Massage World - Dec 2007

MASSAGE WORLD The Massage and Body Therapists Magazine ÂŁ4.00 December/January 2007 www.massageworld.co.uk

A Weekend - head & shoulders above the rest A Personal Perspective for a Practical Solution Hamstring Injury - the athletes nightmare Taking Care of Your Fingers in Massage

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calendar I news & views I products I research I student section I directory

L A I

R FE F O N IO E 28 T IP G CR E PA S B E SU S

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C E P

MASSAGE WORLD EDITOR

FEATURES WRITERS

Wendy Kavanagh Morag Coulter James Earls Susan Findlay Diane Harris Edith Maskell Darien Pritchard Charles Wells

GRAPHIC DESIGN

Sal Bourne

MEDIA COMMUNICATION

C J Newbury

PUBLISHERS

NK Publishing

welcome editorial by Wendy Kavanagh

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easons greetings to all our readers, how did the end of the year creep up so quickly? The last twelve months have seen a rapid progression in the move towards voluntary self regulation for massage, Edith Maskell poses the question in this issue "are we prepared?".

There is a personal diary piece allowing us to be a fly on the wall at a weekend course for Continual Professional Development, alongside all our regular features.

We remain seasonal with the aromatherapy of frankincense and myrrh, those exotic oils.

The period between December and January was called the "cold time’ and ‘stay home time’ by the Celts. It is a time for withdrawral but also regeneration and new resolutions. Go forward and build on your skills and knowledge and make the coming twelve months your most successful yet.

Wishing a peaceful and prosperous new year to you all.

ANNUAL SUBSCRIPTIONS

UK / EU: £25 UK Student: £20 Rest of World: £40 Single Copies: £4.00 ISSN 1474-4171

how to contact us Massage World PO Box 54879 London SW1P 9FW T/F 020 7387 9111 E

massageworld@btconnect.com

W www.massageworld.co.uk DISCLAIMERS The publisher has taken all reasonable measures to ensure the accuracy of the information in Massage World and cannot accept responsibility for errors in or omissions from any information given in this or previous editions or for any consequences arising thereof.

The Editor may not always agree with opinions expressed in Massage World but allow publication as a matter of interest, nothing printed should be construed as Policy or an Official Announcement unless stated.

No part of this publication may be reproduced in any form or by any means whether electronic, mechanical and/or optical without the express prior written permission of the publisher.

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“As a result of the advert, on the CThA Members Forum, I have one new holistic massage therapist who has joined the team and is very much appreciated by the clients�

Donna Woodcock Massage Therapist

To find out how the CThA helped Donna and hundreds of other members last year just when they needed it, call a member of the CThA team on: 0845 202 2941or visit our website at: www.ctha.com

Professional help when you need it

contents Hamstring Injury - the athlete’s nightmare

feature 9

Continuing our series examining sports and remedial common conditions,Susan Findlay of the NLSSM looks at hamstring grade 1 strain, the cause, effect and treatment.

Taking Care of Your Fingers in Massage

feature 13

This is the third in a series of articles extracted from a forthcoming book on Dynamic Bodyuse for Effective Strain-free Massage which is designed to promote good bodyuse as an integral part of doing massage.

A Weekend - head and shoulders above the rest

feature 18

A personal account of a two-day course in advanced massage skills for the neck and shoulders, held at the Maitri Foundation in the tranquility of the Cotswolds.

Oil of the Orient – frankincense

feature 29

A Seasonal choice from Charles Wells , a look at essential oils that are precious as well as potent.

A Personal Perspective for a Practical Solution

feature 38

regulars

Whilst it has been the dream of CAM practitioners to participate, contribute, be respected and hence make a difference to the health of the nation for eons, do we deserve it and have we properly prepared ourselves?

editorial

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industry news and views

6

the journey of hands

23

muscle of the month

24

product reviews

26

faqs

33

research

34

resource directory

44

course listings

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news&viewsnews&viewsn Marks Out of Ten Strictly Come Dancing celebrity Carole Smillie survives her gruelling dance training with Mandala Aroma organic strength body oil - just one product in a wonderful aromatherapy range proving the potency of essential oils.

Carole said " I am aching from the top of my head to the tips of my toes… we train for eight hours a day, the strength body oil is fantastic to rub on my aching legs and when I get home the Wisdom Organic Bath oil sends me off to a sound sleep… they are beautiful fantastic products".

Bowled Over

With the 2005 Ashes title to defend, the England cricket team set off for Australia with a team of support staff that includes Massage Therapist Mark Saxby. His remit is to work closely with the medical team and generally help maintain the players form and consistencey. With a background in athletics, swimming, hockey, triathlon and gymnastics through the English Institute of Sport, Saxby from the East Midlands has been working with the team throughout the summer.

Performance at this level of cricket brings the stresses and strains of high intensity play, bowlers being the most regular visitors to the massage table, often during intervals and at the end of each day's play.

"To work with the England team at any time would be a fantastic experience but to be involved while they have been so successful has been a great privilege," explains Saxby. "I’d like to thank EIS regional manger Matt Hammond and the strong relationship between the EIS and the ECB for giving me this opportunity to work with my favourite sport."

"The main work that I have been doing is general maintenance with the players while they’re playing and practicing. It’s great to work in a strong multi-disciplinary team alongside the England physiotherapists and strength and conditioning coaches. It helps to ensure the players are getting the best support possible."

