of Speech-Language Pathology (online) Rockville Vol.20, Iss 3, Aug 2011) 161-162A. 8.3. Cockrane, Suzanne; Possami-Inesedy, Alphia. (2013) Complementary Therapies in Medicine; Kidlington Vol. 21, Iss. 1, 73-6 9. Ibid 10. Verhoef, Anne L. Casebeer, and Robert J Hilsden Assessing Efficacy of Complementary Medicine: Adding Qualitative Research Methods to the ‘Gold Standard’. Published online 5 July 11. Descartes, M. The World of Perception (1948) Lecture 45: Man from the outside. P.23 Translated in 2004 Routledge Press, 12. Moustakas, C. Phenomenological research methods. (1994). London: sage Publications. 13. Eddles-Hirsch, K. Phenomenology and Educational Research. International Journal of Advanced Research (2015) Volume 3 Issue8,251-260 14. ibid 15. van Manen M. But is it Phenomenology (2017) Qualitative Health Research Vol. 27 (6) 775-779
Greg Morling has been a remedial massage therapist for over three decades and has written various scholarly articles and delivered workshops on a range of topics including; the Iliopsoas and its relationship to back pain, the use of thermal stone in remedial massage focusing on a range of musculoskeletal conditions, visceral massage techniques and humanistic research methodologies to give our palpatory work validity. www.mostlymassage.co | gmorling@live.com.au
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Body Within The Mind: The Evidence of the Holistic Network By Giacomo Sandri Introduction Any experienced holistic bodyworker is aware that the physical body is connected to the ethereal mind; many holistic psychotherapists know that their work on psychological complexes will affect their client’s physical state. While conventional medicine still relies on the Cartesian axiom that psyche (mind) and soma (body) are two different entities independent from each other, modern science provides us with much of evidence that matter and mind are wonderfully entangled. The mind-body entanglement concept sounds already very familiar to those who have studied or have been influenced by Eastern philosophy. In Zen and Buddhism, for instance, it has been known for millennia that mind and body are congruent and ultimate peace of mind, also called Brahmic state or enlightenment, will inevitably bring peace to the bodily senses. With the following article, I will present and discuss the available scientific evidence for the existence of the body-mind network, from a Western science perspective.
The Autonomic Nervous System The main medically recognised connection between the mind and the body occurs through the nervous system; specifically, a branch of the Central Nervous System called the Autonomic Nervous System (ANS) (1). The ANS is not under voluntary control and regulates our vital functions, such as heartbeat, digestive motility, respiration etc. The ANS has two sub-branches: the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS). The SNS is responsible for activating the famous ‘fight or flight’ response in a circumstance of perceived danger, while the
PNS is in charge of your vital organs normal functioning. A balanced ANS is therefore of paramount importance for our survival. Let’s explore further the dynamics of the SNS: When our prefrontal cortex perceives a danger (real or IMAGINARY), it triggers a cascade of reactions that will result in hormonal and neurological change in the body. These changes will affect all the systems in the body as it gets ready to escape or face the danger. In terms of the musculoskeletal system, as the delivery of nutrient-rich blood shifts from vital organs to the cardiac and skeletal muscles, some muscle groups will have an increased blood supply in order to allow the individual to run faster or punch harder. In other words, if you keep reproducing a video clip in your mind of your angry boss shouting at you even while you are at home lying on the sofa, your body will react to this thought as a real and concrete threat.
collagen, which together act as a conductive medium allowing an electrical current to flow through. Collagen is one of the most abundant protein in the body and makes up most of the FASCIA. The FASCIA is an ubiquitous 3D matrix of connective tissue that wraps nearly every tissue in the body, including muscles, tendons and organs. From her studies, it also turned out that the collagen matrix that makes up the fascia behaves as fluid crystals, the same components in a screen of an electronic device. The properties of the fluid crystals are the following:
Fascia Crystalline Matrix
When an electrical current flow through a fluid crystal matrix, it changes its structure following a precise pattern. This is what allows us to delight our sense of sight when watching pictures on the screen of our smartphone.
Another model of a communication network between body and mind has been proposed by Dr. Mae-Wan Ho in the late nineties (4), while she was investigating the nature of the meridian system, a fundamental concept in Traditional Chinese Medicine (TCM) (2). TCM doctors who also do not recognise any separation between body and mind, state that throughout the physical body runs a system of subtle energy (or Qi energy) called the meridian system. A meridian is an energy channel that carries the Qi energy throughout the body. Not only diet and lifestyle will affect the flow of Qi through the meridian system but also thoughts and emotions. Dr. Ho’s extensive studies on the subject revealed a quantifiable low voltage Direct Current (DC) system throughout the body. Water molecules bind to a protein called
• Piezoelectricity: The ability to generate an electric voltage when subjected to pressure. • Fluid-structure: They have a fluid structure which responds to factors such as temperature, hydration and pressure.
What implication for our health does this discovery have? Let’s go back to the fascia system. Our anatomy books tell us that fascia is nearly everywhere in every portion of the body. Dr. Ho’s discoveries show us evidence that electricity flows throughout this system, shaping its structure by altering the orientation of its collagen proteins. Could this system constitute the most complex network of information exchange within the body? Could our thoughts, emotions Issue 109 2020
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and beliefs play a major role in altering this flow of current? And, in terms of healing, could these discoveries provide us with solid scientific evidence for explaining acupuncture, reiki and other forms of energy healing? More research on the subject is needed in order to answer these questions, and unfortunately, the studies of Dr. Ho haven’t been explored further after her death in 2016. Nevertheless, the world of alternative medicine is immensely grateful to characters like Dr. Ho who dedicate their life to scientifically explore concepts that modern medicine refuses to accept.
Molecules of Emotion Another model of the mind-body relationship is proposed by the neuro-scientist Candace Pert, author of the bestseller ‘Molecules of emotion’ and co-founder of the branch of neuroscience called Psychoneuroimmunology (3). In her inspiring book, Dr. Pert describes the path which led her to discover the existence of feel-good peptides, such as endorphins and dynorphins. After this discovery, a few events in her life brought her to draw the conclusions that the feelings we experience as individuals are strictly connected to the movement of emotion - carrying peptides through the body’s tissues. From her research she found out that not only neurons, but also endocrine and immune cells have receptors for such peptides, therefore opening the gate to a sector of research on how emotions can influence our hormones and immune system. Dr. Pert provided evidence that the perception (and she highlighted the word PERCEPTION, because danger and calm are utterly subjective concepts) of a calm and pleasant experience will release through the body feel-good molecules such as endorphins, serotonin and dopamine; on the other side, stressful or worrying circumstances will cause a flow of anxiety causing peptides, such as
corticotropin releasing factor (CRH), cortisol and adrenaline. This flow of emotion carrying peptides is a natural mechanism of survival as we learn to feel discomfort in a dangerous situation and comfort in a pleasant one, which links back to the fight and flight response. Therefore, emotions such as anger, grief and fear, which are strongly denied and repressed in our modern society fundamentally need to be experienced and expressed in order to maintain balance in our organism. The problems arise when we linger for too long in one emotion or we deny its existence; in such circumstance, the flow of emotion carrying peptides is hindered and these molecules get ‘stuck’ in various body tissues, causing the individual to potentially experience chronic emotional imbalances, which often have a remarkable impact on the overall wellbeing of the individual. In brief, the concept which Dr. Pert is advocating is that emotional expression is of paramount importance for maintaining a balanced immune and endocrine system and ultimately for living a life of unhindered flow and harmony.
Bodywork and Mind Healing As psychotherapy, hypnosis, and counselling can initiate the healing process of the physical body, stretching, massage and exercise can promote psychological wellbeing. As a holistic bodyworker, I have witnessed how my sessions with clients have had a profound transformative effect on their mood. As ‘knots’ in the physical body were released, the client allowed him/herself to experience the emotion that was entangled with such tension. Although the outcome of a holistic massage session can be really profound and transformative, the emotional release is not always what we label as positive; bodywork can indeed trigger the release of deep-seated anger, fear, sorrow or
guilt, which often manifests as unpleasant feelings such as dizziness, tiredness, headache, digestive discomfort etc. It is important then to grasp the meaning behind these ‘negative emotions’ and acknowledge their importance without repressing or holding onto them. In conclusion, the dynamics of the autonomic nervous system, the fascia crystalline matrix and the molecules of emotions, provide a hypothesis of the inseparable nature of the mind from the body. There is no healing process of the physical body which will not have an impact on the mind and vice versa. Through the path of self-discovery, it is then possible to eventually unlock the full potential of our human experience and achieve deeper healing of our bodies and minds.
References 1. Tortora, Grabowski. 2003. Principles of Anatomy and Physiology. Wiley and sons Inc. 2. Ho, MW. 2012. Super-Conducting Liquid Crystalline Water Aligned with Collagen Fibres in the Fascia as Acupuncture Meridians of Traditional Chinese Medicine. Forum on immunopathological diseases and therapeutics 3(3-4):221-236 3. Pert, C. 1997. Molecules of emotions. Simon & Schuster UK ltd 4. Ho, MW. 1998. The Rainbow and the Worm. World Scientific Publishing. Singapore
Giacomo Sandri graduated in Herbal Medicine (BSc Hons) at the University of Lincoln in 2017, and attained a diploma in Holistic massage at the Bristol College of Massage and Bodywork in 2018. He holds certificates in Facial Acupressure, Complete Manual Therapy and FREC3 First Aid. He is also a member of the National Institute of Medical Herbalist (NIMH) and Massage Training Institute (MTI). In 2019, he coined the term Naturopathic Massage Therapy, a discipline which combines herbal medicine, nutrition and bodywork to provide a clearer understanding and a tailored deeper treatment to individual suffering from musculoskeletal and neurological disorders. Giacomo currently practices as a herbalist and massage therapist in Bristol under the business name of Blue Ginkgo offering consultations at the Easton Business Centre and online.
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“What Makes a Great Massage Therapist?”