"A typical test match day for me would be to shadow the team on arrival, through their practice sessions and at the hotel keeping an eye on them all the time. The players generally need maintenance at the end of a long Test match day."

"Each individual in the squad will have his own individual requirements and will suffer their own injuries. We generally have a fair idea of what injuries we will have to deal with but if something a little different comes up, we as a team will be confident that we’ll be able deal with it".

UK Market Leaders in Portable Therapy Equipment Tables, Chairs, Stools & Accessories – Table prices start from £170

Click online or FREEPHONE: 0800 083 5530 for more information or to locate a dealer www.therapyessentials.co.uk 6

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news&views The Final Countdown At the final conference held at the Royal Overseas Club in St.James, 200 members of the Massage Therapy Institute of Great Britain gathered for the last time. Speakers such as Dr Kevin Bryon, Professor Michael Hyland, DrAmanda C De C Williams, Linda Kimber, Mary McNabb and Henry Marsh were there to make the thirteenth and last conference the best ever.

Clare Maxwell-Hudson was presented with a gift by Richard Burton, an Honorary Member of the MTIGB in recognition of her contribution to massage.

Clare has been a world authority on massage, her books have sold in millions in 22 countries and she has achieved international recognition in massage and health. Established in 1980, she and her fellow tutors at her massage school in London offer a wide range of massage courses preparing students for a rewarding career in the fast growing field of massage and complementary therapy. Due to her retirement The Clare Maxwell-Hudson School, together with it’s alumini association, the Massage Therapy Institute of Great Britain, will be closing at the end of 2006 after 35 years in this industry. What an achievement.

Clare and her colleagues would like to wish all their supporters over the years the best of luck with their massage. Massage World would like to thank her and MTIGB for all their encouragement and to say that the profession owes her a great debt for the pioneering work she has done over thirty five years, bringing massage therapy into the mainstream.

www.cmhmassage.co.uk

calendar of events 25-27 February 2007

10-11 March 2007

Professional Beauty 2007

Mind Body Soul Exhibition

ExCel, London

Kempton Park Race Course, Surrey

The industry’s showcase for therapists and clinic owners. Over 19 years this exhibition has grown to be the market place for new products and opportunities.

A popular venue for this exhibition covering complementary therapies, personal growth and spiritual awareness. Come and visit us on the Massage World Stand 40.

CONTACT 020 7610 3001 • W www.professionalbeauty.co.uk

CONTACT 01787 224040 • W www.mbsevents.co.uk

11-12 March 2007

24-25 March 2007

Total CAM Show

SMTO Conference 2007

The Brighton Metropole

Napier University, Sighthill Campus, Edinburgh

The purpose of this show is to provide a forum for the CAM Practitioner and the specialist CAM supplier.

The annual two-day conference and workshop for the Scottish Massage Therapist Organisation.

CONTACT 01923 690699 • W www.totalcamshow.com

CONTACT 01224 822960 • W www.scotmass.co.uk

To publicise your event/conference/exhibition on our calendar page email: massageworld@btconnect.com Dates and venues correct at time of going to press.

December/January 2007 M|W

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Hamstring Injury the Athlete’s Nightmare

by Susan Findlay ontinuing our series examining the common conditions that a sports & remedial massage therapist will come across on a regular basis, Susan Findlay of the NLSSM looks at hamstring grade 1 strain, the cause, effect and treatment.

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Similarly, sudden over-stretching, or an extreme contraction of the muscles, can cause damage to the belly or at the musculotendinous junction. Other examples include a combination of deceleration, acceleration, pushing off, jumping, turning, side stepping etc.

It is frequently a runners’ injury, whether it is during a game of football, tennis or long distance running.

Hamstring strains tend to happen in the gait cycle during the terminal swing phase and heel strike, this is when the hamstrings produce the greatest eccentric force to decelerate the leg.

The causes of strain can be attributed to; inadequate warm-up, being exposed to prolonged periods of cold, decreased flexibility, overuse syndrome, muscle imbalance, biomechanics, scar tissue present from a previous injury, as well as an athlete who is fatigued.

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sportsmassage hamstring injury - the athlete’s nightmare

Strains can be classified within 3 different grades GRADE 1 Mild or 1st degree strain Minimal tear to the tissue, no local oedema, bruising & heat are minimal or not present. The person can continue with the activity experiencing a nominal amount of discomfort

GRADE 2 Moderate or 2nd degree strain TREATING WITH THE LEG IN THIS POSITION, IS AN EFFECTIVE WAY OF MASSAGING MUSCLES AND ENCOURAGING LYMPHATIC DRAINAGE.

A greater number of fibres have been torn. There may be evidence of heat, local oedema, and bruising. A gap may be palpable at the site of injury.

A snapping sound is sometimes heard at the time of injury. This person has difficulty going back to the activity they were doing.

GRADE 3 SIDE LYING IS VERY USEFUL FOR ADDRESSING FASCIAL LINES AS WELL AS APPLYING ACTIVE AND PASSIVE STR TREATMENT TECHNIQUES.

Severe or 3rd degree strain This is a complete rupture of the musculotendinous unit (or an avulsion fracture),often the muscle shortens and bunches up, leaving a palpable gap. A snapping noise will be heard at the time of injury. Evidence of heat, haematoma, bruising and local oedema. The person cannot continue with the activity, there is a severe loss of muscle function.