Bringing Anatomy to Life By Kate Browne
When you think about the question, what do you think of? Is it how a therapist interacts with their clients, how they present themselves, how they communicate? Is it their level of skill and training or their natural intuition and insight? Or is it their ability to advise their clients about self-care and aftercare, their body use and the way they move? It’s a long list! 24
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hilst I’m a strong believer that creativity and intuition play a significant part in massage therapy, I also believe that this should be underpinned by a good understanding of how the human body works. What muscle are we working with? Why are we working with it, and if this muscle is shortened or lengthened, weak or dominant, then what else is likely to be affected? Will there be knock-on effects to consider from treatments or therapy? Anatomy and physiology are the very foundation of what we practice. Understanding what we’re interacting with and why, can help to model treatment plans and develop clinical thinking skills. We’re also more likely to explore different methods of treatment, with greater success, if we are working off the same “human anatomy road
W
map”. We can communicate findings, aftercare and recommendations to clients with more confidence because we have a sound basis to work from, plus the reasoning to back it up. For many of us, though, the process of learning anatomical terms can be challenging. Working from a book and mapping 2D illustrations onto a real-life body (that comes in all shapes and sizes as we all know!) often doesn’t easily translate. And, once we’ve left the comfort of our training provider, we tend to forget a lot of what we’ve learnt, especially if we’re not applying it regularly. Anatomy isn’t easy. Thousands of names derived from Latin can be overwhelming. Of course, we don’t need to know it all. Body Paint Anatomy came from the realisation that learning muscle anatomy as a
anatomy&physiology bringing anatomy to life
student or revising it as a practitioner could actually be a joyous, creative and productive occasion. Who knew! This inspired me to put together a series of relaxed and interactive workshops designed for massage therapists, that would demonstrate how to locate anatomy through palpation and landmarking and give a brief introduction to each muscle and how we’re likely to come across this as a therapist, including injuries or dysfunctions. The workshops also show how to activate the muscle; it’s origin, insertion and action, even its fibre orientation. With the bonus of live examples of the muscle in action – as a participant flexes and relaxes, or moves around the space, you can follow the movements more clearly. The very act of applying paint onto the body helps to configure where structures are, particularly in relation to other structures. You may be surprised to see how shapes and sizes vary from body to body, depending on muscle development, posture and proportions. Colour itself is an important feature in our workshops, as it promotes better memory recall. Associating a colour with a muscle means that you are far more likely to visualise and remember it than if we were painting solely in flesh or skin tones. If you’re sat there thinking, “I don’t have an artistic bone in my body”, then don’t worry. You
don’t need to be the next Van Gogh to have a go at body painting. You’ll see that a lot of it is right there in front of you. Finetuning, repeating palpations and activations will soon see marked improvements in your understanding and abilities. “As a visual learner, I jumped at the chance to revisit anatomy through body painting. Completing the workshop has expanded my knowledge and developed me as a therapist. I’d recommend it to all levels it was a lot of fun!” 2020 Workshop attendee. Whilst our Body Paint Anatomy workshops scheduled for this year have been postponed for now, body painting is something you can try at home by yourself. Just get your hands on a couple of face paints and pick out a few muscles from an anatomy book to study. I’d try to resist the temptation to take on too much at once as this is an easy way to end up feeling overwhelmed and defeated. I’d recommend taking two or three muscles in the same area to start with and familiarise yourself with them before moving on. Then, once social distancing restrictions are relaxed, you may like to consider meeting with a therapist you know locally and practising on one another. It also makes for fun and informative content that you can use on your website or on your social media platforms. Body painting doesn’t just have to be about muscles either. You can paint fascial patterns, the lymphatic system, chakras, meridians, skeletal structure, organs and other systems. Issue 109 2020
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Painting anatomy is about bringing what we learn out of the theoretical world and into the 3D world where it’s bought to life with colour and form. Learning doesn’t have to be a chore. As a wise woman famously said: “In every job that must be done, there is an element of fun. You find the fun and - SNAP - the job’s a game.” (bonus point if you knew who said that). Don’t be afraid to challenge what you know or discover what you’re a little rusty on! None of us remember everything we’ve ever learnt. It’s about refreshing those pools of knowledge and not feeling embarrassed about having to check something in a textbook or re-think something you previously thought to be true.
Re visi on Top ti p: Disguise regular revision as research! Yes, it’s great practice to research any known or suspected conditions, pathologies or dysfunctions before you first see your client and even throughout the treatment process. Not only is it a great opportunity to refresh what you know, but also because any considerations will now be at the forefront of your mind, meaning you can adapt and plan treatment accordingly. You’ll also be better equipped to communicate with your client from the get-go. This makes you look well-prepared, professional and attentive.
Be curious, get creative and try not to be hard on yourself. Learn to recognise your achievements – no matter how small they may feel and reward yourself for getting up and having a go. We are all on a journey of learning, so reach out to your fellow therapists and exchange what you know, there’s so much we can learn from one another. We would love to have you join us for one of our future Body Paint Anatomy workshops. Each attendee will receive a handbook filled with everything you need to know, including a bonus colour-in section to reinforce the colours used during the workshop.
You can keep up to date with the latest dates and locations by searching for and following “Body Paint Anatomy UK” on Instagram and Facebook. @bodypaintanatomyuk @cotswoldmobilemassage cotswoldmobilemassage.com
Kate Browne began her therapy journey in 2014, training in Holistic Massage at the Bristol College of Massage and Bodyworks. Eager to expand her understanding, Kate returned two years later to complete her level 5 Remedial and Sports Massage Diploma. Her interest in anatomy and passion for delivering a higher standard of massage has always been at the forefront of her work. In 2019, Kate gained recognition after she entered the National Massage Championship in London and took first place in her category of Advanced Massage Therapy. She also went on to win the overall competition and was awarded the Judges Choice Excellence Award. Kate was due to compete in the 2020 World and European Championships which will now likely take place next year.
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A New Model for Massage Therapy in the Covid-19 Era
At the time of writing you can hear the metaphorical popping of champagne corks all over the UK at the news that massage therapists are now able to legally practice hands on work. This is truly a time for celebration – the waiting has been long and arduous for the massage community worldwide. Robbed overnight of both our passion and livelihood by strict lockdowns, massage therapists internationally felt hopeless, angry and uncertain of their future. We witnessed this despair and frustration firsthand at Jing through our thrice- weekly community Zoominars where massage therapists turned up in their droves to mediate, massage and muse their way through the Coronacoaster with other members of their tribe. s we emerge from lockdown, both jubilant and fearful for the future in equal measure, it is vitally important that we realise that this is not a return to business as usual. Covid-19 is still very much with us and although lockdown has eased for the time being, we feel the inevitability of further national or local lockdowns and the looming spectre of a second wave of infection in the autumn. The pandemic has long term consequences for the massage industry. We have a public health, professional, legal and ethical duty to change the way we practice, potentially for the long term.
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The road ahead is not necessarily an easy one. But as we have done over the last months, we will navigate it together with you, hand in hand, with laughter and love for this wonderful profession and each other.
A new model for Massage Therapy “Two roads diverged in a yellow wood And I took the one less travelled by And that has made all the difference” We stand at a crossroads in our profession. Two roads are available to us – one is
to carry on more or less as we did before, paying lip service to government guidance around hygiene and PPE, but more or less retaining the old model of how we worked. The other is more radical and involves changing key features of our approach. Without a doubt this is the “road less travelled” – change is challenging for most people; it is far easier to retain the status quo. However, those brave and forward thinking pioneers who embrace the new model I am outlining here will see untold benefits both for their clients and their business. As I say “I can’t tell you it’s going to be easy; I can tell you it’s going to be worth it”
dadvancedcpdadvancedcpd The inevitability of change
Threats to our current business model
Over the past few months the world has changed and those massage therapists who will have a thriving business in this new normal will need to embrace this firmly. ALL massage therapists need to seriously take on board the guidance laid out by both the government, the General Council for Massage Therapies (GCMT) and Professional Associations. For a thorough and detailed review of this guidance please check out our weeks’ worth of in depth Zoominars which will skill you up in every aspect of our new normal. (https://www.jingmassage.com/ purchase-recording-coronavirus-and-ukmassage-therapists-qa-with-a-panelof-expert-industry-representatives/)
IIf we look at these requirements from one angle, we could say that they represent threats for all of our businesses. The whole pandemic means that we have to face severe challenges for example: • Decreased activity time might mean that we are unable to offer longer treatments as part of our services • Wearing of PPE might mean that relaxation massage is no longer that relaxing! • Increased time between appointments means that we have to see less clients per day or work longer hours to bring in the same money
A synopsis of the required guidance for adapting our practices to be Covid-19 secure include: • Mandatory risk assessment: The government guidance is clear that all businesses need to carry out a thorough risk assessment to identify and mitigate any features of their business that may contribute to the spread of Covid-19. The word risk assessment tends to strike fear into the heart of most massage therapists so check out our friendly, fun (yes honestly) and accessible guide here (https://www.jingmassage.com/ purchase-recording-coronavirus-and-ukmassage-therapists-qa-with-a-panelof-expert-industry-representatives/)
• Decreased activity time: Government guidance is clear that we all need to spend as little time as is feasibly possible in close contact with another person especially if we are indoors. This is because the longer you spend with someone the more the possibility of infection (remember either you or the client may be infected and not know it). This means that longer appointments (75 or 90 minutes) are not recommended.
• Wearing PPE: Minimum government recommendations are to wear a visor and gloves for any “close contact” activity. The GCMT have recommended that this is a minimum to keep yourself and your client safe and that additional PPE such as a mask and gown (or scrubs/ top that opens from the front and is changed for every client) is wise.
• Changes to treatment: There is less risk of infection with the client prone or side-lying than there is with supine work. Also, the face is regarded as a high-risk area, so decreasing time spent there is highly advised. At the time of writing the government has just announced that facials with therapist wearing PPE are permissible from August 1st. However, you need to be mindful of which activities carry more risk for yourself not just what you are “allowed” to do. You are in control here!
• Increased hygiene before and between appointments: The new normal requires an awful lot of cleaning! We need to ensure that all contact points are thoroughly cleaned between clients and that linens and elements of PPE are changed. This takes a minimum of 30 minutes to do effectively so you should leave increased time in between appointments
• Compliance with test and trace: As professionals we will be expected to comply with the requirements of the test and trace system. This will mean asking our clients permission to pass on their details in the case of them being related to an outbreak. It will also mean that if you have been in contact with an infected person you will be asked to self-isolate for 14 days.
• Our profit margins will decrease because of increased money spent on PPE • Some clients may not return to hands on work because they feel fearful of infection • Some clients who at more risk may feel uneasy about receiving hands on treatment i.e.: pregnant people, the elderly, the immunosuppressed. • The likely upcoming recession means that people may have less money to spend on services seen as non-essential • Covid-19 is still a new phenomenon and we are still finding out about the implications. Initial research suggests that there may be complications with those infected with Covid-19 that may have implications for the type of bodywork we may be able to offer. For example there are signs that there may be increased blood clotting (for a full exploration of this topic see https:// www.abmp.com/updates/blog-posts/ covid-19-related-coagulopathy)
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advancedcpdadvancedcpda A crisis brings opportunity as well as danger However, the savvy entrepreneur knows that every crisis brings opportunity. If we view the crisis from another angle, we will spot that it has also offered up certain changes that could be fertile ground for opportunity. For example: • People are literally starved of compassionate touch! • The anxiety and stress of the last few months and ongoing uncertainty is likely to result in increased musculo-skeletal pain. • There are an increased number of people working remotely • There are an increased number of people familiar with online face to face video calling platforms such as Zoom and Skype.