Rehabilitation takes into account these three classifications and well as the stage in which the injury presents itself; acute, subacute, chronic, and acute chronic. In all grades of strains, if it is acute, first aid principles apply such as R.I.C.E. and referral as appropriate. Grade 3 strains often require surgical repair.

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GRADE 1 Strain Typically most clients "work through" these minor episodes of mild strains, which can accumulate and lead to bigger problems in the future if they are not addressed adequately in the first instance.

Testing When a client comes in with a minor strain, as well as taking a thorough case history, it is also advisable to do a postural assessment and note any muscle imbalances.

Observe for any gait changes, with a mild strain there might be a limp, sometimes not. Isometric contraction can produce a mild local pain.

Testing for ROM (Range of Motion) would appear normal or near normal.

Flexion could compress the strained muscle and thereby cause some discomfort. Test the affected plane of motion last, when the muscle reaches a stretched position, a mild pain or discomfort will be felt.

Acute Stage Treatment First aid treatment, R.I.C.E (rest, ice, compression and elevation) is implemented.

Massage above the site to encourage flushing of the injured tissue above the area.

Reduce protective muscle spasm, but care must be taken to not significantly change this mechanism as it is there to give it stability.

sportsmassage hamstring injury - the athlete’s nightmare Sub Acute Stage Palmar and fingertip kneading is useful to increase circulation and decrease adhesions. If friction is chosen as a choice of treatment, be careful to not to over-treat.

Maintain ROM, using passive relaxed stretches. Remedial techniques such as MET (Muscle Energy Technique), STR (Soft Tissue Release), and Activated Isolated Stretching would be appropriate.

Always flush out the area with effleurage and petrissage.

Chronic Stage If a condition keeps repeating itself, the reasons for it occurring need to be addressed. Questions could be; is it a training or a equipment problem, a biomechanical dysfunction, are there compensatory factors affecting muscle balance related to the original condition not having been resolved sufficiently?

Acute Chronic In an acute chronic condition, the acute aspect of the condition needs to be treated first before addressing the underlying reasons for it being chronic.

Other Rehabilitative Considerations In all stages the remedial exercises should include gradual training programs that include strengthening and stretching to work to the onset of pain only.

Stretch shortened muscles within a pain free active ROM, gradually increasing the strength within this range.

In a grade 1 strain, the client can return to the activity with support such as strapping and taping, or an elastic support bandage after a couple of days.

Conclusion The signs and symptoms of a grade 1 strain might not appear to be significant to most, but they are an indication of possible underlying problems and can build up to present themselves as a Grade 2 or 3 strain in the future.

Hence, it is important to acknowledge pain, and address the reasons for it.

HAMSTRING ROM TESTING, SUPPORT LIMB, TESTING AFFECTED PLANE OF MOTION LAST.

Susan Findlay is the Director of North London School of Sports Massage & the Institute of Sport & Remedial Massage.

Originally from Canada, she has a BSc in Nursing and has headed numerous health & fitness programmes in conjunction with GPs. Susan lectures on a range of courses at the NLSSM & LSSM. She also has a busy clinic in North London.

To contact Susan you can visit:

www.nlssm.com or email:

apply@nlssm.com

December/January 2007 M|W

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Taking Care of your fingers

in Massage his is the third in a series of articles extracted from a forthcoming book on Dynamic Bodyuse for Effective Strain-free Massage which is designed to promote good bodyuse as an integral part of doing massage. It presents guidelines on how to reduce the poor working habits that take a cumulative toll on the massage practitioner’s body. The previous article focused on protecting your thumbs. This and the next articles will focus on how to look after the other common ‘tools’ used to deliver massages - your knuckles, fist, forearm and elbow. Future articles will then cover using the rest of your body to back up those working ‘tools’.

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This article looks at the commonest risks to your fingers in massage, and how to

minimise these when you can’t avoid using your fingers. Bear in mind that if you are stiffening or straining with your hands, you are probably also tensing your shoulders. Conversely, being tight in your shoulders, which is an unconscious habit for many of us, will impede the transfer of power from your trunk to your hands. If the power for the massage is not coming from the rest of your body (the subject of future articles), then you are likely to be overusing your shoulder and arm muscles, and your hands are not likely to be relaxed. And, if you are using your wrists awkwardly (which is the subject of the next article), you will have to work harder than necessary with your hands.

Dynamic Bodyuse for Massage Practitioners

by Darien Pritchard

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newtechnique taking care of your fingers in massage

Caution - fingers at risk!

Figure 1 ‘Feathering’ strokes with the fingertips

The fingers and thumbs are the most overused parts of the hand in massage, and are often strained in the process.

People with small hands and those with long, slender fingers are most at risk and need to take special care of their fingers (and thumbs).

Try to avoid the following practices, which put pressure on your fingers, especially if you use them regularly: • putting too much pressure through your fingers; • bending them back (hyperextending them) when pressing; • not supporting your fingers when pressing with them; • using your fingers when it would be better to use a larger part of your hand to apply pressure.

Saving your Fingers

So, using just the fingertips is fine for light ‘feathering’ strokes (figure 1), but is not good for applying pressure

Relaxing the rest of your hand Figure 2 Tensing the thumb when using the fingers

The fingertips have a sensitivity which is unsurpassed for initially palpating tissues.

Although it is often appropriate to use the fingertips for massaging sensitive areas such as the face or for palpating in order to gain maximum information, they are also the most delicate parts of the hand and too easily overused.

“mechanical massage may be advantageously used as a substitute for a number of the procedures of manual massage. I have, however, found no device quite equal to the human hand”.

John Harvey Kellogg, MD The Art of Massage (1895) 14

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As well as focusing directly on how you use your fingers, it’s important to keep the non-working parts of your hands as relaxed as possible. Many massage beginners, for example, stiffen their thumbs when using their fingers (figure 2).

This uses unnecessary extra effort. It is also quite likely to lead to tensing your hand, which, in turn, will cloud your ability to palpate the client’s responses. It takes time and practice to teach yourself to monitor your whole hand, not just the part that you are using, but it is important in helping you to look after your fingers.

newtechnique taking care of your fingers in massage

Putting pressure on the fingers Figure 3 Hyperextending the fingers when applying pressure

Supporting your fingers However, even with your fingers straight, there is another potential strain on them.

When your only contact with your client’s body is through your fingers, they will be taking the pressure of maintaining stability as well as doing the actual massage. Some easy ways of supporting your working fingers to reduce this pressure are described below.

Figure 5 Supporting your working hand in squeezing

Hyperextending your fingers (bending them back) when applying pressure is the WORST way of using them (figure 3). It puts considerable strain on them. It is also not very effective in transmitting the power from your arms to the client.

Keeping the fingers straight Figure 4 Straight, unsupported fingers when applying pressure

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Figure 6 Resting the working hand on the other hand

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Keeping your fingers relatively straight when pressing with them is better (figure 4).

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newtechnique taking care of your fingers in massage

Figure 7

Figure 9

Resting the working hand on the other forearm

Using the back of the hand

Whether you are pressing on one point or sliding the pressure, rest your working hand on your other hand (figure 6) or forearm (figure 7) whenever possible to take some of this pressure off your fingers.

Figure 10 With the other hand on to increase the pressure

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It’s always useful to consider whether there is another larger and stronger part of your hand or forearm that could be appropriately used in order to avoid overusing your vulnerable fingers (and thumb).

Figure 8 Using the outside edge of your hand

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Another good substitute is your knuckles.

Using them and your fist, forearm and elbow to give your fingers a rest are the subjects of future articles.

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The back of the hand (figure 9) is underused in massage. It provides a much stronger massage ‘tool’ than your fingers for firm sliding strokes. It’s particularly effective when you press on it with the other hand to increase the depth and pressure of the stroke (figure 10).

The outside edge of your hand is useful for sliding strokes on narrow areas, such as under the scapula (figure 8). You can increase the pressure by pressing down on it with your other hand.

Bear in mind, too, that varying your techniques can be very helpful in reducing the strain on any one area of your hands.

Techniques such as pulling, dragging and stretching, for example, can be applied in a way that stretches your fingers out rather than compressing them.

newtechnique taking care of your fingers in massage

Conclusion This article presents three ways of reducing the strain on your fingers in massage: • keeping your hands as relaxed as possible, particularly making sure that you are relaxing those parts that are not actively involved in the massage stroke; • using your other hand to support your fingers when you are using them to apply pressure; • using other parts of your hand to reduce your reliance on your fingers.

However this information is only the beginning of the story. You, the practitioner, need to apply these ideas at the massage table - observing your habits, experimenting with new ways of working and incorporating those that seem least stressful and most effective. I hope you find this process fruitful.

Darien Pritchard has thirty years of experience as a bodyworker, including twenty-five as a massage trainer. For twenty years he has run professional development training for qualified massage practitioners in UK, Australia and Scandinavia.

With Su Fox, he co-authored Anatomy, Physiology and Pathology for the Massage Therapist (Corpus Publishing, 2001), a textbook for massage students and practitioners in their early years. Dynamic Bodyuse for Effective Strain-Free Massage will be published in early 2007 (Lotus Publishing, UK; North Atlantic Books, USA).

CONTACT DETAILS: T: 029 2045 4506 E: darien.pritchard@virgin.net W: www.dynamicmassage.co.uk

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A Weekend - head & shoulders above the rest

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he Maitri Foundation’s latest weekend course was head and shoulders above the rest!

I attended the two-day course in Advanced Massage Skills for the Neck and Shoulders, covering many aspects including posture and safe working for therapists together with effective techniques and working deeply through intent.

Run by therapeutic massage and craniosacral therapists Sheila Kean and Martin Taylor, it was fun besides being a highly informative weekend.

There’s unlikely to be a more tranquil venue than Maitri’s setting at Whiteway Colony near Stroud, Gloucestershire, on the edge of the Cotswolds.

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Sheila and Martin’s wooden home where all courses are run is in the middle of a 40-acre former Tolstoyan anarchists’ colony.

With nine people our group was small enough to have a lot of individual attention from the tutors but large enough to have a good diverse mix of participants.

A rainbow of colour flits around the main room at ‘Stillpoint’ during both theory and practical sessions, cascaded from a crystal hung on the windows overlooking the garden. It’s a touch of magic, radiating light, calm and peace.

These included snowboarder Roz Fisher, a reiki practitioner who spends six months of the year working in the Alps, and cattery owner and website designer Jess Bale.