Adapt to survive and thrive: Diversifying your practice into offering online self-care Our main rallying cry to massage therapists worldwide is that your best opportunity to not only survive but to thrive in the current climate is to diversify your services so that hands on treatments are not the only thing you are offering. Specifically, we recommend that you develop your skills in offering online appointments that can help give your potential clients what they are looking for – a decrease in pain, increase in range of motion or support through pregnancy for example. For most therapists this is a radical mind shift – we are accustomed to being fully invested in our hands as being the main tool that helps people get better from musculoskeletal pain. Yet if you really sit down and think about what else you have to offer you are likely to also have the following skills: • “The cloak of compassion” – a genuine ability to listen, connect and empathise with your client • Knowledge of pathology and musculoskeletal pain • Knowledge of self-care measures such as stretches, trigger points, acupressure, breathing exercises or rehab • A genuine desire to help and walk alongside your client on their healing journey
A tried and tested approach to online self-care For the past few months at Jing we have been urging therapists to diversify their practices in this way through offering online self -care. In essence this is nothing new – teaching self-care has always been very much part of the Jing method of treating musculoskeletal pain. Our book “Massage Fusion” contains a whole chapter on the benefits and research around self-care and we have always urged therapists to devote proper time to this aspect in their treatments. However, this is now the time to bring the self-care aspect of massage therapy up and fully centre of our approach. We outlined a thorough model that could get results with chronic musculoskeletal pain such as back pain, neck pain, headaches and sporting injuries. Make no mistake this was not an easy mind shift – therapists were pushed out of their comfort zone and we set up an exclusive course and mentoring group to help therapists through the process. But slowly and surely people got their heads around it. The results exceeded our wildest expectations. Therapists started offering sessions in self -care to those working remotely, both teams and individuals. Bodyworkers found new ways to get results and help their clients through offering online retreats, group sessions to address concerns ranging from support in pregnancy to alleviating low back pain to wellness sessions with businesses and charities. Our amazing final year BTEC group switched the focus of their dissertation to offering online self-care rather than the original hands on work they were planning. Gradually therapists adjusted to a new way of working in a time when they could do no other. This required bravery and flexibility but without exception those who tried it were heartened by the results and feedback they got from clients. As a group when the news broke that we could return to hands on work, those who had been offering online self-care responded with a joint voice of “we’re not going back”. These therapists saw that offering online self-care was a radical way to bullet proof their business for the
Old model
New model
Hands on is the only service offered
Hands on is one of a range of services offered including online one to one and team self care/rehab appointments
Consultation is given in person
Consultation given online
Pushing ourselves to work if we feel a bit unwell
Do NOT treat if feeling unwell
No Covid specific screening before appointment
Covid specific screening before appointment
No PPE
Wearing of PPE
Little time between appointments
Increased time between appointments (30 mins recommended)
Self-care given in person
Self-care given online
Elderly, vulnerable and immunosuppressed treated in person
Vulnerable clients treated online/over phone with self-care/rehab
Longer treatments are common (75-90 minutes)
Shorter treatments (45-50 minutes) as this decrease’s possibility of infection
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dadvancedcpdadvancedcpd “Old and new make the warp and woof of every moment. There is no thread that is not a twist of these two strands.” Ralph Waldo Emerson future – being able to offer online services meant that they could maintain their financial position and guard against the possibilities of future lockdowns or having to self-isolate. These therapists are ahead of the game in offering a blended model of care – one that encompasses both hands on and online offerings. We urge you to follow their example and do the same.
The new model for massage therapy However, you feel about online work, all therapists are recommended to take both consultations and aftercare online. This is because there is a higher risk of infection with activities that require face to face contact and speech. This new way of working means that all therapists would be well advised to offer both consultations and aftercare online. See the table opposite for a comparison between our old and new ways of working. At Jing we understand that change is difficult which is why we have pledged to provide ongoing personal support for all massage therapists at this difficult time.
“There is no better than adversity. Every defeat, every heartbreak, every loss, contains its own seed, its own lesson on how to improve your performance the next time.” Malcolm X
! g n o r t s S ta y
To support you we are offering: FREE Monday community Zoom sessions open to ALL therapists. Our regular Monday high noon slots are a chance for everyone in the community to gather, educate and cogitate about the changes in our industry. Sign up to our mailing list to receive the Zoom link or check on our Facebook page (https://www.facebook.com/JingMassageTraining/ • FREE resources on the blog section of our website: During lockdown we pumped out 45 free Zoominars outlining how you can take your practice online. Catch up with them for free here https://www.jingmassage.com/category/blog/ • Covid-19 resource pack: Recorded Zoominars that talk you through every aspect of the changes in your practice. (https://www.jingmassage.com/purchase-recordingcoronavirus-and-uk-massage-therapists-qa-witha-panel-of-expert-industry-representatives/) • Online consultation class: A workshop to help you get your head around taking your consultations online (https://www.jingmassage. com/cpd/the-jing-method-consultation-and-assessment/) • Professional mentoring business and support group: A unique subscription course that will help guide you through the maze of changes and challenges to your practice. Your £29.99 monthly subscription enables you to access exclusive mentoring Zoominars with Meg and Rache, founders of Jing, a taking your practice online course plus a highly supportive Facebook group. Check it out here https://www.jingmassage.com/cpd/ jing-method-online-self-care-therapist-advanced-cpd-course/ Above all stay strong and stay connected. We will get through this together just as we have weathered other storms collectively and individually with our hands, head and heart. Keep your light alive and if it is flickering let us help you re-ignite your passion, confidence and belief.
Rachel Fairweather is author of the best selling book for passionate massage therapists – ‘Massage Fusion: The Jing Method for the treatment of chronic pain”. She is also the dynamic co-founder and Director of Jing Advanced Massage Training (www.jingmassage.com), a company providing degree level, hands-on and online training for all who are passionate about massage. Come and take part in one of our fun and informative short CPD courses to check out the Jing vibe for yourself! Rachel has over 25 years experience in the industry working as an advanced therapist and trainer, first in New York and now throughout the UK. Due to her extensive experience, undeniable passion and intense dedication, Rachel is a sought after international guest lecturer, writes regularly for professional trade magazines, and has twice received awards for outstanding achievement in her field. Rachel holds a degree in Psychology, a Postgraduate Diploma in Social Work, an AOS in Massage Therapy and is a New York licensed massage therapist. jingmassage.com | 01273 628942 | © Jing Advanced Massage April 2019 | Photos: all © Jing Advanced Massage; except 3 & 4 ©Handspring Publishing
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bookreviews Reiki in Clinical Practice: A science-based guide Ann Baldwin This is the first book to indicate the effectiveness of Reiki in alleviating a range of specific diseases and disorders, based on published, peer-reviewed, scientific data. Reiki is a healing technique, using gentle touch with the hands placed on or slightly away from the body to optimize physical, mental and emotional health. It is based on the assumption that the flow of energy through the body can be supported and adjusted to promote wellness. This book is aimed at two main groups: ‘medical’ practitioners and those with a ‘medical’ background such as nurses, osteopaths, physical therapists, who may be familiar with Reiki but lack an evidence-based guide on conditions for which Reiki is most effective and who want the ‘ammunition’ to justify its use in their practice; those unfamiliar with Reiki but who are interested in finding how it can benefit their patients. The book provides an accurate description of Reiki, based on qualitative and quantitative scientific evidence, in terms of how it can be used in medical settings to benefit patients of all types, physiologically and psychologically. Ann Baldwin is a research and Professor of Physiology at the University of Arizona. She is also a professor of Reiki to people experiencing stress-related problems. As a scientist, Baldwin was sceptical about the efficacy of Reiki until she found herself working with an enthusiastic practitioner of the therapy. When she saw the positive effects that Reiki had on rats during an experiment, she decided to give up her position at the University of Arizona in order to help people reduce their stress with Reiki. She trained to Reiki Master level, started her business, Mind-Body-Science, became editor-in-chief of the Centre for Reiki Research, but still continues to work part-time at the University of Arizona as an active instructor and researcher.
£35.00 Published by Handspring Publishing IBSN: 9781912085361
Hydrotherapy for Body workers, 2nd Edition Improving outcomes with water therapies MaryBetts Sinclair This is the second edition of a highly successful book, first published in 2008. Hydrotherapy is easy to incorporate into a massage therapists practice and can provide additional well-being and relief for the patient. This book has been tried and tested in its first iteration but has benefited from an update. This new edition still introduces the reader to hydrotherapy, its effects and treatments, but it has been fully revised and updated. It is now highly illustrated in full colour and with many new photos and line diagrams. It includes of new treatments, extended coverage of the use of herbs and essential oils, new case histories, more review questions and handouts and increased coverage of hydrotherapy and pain relief. Hydrotherapy for Bodyworkers, Second edition is an excellent book for therapists wishing to extend their skills and practice beyond massage therapy and for those working in other areas of manual and movement therapy who want a better understanding of the benefits of hydrotherapy and how it might complement their practice and extend their skills.
£49.95 Published by Handspring Publishing IBSN: 978-1-912085-52-1
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bookreviews
Talia Stiles
How to Treat Your Own Achilles Tendon Paula Clayton Leading physical therapist Paula Clayton brings her thirty years of experience, treating everyone from the keen runner to elite athletes, to this highly practical, quick-fix book. Paula wrote this book to help you understand what could have caused your pain and why you continue to experience pain, to help you get back to doing the things you love, and help you to minimize the risk of damaging your Achilles tendon in the future. Using illustrations and a step-by-step guide, Paula explains how to prepare for rehabilitation, how to self-treat your Achilles tendon and how to build a series of individualized progressive-loading exercises. Paula Clayton has worked as a senior performance therapist for the English Institute of Sport and British Athletics between 2003 and 2014. She has travelled extensively to Olympic Games (Athens, Beijing and London), Commonwealth Games, World and European Championships with GB track and field as part of the medical team.
ÂŁ10.99 Published by Lotus Publishing ISBN: 978-1-905367-97-9
Our new website is launching soon! Follow us on Twitter to keep up to date on the launch @massageworlduk
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ty i n tu r o pp O ss e n si u B te o Rem
Move Your Practice Online By Emma Gilmore
Who would have thought that bodywork therapists could work remotely? Well, 2020 has shown us that if you think outside the box, almost anything is possible. Would you like to work remotely to support your clients but lack confidence or simply don’t know where to start? Below is an introductory guide and some ideas to help you to develop your skills and communicate clearly with your existing and potential clients. Every idea could be a workshop. Please contact your insurance provider to check the implications. Many of my graduates now have a successful, remote practice that they can keep going after the Covid-19 pandemic is over. If you want to support existing clients or need a new string to your bow – read on.
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Find your voice You will need to initially decide on how to let your existing clients know that you have the skills to work remotely: • Develop your email list (from your clinic notes) and communicate via a newsletter (e.g. Mailchimp). • Build your audience via social media – working remotely, there is no limit to the area you can work; many of my graduates are now working globally, supporting clients. Group work can be done by streaming live videos via Instagram and Facebook. More on group work below.
practicalprofession remote business opportunity
Be authentic When you communicate on any platform, authenticity and continuity is key. Find your authentic voice, take the time to truly think about this as it will serve you going forward. • What is your skill set? We are all wonderfully different, so sit for a moment – what are your skills, can you offer your client a mindful self-massage or do you work in a dynamic (remedial and sports massage) way – where you will be teaching self-care through stretches and strengthening? Is it your comforting voice that will reassure your client in these extraordinary times? We all have a multitude of skills, and if you are unsure of your strongest skill set, ask a friend to help you brainstorm. • Describe yourself effectively. What adjectives describe what you do? How can you support your clients? What will you be offering during the remote work? See below. • Your presence needs to be regular, this will help clients build confidence in you.
Share your knowledge & wisdom Useful information will build confidence and show the depth of your knowledge. When you learn something new (from reading or attending online training) share it, when you are excited by something, share it.
Share your successes
Set yourself up for success
Every time a client gives you a compliment, something like “it was almost like you were in the room with me” or “I feel so much better” ask them if you can use their words. People love to see positive interactions on social media - use this to your advantage. Respond to enquires as soon as you can – people in need like to be heard (keeping people waiting to look busy is not a good strategy).
Explain to your client IN ADVANCE what they might need, where might they like to be, and what to expect. Every client will need something different – if you are working in a dynamic way, this will require a totally different set-up than for a client requiring a quiet, nurturing, mindful self-massage. You will need to set the scene for them, and it may well be a new (and potentially daunting) experience for them. Things to think about in advance:
Booking in and preparing for remote appointments Before you start:
• Do they want to be in a quiet room or an outdoor space? • Do they need to wear comfortable clothes? A vest to access their skin. • Do they need oil?
• Choose the platform with a video link that you are going to use to hold your remote session: Zoom, Skype or Facetime. Support your client to understand how to use this, especially the elderly, this all takes time and patience.
• Should they wear sports or yoga clothes for stretches?
• Book in the appointment time, just as you would have done previously and always be on time.
• Will you work seated, standing on the floor or yoga mat?
• IF the video link connection fails, you need another method in which to communicate, e.g. phone or email (this is an insurance requirement).
• Do they need any accessories, e.g. spikey ball, foam roller, soft ball. • Towels, pillows, cushions for warmth and comfort.
• Is it nurturing ME TIME your client needs, or do they need the opportunity to talk - to be heard? • Or is it more dynamic stretching they require?
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practicalprofession remote business opportunity
Prepare yourself in advance
Empower with self-care
If this work is new to you, give it some thought. How is it going to work for me? Very often, it is our hands-on work that quiets our mind and bring us focus. Without this tool we may need to be mindful of other tools we can use to prepare ourselves.
This as with all treatments is individualised, what do they need right now? Beside our empathy and listening ear?
• Slow your breath, and quiet your mind and body. • You will need time to prepare yourself, sit in your own space, occupy your space. • Where are you going to work from? It needs to be quiet, with good internet and no distractions. • Set up the room, what is your backdrop? Is it appropriate? • As always with existing clients, take the time to read through their notes before the appointment.
Remote consultation & connection There is no doubt that a remote consultation has its challenges. At first contact, I might say “shall we just sit for a moment”. I might do a very simple breathing exercise to facilitate a quietening down. This slower pace will immediately make for an easier connection with your client. A remote consultation will also require: Full Body Listening We need to listen with our ears, our eyes, and every cell in our body • Ears, we need to listen carefully and not interrupt – even when our clients finish – pause a little longer, there is often something else to say. Always ask, is there anything else? • Eyes are important for eye contact, as they also allow us to observe body language, facial expression, posture, how our client is holding themselves, do they fidget, do they have altered body movements when they talk about something in particular? Do they seem calm or overwhelmed when they talk? Whatever it is that you observe, it may feel relevant to feed back to them – I noticed that when you said XXXX you looked XXX. • Full body listening requires that you are still and quiet in your own body, try not to fidget or drink tea, check your phone – your client deserves your full attention. Clients right now may be confused, isolated, and lonely, scared about what the future holds. They may be grieving for the absence of people they cannot see (children, friends, or grandchildren) or for a past existence that now seems unobtainable. Whatever it is that your client is going through, acknowledge it. Simply LISTEN, but don’t try to FIX, they are entitled to their feelings – there is a brilliant Brene Brown piece on empathy that I would recommend, this will be found on YouTube. Whatever it is they are feeling, it can be helpful to NORMALISE this for them “it is completely understandable, considering the circumstances that you feel XXX, it would actually be strange if you didn’t feel XXX.” “My other clients have also expressed XXX”. As always do not judge anything they say, take a real interest in their life. All of this will build rapport.
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• Hands-on self-massage? This can be developed from your existing skills (see below). • Breathwork, a huge subject. If anxiety is a problem, perhaps work with bolsters to open their chest and explore their breathing patterns. Simply breathing together can be extremely calming. You could encourage your clients to raise their arms above their heads to bring space into the thoracic cavity. • Movement is so important, and it does not need to be complicated. When stressed, we might just need a simple reminder to do some everyday movements. The more stressed we get, the more static we become, this vicious cycle leads to more stasis, increased anxiety and often pain. By encouraging clients to move their pain will reduce. Simple everyday pastimes – walking, making the bed, cooking, doing the washing up – signals that we are ok. • Stretches, to reduce pain, build this into the session - do these together to ensure accuracy and safety, check in at all times. Always work within your remit, with a video link to ensure you can see your client and that they are safe.
Self massage Share your knowledge, teach your clients about quality of touch, explore still hands and moving hands, explain to them about the power of nurturing touch. • Soft, responsive hands, you can start with exercises to loosen shoulders wrists and fingers, this may improve their self-treatment. • Explore pace, faster pace to warm tissues, slow to lengthen strokes and facilitate deeper work, using their forearms may feel good. • Help them to notice how repetition results in tissue response. • The power of stillness, if working with stillness, you could place your hand on the screen to touch in where they are touching. Notice does the Autonomic Nervous System let down? • Work out in advance what self-massage techniques would benefit them and build these in – do these together – witness the response. You could send over a recording of the treatment to help them.
practicalprofession remote business opportunity
Group work You can teach self-massage or partner massage in groups. As with all clinical work, you would need to do a consultation with every participant to ensure you are working safely. You could send the consultation form in advance and then set the time and date for the group massage. Client records and consultations would need to be kept in the same capacity as always.
Resourcing A huge subject and it takes real skill and subtlety to explore this well. It is one of the most important things that we can facilitate for clients right now. Really take time to explore this, as it is this that will serve them once you have gone. What lets them know they are ok? What facilitates a sense of happiness and health? What is it that lets them know they are ok? Allow them to think about this. If they are really stuck, you could offer ideas. • Stroking their pet, watching the sunrise or sunset, listening to the birds, curling up in bed reading, taking a relaxing bath with candles, maintaining a yoga pose, listening to meditation.
Insurance considerations Most insurance companies will cover you for online work in the same way they cover in-clinic work, however, do check your individual policy with your insurance provider. If working with clients abroad there will be a supplement to pay. Always work within your remit and ensure you are always working safely.
How to charge for remote work?
• Ask them to describe their recourses, as they do this – watch and listen, does their expression change? Does their voice change? Does their posture change? If these improve, you know they have chosen a good resource. Ask them to notice their body – how is it feeling right now? You could point out to them if their voice, breathing or posture has changed and encourage them to use this resource if in need.
I personally feel you should charge the same as if you were in clinic, as it is your experience and knowledge that your clients are paying for. Some therapists are charging a sliding scale, depending how affected the client’s wage has been by Covid-19. Other therapists are charging “by donation”, and most clients are extremely generous with this method. As with clinical work – less is often more, don’t try to “do” too much, be quiet and resourced in yourself, and hold the space for some positive change to take place. Good luck, let me know how you get on, I am offering bespoke tuition in remote work - by donation – until the lockdown is over.
Every moment of every day we can go to our resources to help ground, embody and simply remind ourselves that we are ok. There are a multitude of other skills that can be used remotely, Shuttling or Embodiment; both of which are huge subjects that can be explored at a later date. Offering clients a thorough understanding of pain can assist in the reduction of pain.
As I said, this is really an introductory guide to help you commence or build online or remote treatments. All the subjects above can be explored in detail; many of the ideas such as breathwork, movement, resourcing, shuttling, group work, or understanding pain could be whole workshops. I suggest you explore these ideas and get in touch if you would like to know more.
Emma Gilmore was a judge at the National Massage Championships, is a founding member of the Fascia Research Society (FRS), and is currently writing a book on fascia and the body-mind complex. Having been a bodywork therapist for 25 years, Emma shares her detailed knowledge in an accessible and engaging way. She encourages all students to develop their own style, drawing on their personal knowledge and experience when dealing with clients. Emma’s journey through the world of bodywork has been a very personal one of selfdevelopment and healing and it is with this understanding and sensitivity she shares her knowledge.
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OIL PROFILE
Eucalyptus Eucalyptus globulus, also known as Blue Gum, is the most common variant in aromatherapy. Eucalyptus trees are native to Australia, however, this variant is cultivated in China, Spain and Chile. The essential oil is pale, green or yellow in colour with a characteristic camphoraceous aromatic odour, associated with the main component, eucalyptol or 1,8-cineole. LATIN NAME: Eucalyptus Globulus Labill. FAMILY: Myrtaceae METHOD OF EXTRACTION: Steam distillation of Eucalyptus leaves HISTORICAL USE: Eucalyptus globulus has been used to treat respiratory issues, breathing, coughs,
decongestion and help with muscular issues and wound healing. FOR MASSAGE: Eucalyptus globulus can be blended with a carrier oil such as sweet almond oil,
however, care should be taken with this essential oil and the correct dosage guidelines should be followed. The essential oil should only be used for massage by qualified therapists. The odour is particularly strong and can dominate other oils in a blend so please dose this oil carefully for massage. THERAPEUTIC PROPERTIES: Eucalyptus globulus oil has been shown to be analgesic, expectorant,
respiratory, anti-microbial and antiviral amongst other properties. It is excellent for treating bronchitis and infections, as well as nervous issues, fatigue and debility. OTHER USES: It is a helpful antiseptic, useful as an expectorant in cough syrups or for steam inhalation. CONTRA-INDICATIONS: Conflicting views exist regarding levels of toxicity,
however, Eucalyptus species can definitely cause hazardous reactions if used incorrectly. Extreme caution is advised; follow dosing guidelines, avoid direct contact with the skin, do not use old or oxidised oils. Eucalyptus globulus specifically is unsuitable for use on faces of infants and young children. It poses a risk of central nervous system issues (CNS) and breathing problems. Eucalyptus oil poisoning is another risk, so these oils are not recommended for internal use, especially during pregnancy.
OIL PROFILE WRITTEN BY NANA MENSAH
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Reflexology
Reflexology for Arthritis Mark Woollard
Arthritis is a common condition that causes pain and inflammation in a joint. Osteoarthritis and rheumatoid arthritis are the two most common types, but I will also discuss two other types of related conditions; Fibromyalgia and Gout. As a therapist, do not look for results in a minute or even a few weeks. It will take time when you are presented with a client who has any of these conditions. As with any client, you should always do a thorough full-body reflexology session first and then go back and concentrate on the appropriate reflexes relating to each specific arthritic condition.