Stillpoint is the perfect place to practice – wonderful for tuning into what this fascinating healing therapy is all about.

Our course entitled ‘Working With The Neck And Shoulders’ was the second of two seminars looking closely at a specific area of the body.

Some had been on an earlier weekend focusing on the lower back.

While the emphasis is clearly on the level of Continuous Professional Development, all theory and practice is taught in an engaging and fun way. All agreed a highlight of our weekend was the wonderful bring-and-share vegetarian lunch.

massagereport a weekend - head & shoulders above the rest In fact Canadian Mary Beth Staddon said during the introductions that Maitri’s reputation for great food was what had partly attracted her!

But it was the depth of knowledge and insight into diverse techniques and massage moves on the neck and shoulders which gave this course a distinct edge over many others.

Tutors Sheila and Martin have been practitioners for a combined total of nearly four decades.

The first Saturday morning theory session brought their craniosacral expertise into play as we looked at alternative tools which could be employed when we are unable to achieve a physical release in the neck and shoulder areas using conventional massage skills.

"We can be quite bossy as massage therapists when we find a tight area that we would like to be more loose," said Sheila.

"We ask practitioners to consider the possibility this is not necessarily the most effective way to approach matters."

They shared some basic concepts of craniosacral therapy, exploring the idea of being patient about change and not judging if it doesn’t always happen as we would like.

The focus was very much on working with instinct and intent in assisting the body to heal itself.

"The neck is a highly complex area," said Martin.

"The aim was to get everyone to stop thinking about necks at just the level of bones and muscle but to concentrate, too, on the myriad of other systems operating through that compact area. Sometimes by acknowledging or focusing on these other systems we suddenly find the right level of conversation for the area and the dialogue can then begin.

"Even the most gentle touch – like rocking for example - when applied with the appropriate intention, via movement, can help increase mobility and create the space for change we look for."

Participants were encouraged to think of working in a way that supports the client’s

body how it is, rather than fighting the tight areas and forcing change.

"This involves working in a way which facilitates rather than dictates movement," said Sheila. "We want to provide the opportunity or environment to create the space for change to happen.

"We believe this then enables a client to play a major role in their own healing and rebalancing.

"There are far more subtle ways of doing this than working physically deeply into muscles – including working with intent –making sure we are focused on what we are doing through our massage and why."

We were taken through some anatomy and physiology by piecing together the cervical vertebrae of a real skeleton.

Just before lunch there was a practical session on different positioning for the practitioner besides client comfort and a chance for a bit of hands-on massage.

Later, following a video on the deeper cervical muscles we had a fun exercise making and placing some on Wellington the resident Stillpoint skeleton.

The first day finished with a welcome practice using demonstrated techniques.

These included releases and passive movements and traction for the neck and shoulders, particularly with a side-lying client – clearly demonstrating how much more accessible this position can make those areas.

Besides the welcome opportunity for more hands-on practice these sessions obviously have the added benefit for all concerned to be a ‘body’ and receive some massage!

It is always as equally helpful to experience the different techniques and releases as it is to practice them.

Among the specific techniques on this weekend course was guidance in using your whole body to create a movement and massaging with rhythm.

A major chunk involved concentrating on specific muscles or body systems. This necessitates good anatomical knowledge and palpatory skills and the ability to select the most appropriate ‘tool’ to address the area.

"It’s not necessarily about very physical work but that tiny engaging of tissues the nerves need in order to create positive changes," said Sheila.

"We can focus on the endocrine or nervous system or circulation if the musculoskeletal system is not responding as we would like."

The group also looked at the effect of stretching and compressing muscles and also just holding – how powerful the slightest movement and pressure can be.

We explored being responsive to the client and working with rather than against the tissue.

Great emphasis was also placed on positioning and posture to ensure the comfort of the therapist as well as the client.

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massagereport a weekend - head & shoulders above the rest support the arm either across your open hand or forearm and with the fingers of your free hand gently hooked under the scapula move the arm very slowly in random pattern, feeling for, and playing the edges of, the areas of restricted movement.

We explored this while doing both table and seated massage and practised using the knuckles and forearms besides hands, so the wrists and fingers are not strained.

Some of the specific techniques taught included: 1. Traction of the neck – after a general effleurage stroke started by pressing posterior on the pectoral muscles and following around the deltoid while pushing inferior on the top of the trapezius and then sweeping superior, coming up the cervical vertebrae; finish by holding under the occipital area and performing gentle traction, using your bodyweight to ease the neck gently away from the trunk. It was emphasised that this needed only to be an incredibly gentle touch – just enough to engage the tissues, not to pull on them.

2. Press and hold release on the levator scapulae, encouraging the proprioreceptors to ‘reset’ the muscle.

3. A hold technique where, with the therapist in a seated position and the client supine, you cradle the head in the palms of your hands with fingers pointing down the neck. The middle finger of each hand is gently brought superior so that it relates to, but does not push into, the transverse processes of C1 and C2. This enables a subtle disengagement of the occipito-atlantal junction and the neck seems to lengthen in your hands.

4. Scapula release. This can be done for a prone client or side lying. On the side,

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5. Work on mobilising the shoulder joint using whole body movement of the practitioner – like a dance - while cupping the area in both hands, giving a nice sense of inclusion and holding of the joint. This allows and encourages shoulder movements with minimal effort from the practitioner – a welcome relief to releases which are hard work for the hands.