OSTEOARTHRITIS • Most common type in the UK • Affects almost 9 million people • More common in women • More common in people with a family history of the condition • Most often develops in adults mid 40’s or older • But can occur at any age as a result of injury It affects the smooth cartilage of the lining of the joint and makes movement more difficult than usual. This can lead to pain and stiffness. The cartilage lining starts to roughen and thin out, which means the tendons and ligaments have to work harder. It can cause swelling and the formation of bony spurs called osteophytes. A severe loss of cartilage can lead to bone rubbing on bone and can alter the shape of a joint. This can force the bone out of its normal position. Most commonly affected joints: • Knees • Hands • Hips • Spine
It’s important to ascertain which area is affected by your particular client’s osteoarthritis. This is always the major reflex of the body I will concentrate on when re-working. I will also concentrate on the spine and do a beautiful spine twist to ensure it’s given a decent stretch. Never underestimate a spinal twist. It can break down many toxins and enable your client to feel taller and relieve pain. The parathyroids are another important area. These four small glands of the endocrine system regulate calcium in our bodies, and calcium metabolism may be a cause of osteoarthritis. I will always ensure the adrenals are given special attention. One of the hormones the adrenals produce is cortisol. As cortisone shots can be used as a treatment, I find it very beneficial to my clients to aid the production of their own natural cortisone. I will also revisit the liver, kidneys and all eliminative channels. In weak joints, circulation to these areas is impeded, meaning less waste is removed. Thus, why it is important to assist your client’s waste elimination processes. Issue 109 2020
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reflexology arthritis
RHEUMATOID ARTHRITIS
FIBROMYALGIA
• Affects more than 400,000 people
• Causes pain in the body’s muscles, ligaments and tendons
• Women more likely to be affected
• Increased sensitivity to pain
• Often starts when a person is 40-50 years old
• Extreme tiredness
In rheumatoid arthritis, the body’s immune system targets affected joints which leads to pain and swelling. The outer covering of the joint is the first place to be affected. This can then spread across the joint, leading to further swelling and a change in the joint’s shape. This may cause the bone and cartilage to break down. It can also cause a person to develop problems with other tissues and organs. Mainly affects smaller joints: • Knuckles
• Toes
• Neck
• Wrists
• Ankles
• Also knees
As with osteoarthritis, it’s important to ascertain which area is particularly problematic for your client as this is the reflex you need to re-work and pay extra attention to. In addition, I always ensure a thorough working of the spinal nerves. These are bundles of nerve fibres connected to the spinal cord. In advanced cases of rheumatoid, joint deterioration can lead to compression of the spinal cord and/or the spinal nerve roots. I also re-work the diaphragm. Even though rheumatoid arthritis primarily affects joints, it can sometimes cause lung disease. Our aim is to keep this primary muscle used in respiration as healthy as possible. I will also concentrate on the eliminative channels to help the body process and eliminate its toxins. Most important for me when approaching a client with rheumatoid is a thorough working of the immune reflexes. Rheumatoid arthritis is an autoimmune disease, meaning the immune system attacks the cells that line your joints by mistake; you can see then why these immune reflexes are significant. I always concentrate on the stress reflexes as well. This condition can increase tiredness, and there is also an increased risk of heart attack or stroke. Thus, why I find it particularly important to keep the stress levels of a client with rheumatoid arthritis as low as possible. With both osteo and rheumatoid, I will work on the pituitary gland as it plays a major role in regulating general wellbeing.
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• Difficulty sleeping • Headaches • Irritable bowel syndrome
Fibromyalgia is thought to be caused by abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain/spinal cord/nerves) processes pain messages carried around the body. I always assess the client’s specific body aches. This will allow me to focus on the pressure points correlating with their affected areas. It’s important to work on those nerves to relieve the painful symptoms. As fatigue is a common symptom of fibromyalgia, I will stimulate the reflex points of the pancreas and the adrenal glands. Exhaustion can be a result of low blood sugar levels. The pancreas helps regulate blood sugar levels. I would recommend to your client that their self-treat the pancreas reflex point several times a day. Point them in the right direction for doing this. Re-working the adrenal glands may help by improving the production of adrenaline- this increases energy levels. The brain reflexes are also essential as lack of concentration is a common problem. Those with fibromyalgia may also suffer with morning stiffness, often felt all over the body due to soreness of muscles. Get your client to point out their specific areas of stiffness, so that you are better able to work on the reflex points associated with their stiffness. I also personally love to work on the arch area of each foot (the spine) as this helps to really stretch out your client and release any tension there. Bowel movements can often be affected, so I suggest a thorough working of the colon; ascending, transverse, descending and right into the rectum and anus. This can help regulate your client and send the right signals to the bowels. An important point to remember if you are presented with a client suffering from fibromyalgia; they tend to have an increased sensitivity, so I suggest a gentler touch and ensure you continually assess the pressure you are applying.
reflexology arthritis
GOUT • Type of arthritis caused by too much uric acid • Very painful inflammation • Can occur in big toe joint, knuckles, knees and elbows • Causes intense pain, redness and swelling Uric acid crystals build up in the joints Doctors say this can be due to a number of factors: • Diet (too high in protein) • Genetics • Diuretic drugs • Psoriasis • Impaired kidney function
As well as Reflexology for a client presented with gout, the suggestion of a healthy balanced diet can also be helpful and produce extra-special results. Advise them to have plenty of vegetables and some low-fat dairy foods, drink plenty of water and to avoid a lot of red meat. The specific reflex points for particular attention are: • The kidneys – important as gout can sometimes be attributed to irregular kidney function. Also, a far more important point for concentrating on the kidneys- high uric acid levels occur when your kidneys don’t eliminate uric acid efficiently.
Whether your client arrives at your door with osteoarthritis, rheumatoid, fibromyalgia or gout, besides regular reflexology sessions, I will also stress the importance of exercise. I tell them to keep moving. Of course, they must avoid intense exercise and also steer clear of any exercise that puts strain on the joints, such as running or weight training. The perfect exercise would be swimming or cycling. With these exercises, the strain on the joints is more controlled.
• The adrenal glands – as these glands are attached to the top of each kidney, it goes without saying the significance of reworking these reflexes. • Diaphragm/solar plexus and the stress reflexes – It has also been said that gout can occur if you are feeling stressed, so do concentrate on these areas. • Eliminative channels – It goes without saying, but as the cause of gout is a build-up of uric acid, ensuring toxins are being eliminated from the body is extra important.
Mark David Woollard has fifteen years of experience working as a Reflexologist and Massage Therapist. Based in South West London, he worked in salons for ten years before becoming a freelance mobile therapist. As well as Reflexology and Swedish Massage, he also offers Reiki, Indian Head Massage and Holistic facials. He is a qualified teacher and enjoys passing on his passion and knowledge to the ‘therapists of the future’. For any questions, tips or information email markdavidwoollard@live.co.uk
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Resuming Treatments Following COVID-19 By Sarah-Jane Tepper
“Nothing eases suffering like human touch.” A quote by Bobby Fischer from the rather unrelated subject of ‘Chess Meets of the Century’ but relevant in any case.
42
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ositive touch is instrumental in our basic human need for connection and belonging. A gentle touch of the arm accompanied with a smile can often better reach the depths of our hearts than some well-intentioned words. Therapists provide this for their clients, and the inability to connect at this level has had a profound effect amid the COVID-19 crisis. We’ve been inundated with the rules of social distancing - keep two metres apart and only venture out for essential needs. Well, on any ordinary day, I would suggest that our therapies and treatments are an essential need, particularly for those in rehabilitation and relying on their regular physiotherapy sessions to keep their bodies functioning.
P
Therefore, how unusual is it to be devoid of touch? A wholesome hug, a squeeze of the hand, a soothing massage, and all of the endearing gestures that we’ve been advised to avoid, unless you’re in the same household, and even then, the level and quality of touch may be scarce. What happens when we are granted permission to do this again? As a Holistic Therapist, I decided to cease my treatments about a week before any governing bodies released their official advice. My first thought was for the health service, and I had an intuitive feeling that this crisis was only going to escalate and create massive pressure for hospitals and surgeries. I began with a very matter of fact approach and confidently informed clients that it was a ‘temporary measure’ yet
covidmatters bringing anatomy to life
necessary. As the days turned into weeks, I began to feel deep emotion and I swirled those key questions around in my head:
• When can we resume business again? • How long will we have to socially distance for? • How will this affect bodyworkers and therapists? • Will clients need us more than ever? I decided to observe from the sidelines, read opinions from experts, and take notes while absorbing and processing the emotions and reactions that have come during this period. Sometimes it has been anger, quite often self-pity, and lots of tears. In retrospect, nobody could have predicted just how big the numbers would become and how life would change in a matter of weeks, yet there is undeniably a very impactful shift that has occurred. We will come through this with new perspectives, new priorities, and new ways to conduct our lives. As whispers of lifting lockdown restrictions begin to grow louder, we are wondering how this will truly affect the massage industry. I’ve reviewed the various perspectives of how going back to work might look; wearing full PPE, prescreening clients, disinfecting everywhere, issuing disclaimers etc. I’ve even seen the humorous videos that suggest we stand on ladders and use paint rollers and plungers to attain those familiar massage techniques, but joking aside; the big question is ‘how can we return to normal
and will our industry survive?’ We need to return to the work we love, we need to be financially stable, we need to help the health and wellbeing of the population. Are we classed as an essential industry? Well, first and foremost, we need to practice safely. There is still a virus out there. And what do we know about this virus, which only four months ago, was more a pandemic of gossip proportions? I feel we are ill-equipped to know with any certainty, how this will play out for anyone. There are no definitive answers, so there can be no definitive guidelines. It is in our treatment rooms where recovery begins, through positive touch and heartfelt listening. However, a highly contagious virus that we still know very little about, means no amount of protection, in a confined space that requires skin to skin contact, can be guaranteed for a fully functional therapy practice, not until testing and tracing is in full operation and the number of deaths and infections is almost zero. Unfortunately, it may be some time before our industry can resume safely, and it pains me to admit it, but rushing into practice with experimental policies and procedures is not supporting public health safety. Even if we ‘screen’ our clients beforehand, there is no guarantee that infection is not present, and some clients may be so desperate for a massage, they twist the truth slightly or convince their therapist that they are willing to take the risk. Signing a disclaimer should not even be an option. We cannot treat clients safely until the risk has been eliminated or we have a full understanding, scientifically and medically, from the public health experts. There is immense frustration in this situation for everyone. Some of us are scratching the creative surface for financial alternatives, while others are sitting back, accepting, and waiting patiently. I class myself in the latter, because until we have a clear directive, we just can’t make any decisions. I accept we may never return to how things were, and even if we are able to, it may be
some time before we are back working to our expectations - if our expectations were realistic and sustainable in the first place. Will our clients need us more than ever? A resounding YES. The benefits of complementary therapies are immeasurable. They bolster the wellbeing of those receiving conventional medical treatment, which in turn supports our National Health Service. They provide rehabilitation for those recovering from injury and trauma, allowing healing on a mental, emotional and physical scale. Healing touch reduces stress, it communicates compassion and empathy, it nurtures positive emotions, and it makes you feel joyful. Touch heals the body through all of its biological layers, not to mention the auric and ethereal. It brings connection, meaning and understanding, and while laying on a massage couch shrouded in warm, fluffy towels, we can briefly transcend time. And I do believe that now, more than ever, the majority of people will place a greater value on time and how we spend it. We should aim to be at the forefront of recovery when we are free to do so, because recovery and healing will be the mode of the nation. The ramifications of this health crisis have highlighted so many delicate human traits and churned within us so many conflicting emotions. Almost everyone is going to need a collective hug before finding their path back to equilibrium and seeking ways to navigate new ideals and lifestyles. I have respectfully observed the therapists who have taken their businesses online and kudos to them for keeping engaged with clients, offering free webinars and workshops. We can indeed send distant Reiki, and we can set up video calls and demonstrate techniques, but there is no substitute for being real and present in the moment, and feeling the exquisite relief when our stress and tension is held in compassion and slowly worked out by a well-intentioned therapist. We will do this. We will follow the guidelines and be safe. We will be prepared for this new wave of healing. It will be immense, but we will recover.
Sarah-Jane Tepper is a Massage Therapist, Reflexologist and Reiki Teacher. She owns Herts Holistic based at Elstree Film Studios in Hertfordshire and is a tutor at the Middlesex School of Complementary Therapy.
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Symptoms, Causes and Therapeutic Treatment of Inner Ear Conditions By Marina Young BPPV My partner described the symptoms as being the worst hangover without the benefits of alcohol. For him, the room was spinning, making him unable to stand or walk normally. He was nauseous to the point of vomiting. Only by lying down and keeping his head very still would the symptoms subside, and it all started suddenly without warning. There had been two previous occasions with sudden bouts of near-identical symptoms. Both times they occurred hot on the heels of sinus infections after heavy colds, and had been diagnosed by his GP as Labyrinthitis. Luckily this time there was no cold, but the condition was now becoming chronic. Could this be a precursor of Meniere’s Disease, a disorder of the inner ear that can lead to deafness and a nightmare scenario for a musician? Google was unable to give definitive answers. His GP diagnosed something completely unknown to us, BPPV: Benign (harmless) Paroxysmal (acute) Positional (brought on by 44
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certain movements) Vertigo (the sense of rotational movement). Symptoms can last from a few days to several weeks. Thankfully this common condition is often easily treated. Prescription medication curbs nausea and light exercise in the form of a series of movements can alleviate symptoms. Some of the exercises, such as the Brandt-Daroff and Semont Manoeuvres can be done easily by the patient, but their effectiveness may depend on which part of the inner ear is affected. BPPV often comes from the disruption to the posterior canal. For this, the Epley Manoeuvre is the most frequently used and can often have immediate effects. Symptoms of Vertigo Vertigo is often used to refer to a fear of heights. It is a term describing a group of symptoms that includes loss of balance, the sensation of the environment spinning, headaches, nausea and poor concentration.
Many inner ear disorders result in vertigo. Subtle differences in symptoms arise because different parts of the inner ear are affected, and the combinations of symptoms offer a good indication of which part of the inner ear is involved. One or both ears can be affected, and symptoms can range from mild, or as in my partner’s case, severe. Inner ear disorders can take weeks to abate, making normal life difficult for sufferers. They are not visible conditions, and this can make it difficult for other people to understand how debilitating it can be. We all take for granted walking from A to B without becoming so dizzy we fall over. We also understand that over-imbibing alcohol will cause a hangover, and is considered self-inflicted behaviour or a bit of a joke. Vertigo can be a hidden condition as people with these disorders may find it hard for their chronic condition to be taken seriously or believed because they look perfectly well.
casestudy inner ear conditions
The Labyrinth and Labyrinthitis Apart from injury, the causes of inner ear conditions can be, viral infection such as herpes simplex, Epstein-Barr, common cold [1], or inflammatory conditions. Stress is also high on the list of possible causes as are the following; sleeping in one position over many years, working a sedentary occupation such as office work. The whole inner ear comes in two parts. The outer, or bony labyrinth is a shell that houses the soft tubes, ducts and sacs of the membranous labyrinth. Vertigo mostly affects just the vestibular system; the inner ear structures excluding the cochlear. Labyrinthitis is associated with inflammation of both vestibular and cochlear nerve stems. When vertigo is accompanied by tinnitus (ringing in the ears), this indicates the cochlear nerve is affected because it is this side of the membranous labyrinth that is responsible for auditory signals and allows us to hear sounds. To have the same symptoms without disturbed hearing could indicate the inflammation was solely affecting the vestibular nerves. This can cause a disorder called Vestibular Neuritis. The vestibular apparatus consists of the other structures of the inner ear. Most notable are the semi-circular canals. These ducts sit at near right angles to each other and connect with the otolith organs, the utricle and the saccule. The semi-circular canals are filled with endolymphatic fluid. Unusually for interstitial fluid, endolymphatic fluid is very high in Potassium. As it passes over, hair receptors cause Potassium ions to create a chemical reaction that opens or closes pathways depending on flow. This action generates a chemical signal to the brain via the Central Nervous System, and is how the inner ear helps us detect which direction we are moving, whether we are turning [2], spinning or tumbling. The otolith organs give us the sense that we are in a horizontal or vertical position, accelerating or de-accelerating, and what our position is in relation to gravity.[3]
in the form of calcite rhomboids called otoconia.[4] In normal circumstances otoconia remain within the utricle and saccule. Dr Timothy Hain is an expert in vertigo at Northwestern University, and describes when things go wrong, “the trouble is that sometimes the little rocks fall off”. [5] This means that dislodged particulates are moving freely around the inner ear. This rebounding of nerve cells is called Canalithiasis [6], and this is how havoc ensues. Free-floating otoconia collide at the junctions of the semi-circular canals, and otolith organs meet the ampullae. They can even be found floating around the semicircular canals. The posterior canal is the most likely to be affected, as it is more sensitive to gravity than lateral and anterior canals. The ampullae are packed with mechanoreceptor cells. Each cell has between 20 and 50 cilia or hairs attached. [7] As otoconia collide with the hairs, a wild variety of signals are sent to the brain regarding orientation resulting in vertigo. As one can imagine, disturbances in any of these structures makes for a very uncomfortable motion or seasick-like experience. When someone experiences vertigo from a condition such as BPPV, it is common for them to display an involuntary, rapid flickering eye movement called nystagmus. The eye flickers rapidly in one or more directions trying to follow the movement of the ‘spinning room’. There are different patterns of nystagmus, and to a trained specialist eye, this can indicate which part of the inner ear is affected.[8]
Nystagmus can be alarming to witness because the sufferer has no steady gaze. Although nystagmus is not always apparent when it is visible, it allows one to see that the sufferer is still going through vertigo. BPPV often makes the eye flicker in a horizontal movement in the direction of the affected ear. This is important during the Epley Manoeuvre. If there is visible nystagmus, it can be a good indicator the client’s vertigo is easing off as the nystagmus diminishes. This can be confirmed with the client by asking them how they feel, and if the symptoms are lessening. Dr John Epley Dr John Epley was an ENT-Otolaryngologist in Portland, Oregon. He made his name as an innovator in his field and in the late 1970s he developed the theory of Particle Theory for Benign Paroxysmal Positional Vertigo (BPPV) [9]; the theory that microcrystals free-floating in the inner ear causing vertigo was radically new. In 1980 Dr Epley gave a talk in California about his theory that ended with a demonstration of his manoeuvre that he developed with audiologist Dr Dominic Hughes that claimed to cure BPPV. It shocked the audience. It went against the established view and suggested that a common illness that was often treated with surgery could be treated in a non-invasive manner with an extremely high success rate.[10]
BPPV Other problems can include an imbalance of pressure of fluid in the canals, ducts and ‘rock falls’; dislodged crystals tumbling in the semi-circular canals. The latter condition causes BPPV. The utricle is a pouch-like structure that houses approximately a thousand microscopic calcium carbonate crystals Issue 109 2020
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casestudy inner ear conditions
The technique involved manoeuvring the head into particular positions to get the otoconia to go back into place. His work was ridiculed at the time, but despite the initial rejection, Dr Epley innovated the technique and proved the efficacy of the manoeuvre. It is now the most common method to alleviate BPPV[11] with a success rate of 70% after an initial treatment and high 90s% on subsequent sessions.[12] The modified Epley Manoeuvre helps the free-roaming particles to find their way back to the vestibule, especially when trapped in the posterior canal, the most common form of BPPV. The following describes a modified, Epley Manoeuvre for the right ear.[13] Movements should be completely passive, so the client is guided into them, and there should be no resistance. • The client sits upright with legs extended out on the couch. • The client is asked to turn their head 45 degrees into the direction of dizziness. • Support the client’s head at a 45 degree angle and bring the client to the supine position. Their head is off the couch 20 degrees. • Check the eyes for nystagmus and wait until this settles. It helps to ask the client to focus on your nose. If no nystagmus is visible wait 30 seconds.
The Epley manoeuvre
As BPPV can affect one or both ears, there is a test to see which side is symptomatic called the Dix-Hallpike Test. It shares the opening moves with the Epley Manoeuvre. Starting with the head turned to the right, the test is for the right side and vice versa. If nystagmus occurs only in one direction, it is likely the cause lays solely with the ear that side. The Dix-Hallpike Test: • Client turns head 45 degrees to the right. • Client is brought straight into supine position keeping their head at 45 degrees and tilted back 20 degrees. Observe the eyes for about 30 seconds.
• When nystagmus has settled, ask the client to rotate their head 90 degrees. Check the eyes • Tilt the head 90 degrees to the left and repeat the observation for 30 seconds. and wait for nystagmus to settle. Wait 30 seconds.
• The side that indicated nystagmus, or • Supporting the client’s head at a 45 degree if there is no nystagmus visible, but the angle and 20 degrees off the couch, ask the client feels vertigo, this side is most likely client to turn left, so they will be facing down. the problem. The client will now be looking down. Wait 30 seconds. Ask the client to flex their knees and help them to sit up quickly. Diagram of Modified Facilitated Epley Manoeuvre.[14] • Now the client rests with chin towards their chest.[15] Alternatively, the client keeps their head in a relaxed but straight-ahead position. Ask the client to avoid lifting their head up or down for at least 24 hours.[16] For example, looking down to tie one’s shoelaces should be avoided, as should looking up to check the top of a door or a high shelf. Movement in those directions, lifting or tilting the head down, can bring on vertigo. 46
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to settle on completing the Dix-Hallpike manoeuvre. Nystagmus did not occur on the left side, so it was apparent to just to do the manoeuvre for the right side. At the end of the Epley Manoeuvre, my partner reported feeling better, but the dizziness was still there. Looking down made it worse, so we adhered to advice [18] to keep the head straight and avoid looking up or down for 24 hours then review.
In most cases, clients report feeling much better almost immediately. In other cases, the Epley Manoeuvre may allay symptoms and speed up the healing process.[17] The Epley Manoeuvre is considered a safe procedure for most people and can be repeated if necessary. When symptoms stop, there is no need to repeat the manoeuvre. When applying the Epley Manoeuvre to my partner, he found it difficult to be comfortable enough to completely relax owing to the symptoms he was experiencing. His nystagmus was very pronounced, particularly in the right eye. It took several minutes
Self-Managing BPPV The Epley Manoeuvre was too difficult for my partner to do by himself. Bearing in mind how suddenly vertigo can occur and there may not be enough space to try it, there are other techniques for realigning the otoconia such as the Liberatory Semont Manoeuvre and the Brandt-Daroff Manoeuvre. The Liberatory Semont Manoeuvre can be performed sitting on a sofa or side of a bed. The diagram illustrates moves for right side posterior canal BPPV. If the cause is the left side follow the moves in the opposite direction to the diagram:
1 Sit in an upright position with your head turned 45-degrees towards the left.
2 With your head at the 45-degree angle quickly lie down on the right side. Resting your head on the bed keeping the 45 degree angle for 1 minute.