On Sunday there was a similar balance throughout the day, mixing theory with practical work.

This further developed how to massage deeply through working intuitively and listening and responding to the body of the client. We were constantly encouraged to let go of any ideas we held about how the body should be, and where it ought to get to. Instead we learnt to meet it where it was right now. This meant there were no ‘battles’ and even tiny changes could be acknowledged and incorporated.

We also covered the relationship of problems with the neck and shoulder region to potential issues with the upper and lower back, and with other aspects of the person – for example how they express

themselves verbally and how they absorb their environment via digestive and respiratory systems.

Additional theory looked at how to adapt our massage strokes with respect to varying pathologies, including working with stroke patients or those with heart problems.

We got extensive handouts to accompany what was taught over the two days.

Martin and Sheila operate with an air of assured calm and relaxed informality while hosting these professionally-run seminars.

The weekend contained inspirational theory sessions alongside a very hands-on approach to learning the practical aspects.

We had a good laugh at the same time as covering an amazing amount of material.

"These courses enable participants to consolidate their existing skills and understanding, besides developing new techniques and extending their knowledge," said Sheila. "No matter how experienced we are as practitioners there is always something new to learn or be gained."

A great weekend is one filled with good fun, food and friends – and that is what you get when attending courses run by the Maitri Foundation.

massagereport a weekend - head & shoulders above the rest

Feedback from other students Beverly Pearson from Haslemere, Surrey, who practices Reiki together with Holistic, Indian Head, Thai Foot and Eastern Facial massage besides teaching English to International students at a south coast college.

"I really enjoyed the weekend - it was the second I’d done with Maitri, having completed the Lower Back course in July.

Booking together reduced the cost and it was great to do both. Because of the nature and complexity of the neck and shoulders I felt a little overwhelmed but the course was well-presented with a nice balance between practice and theory - I love the way they deal with both aspects.

It’s all very informal and everyone has a chance to add their bit and learn from each other. All attending seemed very relaxed and this made for a very pleasant weekend, which was thorough in content.

My only low point was travelling back home on the Sunday. The best bit of the weekend - apart from the delicious grub is giving and receiving massage. You learn so much from each other in these circumstances besides having Sheila and Martin on hand to answer questions.

I wish there had been time for even more - it's great having them to oversee what you are doing and offer feedback. The handouts were very comprehensive and will prove invaluable as I continue to develop my practice."

Charlotte Walpole, Sales manager who also teaches English as a Foreign Language and is a massage therapist based in Cirencester "The highlight for me was the practical aspect of the course, with correction and advice from Sheila and Martin. I enjoyed meeting like-minded people and learning new massage techniques, including some side lying, besides the concept of using intent rather than just physical procedure.

I got new ideas and retraining from the course, which was presented in an

informal yet professional way. It was well thought out and easy to follow.

Overall I found it very informative and helpful and would definitely book another course with Maitri."

Jess Bale, Stroud based massage therapist, website designer and cattery owner.

"I enjoyed the course and deepened my understanding of massage principles as much as techniques. The emphasis on intention and working at depth through it was particularly useful and a welcome reminder that we are aiding the body to change rather than forcing it to do so. I found Sheila and Martin's teaching and professional oversight stimulating and developmental.

I gained a greater confidence in working on the neck, which I have used successfully since with a number of clients who were impressed with the result. Also, the reminder about using the side-lying technique for shoulders and upper back has resulted in positive changes in muscle tone with clients I had previously found difficult to move.

I will do lots more courses with Sheila and Martin because it's such fun and I learn a lot in a supportive environment."

Andy Marsden, therapist based in Gloucester.

"It is so inspirational working with Sheila – you learn so much on these weekends. I gained a completely different attitude to the whole area, to what I’d previously been taught. You get an extraordinary insight into massage therapy – I find these fabulous courses."

The Maitri Foundation is a non-profitmaking organisation, founded in 1989, dedicated to excellence in Massage Therapy Education.

Affiliated with the Association of Physical and Natural Therapists, it aims to provide a comprehensive, experiential education in the art and science of massage therapy, balancing professional expertise with personal growth in a supportive environment.

Maitri is run by therapeutic massage and craniosacral therapists Sheila Kean and Martin Taylor.

www.maitri.co.uk enquiries@maitri.co.uk Tel: 01285 821648

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The Journey of Hands– working our way around the world of massage The tenth stop on our world clock takes us to where East meets West and the massage of the Turkish hammam.

Origins Founded by the Romans, the concept of the public bath was passed on to the Turks via the Byzantines and still remain a social institution today. There are still over a hundred to choose from in Istanbul alone. Two of the most famous are the Cagaloglu and Cemberlitas. The latter of these baths were built in 1584 for the wife of the Sultan of Selim, by the architect responsible for many of the beautiful mosques in the city. The main bath is a wonderful room with shafts of light from the apertures in the domed ceiling, lighting up the great octagonal marble platform.

In contrast one of the oldest hammans in use today is in Bursa, N.W.Turkey. Originally built in the 16th century, the men’s room at the Caravan Seray Hotel has wonderful Roman pillars and more elaborate than the womens section, which was quite usual. Massage therapists in the hammans often came from the same family, following a tradition that skills and intuition were passed down through generations.