3 Still keeping your head at the 45-degree angle, sit up and lie down on the left side rapidly in one movement. Now you should be looking down at an angle. Keep in this position until symptoms go or for up to 1 minute.[19]
casestudy inner ear conditions
aneurysm, and is not suffering from a concussion or another type of head or ear injury. Care also needs to be taken as the swift movements can irritate any existing neck, shoulder, spinal injuries or pain.
The Brandt-Daroff manoeuvre
The Brandt-Daroff manoeuvre [20] is similar to Semont, with the exception of time between moves. It is also recommended to do the Brandt-Daroff in a series of repetitions over a period of weeks. • Begin in a seated position. • Turn 45 degrees right, quickly lie down left down, stay 30 seconds if there is no dizziness. If symptoms are present, stay until dizziness passes plus 30 seconds. • Sit up and wait 30 seconds. • Turn head 45 degrees to the left and quickly lie down on the right side. If there are symptoms, wait for them to pass plus 30 seconds. If there are no symptoms, wait 30 seconds.[21] • Quickly sit up and wait for 30 seconds. Repeat the sequence 4 times for a total of 5 repetitions with the general recommendation of doing this twice a day for 14 days. Conclusion My partner found the first attempt at the Epley Manoeuvre unpleasant, and he still had vertigo afterwards. He did try the Brandt-Daroff manoeuvre because it is easy to remember and being able to do it on his own gave a sense of taking control. However, rapid, repeated movements made him feel worse. We left it a day and tried the Epley manoeuvre again. This time my ‘patient’ was much more relaxed despite the unpleasant symptoms. This was helpful because I could facilitate the moves more easily, support his head and check the nystagmus without trying to compensate for extra tension. The result on this occasion was an 80% improvement. His symptoms were a lot milder and completely cleared within a few days. Although there are many physical indicators as to the cause of vertigo, it takes a specialist clinician, doctor or consultant to diagnose the cause. It was only with GP approval that we took this course of action. For example, an indicator of Meniere’s disease is the feeling of pressure in the head along with vertigo due to disturbances in the pressure, or the fluid in the endolymphatic ducts and canals. There are many other reasons why one might experience vertigo with or without pressure. In clinical situations, it would be imperative to know the history of the client, whether certain conditions such as BPPV and Labyrinthitis is an official diagnosis from a GP or specialist. This is to ensure the client is not experiencing any type of stroke, or
How to avoid BPPV in the first place? As stated earlier, the reasons are unclear, although sleeping in one position over the years as well as stress may play a part. Although it is unclear how stress can affect the inner ear, research in Australia has linked bioelectrical patterns created in by the current generated in the inner ear, that correspond to emotional conditions such as depression, ADHD and even schizophrenia.[22] However, it remains to be seen if these emotional states are a cause of vertigo. It is always advisable to keep stress levels at a healthy level with regular exercise, healthy diet and sufficient sleep. Dr Epley was acknowledged for his ability to listen to his patients’ problems, whether they were related to their illness or to personal problems. He was able to put his patients at their ease by listening, taking their symptoms seriously and improved the lives of millions of people around the world. References [1] www.medicinenet.com / https://www.msdmanuals.com/professional/ear,-nose,-andthroat-disorders/inner-ear-disorders/vestibular-neuronitis [2] Human Physiology 12th Ed. Stuart Ira Fox, pub McGraw-Hill Int Ed. [3] Ibid. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4482761 [4] www.npr.org>2009/04/27>inner-ear-rock-slides[5] www.npr.org >2009/04/27 > inner-ear-rock-slides[6] https://healthjade.com/epley-maneuver/ [7] Human Physiology 12th Ed. Stuart Ira Fox, pub McGraw-Hill Int Ed. [8] https://www.dizziness-and-balance.com/disorders/bppv/dix%20hallpike.htm [9] https://obits.oregonlive.com/obituaries/oregon/obituary.aspx?n=john-mepley&pid=193544603&fhid=2246 [10] https://www.dignitymemorial.com/obituaries/vancouver-wa/john-epley-8794075 [11] https://www.oregonlive.com/health/2019/10/eply-maneuver-for-vertigo-was-inventedby-oregon-doctor.html [12] https://healthjade.com/epley-maneuver/ [13] https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/home-epleymaneuver [14] https://healthjade.com/epley-maneuver/ [15] BMJ demonstration https://www.youtube.com/watch?v=jBzID5nVQjk [16] Bob & Brad Physical Therapists - Epley Manoeuvre for Vertigohttps://www.youtube. com/watch?v=KzLWOX770i4 [17] Ibid. [18] BMJ The Epley Manoeuvrehttps://www.youtube.com/watch?v=jBzID5nVQjk [19] University of Michigan https://www.youtube.com/watch?v=z2KUrQoZ-sU [20] Ibid. [21] University of Michigan https://www.youtube.com/watch?v=voZXtTUdQ00 [22] https://www.healthyhearing.com/report/43720-Balance-vestibular-system
Marina Young trained at City and Islington College under the auspices of Helen Kent and Chaika Holste to complete the ITEC Complementary Therapies Diploma in 2004. This was a multi-discipline year-long course that enabled students to learn a wide skillset and the possibilities of combining techniques to suit individuals needs. Over the next 15 years she continued her professional development and attained many certificates. Her client base is mostly from the arts and entertainment fields. Musicians often get tension due to repetitive movements.
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Welcome to
The International Professional Association with a difference For complementary, beauty/SPA, alternative and integrated healthcare and wellbeing
Why be part of a professional association?
A professional association is there to look after your interests. No one else is. Many people within our industry work individually. Being part of a professional association gives you support, a network of colleagues, access to career development and industry updates, security in your work and helps you ensure you are up to date with legal changes.
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We are ThinkTree. We are founded and run by practising therapists and experts in training. We care about the industry and we know about it because we’re part of it. This gives us a unique edge.
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• Recognition from belonging to a Professional Association • Free online CPD from industry experts • Support for new and existing trainers • Course and Centre approval and accreditation • Monthly newsletter and free access to industry leading Holistic Health Magazine • Special Treatment Licence exemption (which could cost up to £2,500) • Save money on insurance, clinic supplies and other products • Free session with a wellness coach and more
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Who can join • Massage and Bodywork practitioners of all kinds • Beauty Therapists • Health and Fitness Professionals • Medical Professionals • Energy Therapists • Mindfulness, Hypnosis, CBT practitioners • Teachers, Coaches and Course Providers • Students (Free membership) Not listed here? Just ask us
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Kneads Must have put their awardwinning Kneader Chair Massage routine into an accredited and insurable online course so that therapists can: • learn hand-saving techniques using the Kneader massage tool • learn a new and exciting chair routine • grow their business • earn 15 CPD points
Our introductory course offer is just £149.99 (which includes 2 Kneader massage tools). Visit www.kneadsmust.com and the ‘book a course’ option to access the course information page link and view course clips.
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Sweet Cures has over 17 years’ experience in the supply and distribution of glyconutrients. Please visit our website to see our full range of supplements, probiotics and testing kits.
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Sweet Cures
sweet-Âcures.com 01904 Â 789559
PowerLaser™ Pro 1500 The worlds most innovative FDA and CE certified deep tissue healing class 3B laser
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I’ve now had my PowerLaser for about a year and a half, and I simply CANNOT live without it... I’ve helped people with knee pain, neck, shoulder, back and more. - Catharine J.
PowerMedic Lasers UK . 2 Eastbourne Terrace, London, W2 6LG. Tel: +44(0) 75577 71805 . enquiries@powermediclasers.uk www.powermediclasers.co.uk
䄀氀氀 愀戀漀甀琀 䔀猀猀攀渀琀椀愀氀 伀椀氀猀 䔀猀猀攀渀琀椀愀氀 漀椀氀猀 愀爀攀 渀愀琀甀爀愀氀 瀀氀愀渀琀 攀砀琀爀愀挀琀猀 琀栀愀琀 挀愀渀 攀渀栀愀渀挀攀 礀漀甀爀 洀漀漀搀 愀渀搀 眀攀氀氀戀攀椀渀最⸀ 吀栀攀礀 栀愀瘀攀 戀攀攀渀 猀栀漀眀渀 琀漀 栀攀氀瀀 琀爀攀愀琀 猀漀洀攀 栀攀愀氀琀栀 挀漀渀搀椀琀椀漀渀猀 渀愀琀甀爀愀氀氀礀Ⰰ 甀渀搀攀爀 琀栀攀 爀椀最栀琀 挀漀渀搀椀琀椀漀渀猀 愀渀搀 漀昀 挀漀甀爀猀攀 栀愀瘀攀 眀漀渀搀攀爀昀甀氀 昀爀愀最爀愀渀挀攀猀⸀ 䄀爀漀洀愀琀栀攀爀愀瀀礀 椀猀 椀猀 愀渀 愀爀琀Ⰰ 猀挀椀攀渀挀攀 愀渀搀 愀 瀀爀愀挀琀椀 瀀爀愀挀琀椀挀攀 戀愀猀攀搀 漀渀 甀猀椀渀最 攀猀猀攀渀琀椀愀氀 漀椀氀猀⸀ 䤀琀 琀愀欀攀猀 愀 氀漀渀最 琀椀洀攀 琀漀 甀渀搀攀爀猀琀愀渀搀 琀栀攀 瀀漀眀攀爀 漀昀 攀猀猀攀渀琀椀愀氀 漀椀氀猀 愀渀搀 愀瀀瀀氀礀 琀栀攀洀 椀渀 琀栀攀 爀椀最栀琀 眀愀礀 昀漀爀 礀漀甀爀 渀攀攀搀猀⸀ 䄀琀 䔀猀猀攀渀琀椀愀氀 伀椀氀 䬀渀漀眀 䠀漀眀Ⰰ 眀攀 瀀爀漀瘀椀搀攀 琀椀瀀猀 愀渀搀 愀搀瘀椀挀攀 漀渀 琀栀攀 甀猀攀 漀昀 攀猀猀攀渀琀椀愀氀 漀椀氀猀 昀漀爀 愀爀漀洀愀琀栀攀爀愀瀀礀Ⰰ 戀攀愀甀琀礀Ⰰ 眀攀氀氀 戀攀椀渀最Ⰰ 洀愀猀猀愀最攀 愀渀搀 渀愀琀甀爀愀氀 猀欀椀渀挀愀爀攀 洀愀猀猀愀最攀 愀渀搀 渀愀琀甀爀愀氀 猀欀椀渀挀愀爀攀⸀
A family run business developing and producing 1 00% natural Beeswax based products.
圀攀 愀爀攀 焀甀愀氀椀ǻ攀搀 琀漀 最甀椀搀攀 漀渀 礀漀甀 漀渀 眀栀椀挀栀 漀椀氀猀 愀爀攀 戀攀猀琀 昀漀爀 礀漀甀爀 猀瀀攀挀椀ǻ挀 爀攀焀甀椀爀攀洀攀渀琀猀Ⰰ 琀栀攀 猀愀昀攀 焀甀愀渀琀椀琀椀攀猀 琀漀 甀猀攀 愀渀搀 琀栀攀 洀漀猀琀 攀昀昀攀挀琀椀瘀攀 眀愀礀 琀漀 最攀琀 洀愀砀椀洀甀洀 戀攀渀攀ǻ琀 昀爀漀洀 琀栀攀猀攀 洀愀最椀挀愀氀 漀椀氀猀⸀
• Our Massage Wax range offers professional therapists a variety of delicately formulated aromatic blends - one to suit every client! • A fantastic alternative to massage oil - with no spills! • Leaves skin nourished and hydrated without feeling oily • Protects delicate skin, perfect for Baby massage (Be Sensitive) • Recyclable packaging • 1 00% Natural Ingredients.
圀攀ᤠ爀攀 栀攀爀攀 琀漀 栀攀氀瀀 礀漀甀 眀椀琀栀 愀渀礀琀栀椀渀最 琀漀 搀漀 眀椀琀栀 攀猀猀攀渀琀椀愀氀 漀椀氀猀 愀渀搀 眀漀甀氀搀 氀漀瘀攀 琀漀 栀攀愀爀 昀爀漀洀 礀漀甀
Visit our website to see our great multibuy offers and for more information on our product range 倀氀攀愀猀攀 挀漀渀琀愀挀琀 甀猀 愀琀 攀猀猀攀渀琀椀愀氀漀椀氀欀渀漀眀栀漀眀䀀最洀愀椀氀⸀挀漀洀 昀漀爀 昀甀爀琀栀攀爀 椀渀昀漀爀洀愀琀椀漀渀
www.highlandwax.co.uk Highland Wax Company, Foynesfield Cottage, Nairn IV1 2 5SA 01 667 451 736 info@highlandwax.co.uk
theuklc.com
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Update your lymphatic massage techniques! Discover courses backed up with essential education to enhance your client’s health and vitality. £395
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£475
Lymphatic Healthcare and Education
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courselistingscourselistingscourselistings Academy of On Site Massage – Seated Acupressure Diploma and CPD Post Grad Courses Ever thought about offering massage in companies but not sure where to train? We have the answer. As specialist trainers in Seated Acupressure since 1989 you can be confident you will receive the most thorough training and support available. Further training is available via our range of post graduate courses to enhance your skills. Details: For a quick view of course dates please go to our new website at www.aosm.co.uk and check out the CALENDAR Post graduate training includes; • Massage At Your Desk • Massage Tools Course • Advanced Seated Acupressure • Seated Therapeutic Massage • Hands Free Seated Acupressure • Seated Acupressure Refresher Training locations include; • Oxfordshire • Sheffield • Reading
T: 0118 927 2750 E: info@aosm.co.uk www.aosm.co.uk
Anatomy Trains UK Learn from the people who wrote the books! Expand your understanding of myofascial connections through body and gain new skills directly from the experts. Learn to address postural and functional patterns by combining manual and movement skills.
T: 028 9058 0764 E: workshops@anatomytrains.co.uk www.anatomytrains.co.uk
Amanda Hermitage: Anatomy Courses on Cadavers and Dissections with Julian Baker Hands-on experience, these workshops will change the way you view the body and enhance your understanding of anatomy. Open only to therapists and body workers, including students. Details: London venue
E: amandyh@aol.com
FTT Beauty and Training Centre Well established training centre since 2000, Warm and friendly environment based in Hertfordshire. Close to the M25 and M1. Offering a wide range of both Complementary and Beauty Courses, whether it’s an NVQ Level 2, 3, 4 or CPD Fast Track Accredited Diploma. Small groups (Max. 4) allowing for more personal attention to the individuals. Courses are tailored to meet individual needs, suitable for beginners and qualified therapists. Details: Call office for full details on dates and times
T: 01727 768559 /07796268782 E: enquiry@ftt-beautyandtraining.co.uk www.fttbeautyandtraining.co.uk
ISRM/BTEC (Level 5) Diploma in Sports & Remedial Massage Courses On this intensive 12-month Course you will: Revise and consolidate general massage techniques • Learn advanced soft tissue techniques • Analyse touch /connection /palpation • Explore injury and recovery - analysis and treatment • Discover the how to massage in non-clinical settings • Investigate Posture and Core Stability • Examine Flexibility/ Stretching/Relaxation • Gain knowledge of Nutrition & Sports Psychology • And MORE. Details: CPD Workshops; Muscle Energy Technique; Myofascial Release; Soft Tissue Release
T: 01509 551513 E: admin@ukmassagecourses.com www.ukmassagecourses.com
UKCP Accredited Diploma The London School of Biodynamic Psychotherapy (LSBP) was established in 2000, at Gerda Boyesen’s request, to carry forward the professional training in Biodynamic Body Psychotherapy previously taught at the Gerda Boyesen Centre. LSBP offer a four year UKCP accredited diploma training in Biodynamic Body Psychotherapy, along with CPD workshops throughout the year. LSBP provides professional practitioner Biodynamic Body Psychotherapy courses, promotes research in the field and serves as a professional body for Biodynamic Body Psychotherapists. LSBP is a member of the Humanistic and Integrative Psychotherapy section of the United Kingdom Council for Psychotherapy (UKCP) and also of the British Massage Therapy Council (BMTC) and the Association of Humanistic Biodynamic Massage Therapists (AHBMT). Through its membership of UKCP/HIPS, LSBP is directly involved in maintaining the standards of the psychotherapy profession, having a seat on the UKCP registration board. Details: See website
T: 0207 263 4290 E: admin@lsbp.org.uk www.centreforbodypsychotherapy.com
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courselistingscourselistingscourselistings UK Lymphology Clinics Lymphatic Healthcare and Education Advancing training in our ground-breaking therapies to give knowledge and understanding of the lymphatic system for those who want to confidently expand their careers in a new dimension! Details: Breast Cancer Aftercare - Lymphatic Pressure Therapy - Six Months Training - 55 CPD points New and unique, this advanced training offers maximum beneficial aftercare for breast cancer clients. Encouraging five elements of recovery for range of motion to restore muscle connection for mobility and balance, whilst stimulating lymphatic return for an overall post-operative improvement. VTCT Approved. For caring, empathetic therapists confident in their own ability to provide excellent standards of UKLC aftercare! Must have six months massage training and six months practice. Lymphatic Integrated Massage - One Day Attended Course - 12 CPD points Encouraging a new approach towards effective lymphatic stimulation. This two-part course of three weeks home study theory and one day practical results in a short powerful therapy application to be integrated into everyday massage. “Thank you so much for excellent training, I thoroughly enjoyed all aspects of the course and the LIM benefits. You are an inspirational teacher.” Please see more details on our website.
T: 07599 985648 E: info@theuklc.com www.theuklc.com Bowen Technique A soft tissue remedial therapy which is gentle on both practitioner and client while still being powerfully effective. Add Bowen to your existing practice, offering it as an alternative to new and existing clients. Training is rigorous but fun with an emphasi s on your practical skills. Download our prospectus one from the website. Join one of the many Part 1 courses on offer across the UK. Details: Contact us for course dates.
T: 01373 461812 E: info@thebowentechnique.com www.thebowentechnique.com Prenatal Massage Training Training with Comfy Spa Training Company enables you to specialise in pregnancy massage. Our Post Graduate course will teach you all the important do’s and don’ts along with practical skills of how to deliver a beautiful ritual spa treat for mum to be and baby bump. To qualify for training in this unique & beautiful course all you need is a certificate in A&P and massage. Free belly casting is included with this course. Details: Courses are run throughout the year. 1 Day Course with pre-course study £160 + vat
T: 01782 285545 or 01782 639777 E: carol@comfyspatraining.co.uk www.comfyspatraining.co.uk Gladwell School of Massage Gladwell School of Massage is open to everyone who has an interest in the healing arts, whether you are a practitioner or a complete beginner. Our courses include Thai Yoga Massage - the latest and most effective table massage techniques, Postural Assessment - muscle testing and rehabilitation, Chair Massage, and much more. Expert tuition is provided by Daniel and his daughter Lila (see below), at popular locations in the UK or at their retreat home in Greece.
Womb & Fertility Massage Therapy A 4 day Spiritual, Practical & Theory course for therapists who’s passion is to nourish and nurture every women through any stage of their reproductive life. A unique blend of ancient, intuitive and sacred techniques. Details: 2018 National and International Courses: Belgium, Belfast, Ireland, Brighton, Manchester, Bristol, London
T: 07713 477511 E: info@fertilitymassage.co.uk www.fertilitymassage.co.uk Gateway Workshops™ Gateway Workshops™ offering recognised one day diploma massage, beauty and also on-line complementary therapy qualifications. Courses for all levels, CPD courses for therapists, courses for complete beginners looking to learn massage or beauty, gain a qualification or a total career change. Recognised, affordable and insurable training allowing you to use these therapies professionally to gain an extra income, in a clinic or as a mobile therapist. Details: Please check our web site for all the courses we offer - regular monthly weekday and weekend options in London, UK and Ireland.
www.gatewayworkshops.com Practitioner Training in Hawaiian Lomi Lomi Massage With Rosalie Samet. Dynamic, spiritually rich and life-changing authentic massage from Hawaii synthesizes ancient with modern in exceptional 12 Day Practitioner Training of highest UK standard. Intensive, Fast Track and Progressive options. CPD Workshops. Blend powerful massage skills, energy techniques, Huna wisdom and Aloha. Daily massage exchanges, small happy classes. Accredited by FHT and CThA with 2-day Assessment for Certification Details: FAST TRACK One Module of 4 days each – every month over 3 months. Autumn: Oct 10*– 13, Nov 07–10, Dec 05 – 08 INTENSIVE Three Modules of 4 days with one day off between each.
T: 01273 730508 E: info@hawaiianmassage.co.uk www.huna-massage.com McTimoney College of Chiropractic We have been training chiropractors for over 45 years and have graduated many massage therapists who recognised that they needed additional skills and knowledge to enable them to help more clients. We deliver two programmes providing a Masters in Chiropractic. One is suitable for school leavers and is taught during the week and one is specifically designed for mature learners wishing to change their career. This programme is taught over one weekend a month and through summer schools in each year which allows students to continue to work whilst training. Both programmes are registerable qualifications with the General Chiropractic Council. This is a perfect way to upskill, building on your knowledge of anatomy and physiology to learn more about clinical conditions and the practical adjustment skills you need to make a difference. ‘I always wanted to be a chiropractor – I just never knew it would be this good!’ Details: Intakes in January (Manchester and Abingdon) and September (Abingdon)
www.mctimoney-college.ac.uk
www.gladwellschoolofmassage.com Issue 109 2020
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