Treatment The traditional Hammam massage is given on a low marble slab about two feet high in order for the therapist to use all their full body weight and lean into the massage. The atmosphere is warm which aids the release of any tension in the muscle and the routine

usually takes about ten minutes for relaxation or one hour for therapeutic purposes. First, the body is drenched with hot water followed by the application of soap suds, which help the glide of the hands, ensuring a rhythmic and flowing experience. Strong, confident hands then set to work, stroking, kneading and hacking until the body is relaxed and any muscle tension melted away. Finally any soap suds still left are washed away with a quick splash of warm water. It is a really cleansing and unique experience.

Though not comparable to the country of origin, there are a few Turkish hammans in England that offer traditional treatments, one of the better known being Porchester Baths in West London. Some of the newer Spas around the country are also introducing these old traditions - a true East meets West.

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MUSCLE OF THE MONTH

his month we’ll take a look at a group sometimes referred to as the "golf tee" muscles. If you look at the figure 1 you can see how the spelnius cervicis and capitis form a yshape, coming up and out from the spinous processes and the fibres of splenius capitis on both sides cupping the "ball" of the head. Just ready for some giant with a three wood to take a swing.

Don’t blame me I didn’t make this one up!

T

These muscles lie deep to the trapezius and rhomboids but wrap around the underlying erectors and it is from the "bandaging" of that group that they get the suffix "splenius", a Latin term meaning bandage.

Splenius capitis is a common headache muscle, its trigger point referring to the top of the head. It can be aggravated by forward head position or by sitting with a rotation – a little like the position I’m in at the minute as I struggle with my typing at the computer and turn my head to read my notes. It is also the second most commonly affected muscle in whiplash patterns, or "acceleration-deceleration incidents" as they’re now supposedly called.

Splenius cervicis is often a factor in any "stiff neck" problems, though less so than levator scapula.

Trigger points in this muscle can cause radiating pain to the base of the neck, to the side of the

Origin Splenius Capitis Ligamentum nuchae and spinous processes of C7-T3 Splenius Cervicis Spinous processes of T3-T6

Insertion Splenius Capitis Mastoid process, adjacent occipital bone and lateral portion of superior nuchal line Splenius Cervicis Transverse processes of upper cervicals (C1-3)

Action Unilaterally Ipsilateral rotation and side flexion Bilateral Neck and head extension This group of four muscles are less involved in the support of the head as the "golf tee" image would have suggested but are hopefully kept free from that role in order to aid neck and head movement.

By looking at the angles of the muscle fibres you can see that as they travel inferior to superior, 24

similar to the underlying erectors, they can help produce head and neck extension. Because they are lateral to the midline, when contracting on one side only, both the cervicis and capitis can bring about side flexion and as they pass from medial at the spine to more lateral at the head and upper cervicals, this oblique angle will also bring the head and neck into rotation to the same side (ipsilateral).

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Splenius Capitis and Splenius Cervicis head, behind the eye and can even affect eyesight causing a blurring of vision. It can be aggravated for the same reasons as capitis and both these muscles can be involved in the "sleeping in a draft" type of pain and stiffness clients may complain of or you may have experienced for yourself after an uncomfortable night’s rest.

As I mentioned above both of these muscles should not be involved in supporting the head but they are recruited when the head comes forward because of how that position changes the biomechanics and the relative weight of the head. Similar to the levator scapula they can then become "tight", but not necessarily short, as they work in eccentric contraction holding onto the head to prevent it from falling further. To gain true relief in this area be sure to work and lengthen the neck flexors to get a better balance between the antagonistic groups.

Palpation of these muscles can seem difficult at first sight as there are so many layers of different muscles going in similar directions around the neck at this level. The upper fibres of capitis can easily be felt though between the fibres of trapezius and sternocleido mastoid as you can see in the diagram below. The deeper cervicis is difficult to isolate but its body can be felt and assessed and worked by slipping your fingers around the front of the upper trapezius at the level of C7 and gliding medial toward the fibres of the levator scapula.

Sometimes you may be able to work around the levator but on most people you will have to press through it to feel for the bulk of the muscle belly of cervicis, in this case levator scapula should be assessed and treated first if it has any spasm or active trigger points Adding some specific work for these two muscles can bring about much improved results in your neck treatment and time spent searching for them until you get comfortable playing with your partners neck is well spent as its often an area we can feel nervous of working with any depth. Explore gently and slowly and as you go seeking you will be working on many of the dysfunctional muscles anyway so even if you do find them hard to find you can still be doing some good in this area.

REFERENCES Travell & Simons (1999) Myofascial Pain and Dysfunction The Trigger Point Manual Vol 1. Upper Body 2nd Ed. Biel, A (2005) Trail Guide to the Body Finando, A & Finando, S (1999) Informed Touch James Earls is a massage and structural integration practitioner working in Belfast, he is also director of Ultimate Massage Solutions importers of a wide range of high quality bodywork related books, videos and DVDs and provides expert postgraduate workshops. You can contact him on +44 (0)7774 183458 or at www.ultimatemassagesolutions.com.

The diagrams are taken from "Trail Guide to the Body" and has been used with permission of the publishers, Books of Discovery.

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productreview Products S u p e r s a l v e R e c o v ery Rub 150ml £13.99rrp After taking the South African market by storm, this natural honey-based balm is now available in the UK and very popular with sports men and women. Originally developed to relieve the symptoms of arthritis and rheumatism, this deep-acting and soothing natural formula works to enhance the body’s natural healing process making it ideal for those in need of effective relief from tired, stiff and aching joints and muscles.

Using essential oils specifically selected for their age-old healing properties, Supersalve originates in South Africa.

It was developed by an ex-nursing sister, who trained at University College Hospital in London, for her rheumatoid arthritis patients to help increase joint and muscle function and mobility. Having used homeopathic and herbal remedies to help others for over 30 years, it was no surprise that it surpassed all expectations and it was decided to market it to help others. Recommendations by numerous doctors, homeopaths and therapists soon led to sales in South Africa and beyond growing in leaps and bounds.

The Recovery Rub product contains honey, essential oils and herbal extracts including Calendula, Eucalyptus, Clove, Camphor, Comfrey, Rosemary, St John’s Wort and Aloe ferox.

These rich moisturising ingredients not only treat joints and muscles, but also nourish and revitalize the skin naturally.

It contains no Parabens, no Petrochemicals, no Sodium Lauryl Sulphate, no artificial fragrances, no Lanolin and no unnecessary synthetic additives. All products are environmentally friendly, all packaging can be recycled and none have not been tested on animals.

Susan Findlay, Director of the North London School of Sports says; "Supersalve is a deep-action therapeutic natural rub that seems to work miracles on the sportsmen and women I see here. Its consistency makes it ideal to rub in to problem areas, resulting in significant relief from stiffness, aches and pains. Recovery-Rub is a staple product here at our Sports Massage School and we often find our clients want to pinch our products so they can use them at home!"

www.supersalve.co.uk

Holistic Local Holistic Local is far more than just a directory. There are dozens out there and most of them are very poor and offer very few real benefits. This site is trying to build an online community and support network, for therapists, and anyone who is interested in natural health and alternative living. It comprises of several sections including:

Podcasts - regular podcasts with people in the holistic community. Some of them have been about marketing for therapists. Check out the Pete Dickson podcast and also Jayney Goddard of the CMA .

What makes Holistic Local attractive is that all the above services are free.

Social networking where members create personal profiles about themselves and can find and send messages to likeminded people. Business directory where people can easily find therapists and other conscious business services close to home. Events where all members can advertise their events and workshops free of charge.

For business members, they can write as much as they like on their profile and also display a photo or logo, build a simple website that they can control and have access to a business library which contains about 200 articles on business and marketing development all for a very small fee.

Courses aimed more at the schools as a place where they can advertise their courses and therapists can find appropriate CPD workshops.

The site is very user friendly and Andy Metcalf whose baby it is, is a very approachable technophile who makes it all seem very easy to use and understand. He understands our industry and what makes it tick.

Take a look on:

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productreview CD Sarabande Jonathan Richards Diversions 24115 CD ÂŁ8.50 Jonathan Richards was born in 1964 and started learning the guitar at the age of eight. Since graduating from Trinity College, London he has built up an extensive repertoire including the baroque works of Bach, Rameau and Weiss and championed new and unusual music. This album is a delightful selection of his own transcriptions for guitar, of works originally written by J.S.Bach for lute, violin, cello or keyboard. He plays these timeless masterpieces with grace and passion, creating music that takes the listener to a peaceful haven from the hectic pace of life. This makes an excellent choice of something a little different for use in therapy rooms. The recording recreates the ambience of a country house and even has occasional sounds of songbirds in the garden, a welcomed change from whales or water.

www.divine-art.com

DVD Trail Guide to the Body Ultimate Massage Solutions DVD Box set ÂŁ70 This box set is conveniently split over 3 DVDS: 1. Shoulders/Arms/Forearm and Hand; 2.

Spine/Thorax/Head, Neck & Face; 3. Pelvis/Thigh/Leg & Foot Related to that excellent book, the Trail Guide to the Body (3rd edition), Clint Chandler illustrates each muscle group step by step using a variety of models both male and female.

He takes each muscle individually, pointing out it's origin and insertion on one model, then repeats using a different model for further clarity and understanding. Each body has very welldefined muscles, in order for the viewer to identify and learn how to palpate from origin to insertion. You can clearly see each muscle, it's shape and form. The DVD also shows the muscles flexed, extended and rotated, in order to demonstrate each of the muscles movement capabilities and range. The overlaying of computer graphic images taken from the Trail Guide book are also incorporated into the sequences to aid identification. The repetition of each sequence both visually and orally made the information easy to understand and retain, in particular the names of some of the smaller less known muscles. These DVDs are fun and loaded with accurate anatomical information. An extremely valuable tool for the student of anatomy, it certainly helps with studies and will be be invaluable for any body therapist.

www.ultimatemassagesolutions.com

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Oil of the Orient -

Frankincense

The letter began... In order to familiarise myself with both the botanical and chemical features of frankincense, I have collected and read all available references (list enclosed)... However, problems have arisen both with labelling and analytical data when I am comparing the commercial and indigenous material...I would like to stress that I am positive of the species and origin of the raw frankincense tears collected in Somalia... I would therefore like to ask your advice. I was flattered, but fazed because the list of references was most extensive and I doubted that I could add much, if anything at all.

The identification of the origin of Olibanum oils has always been a nightmare. Still, let us establish some guidelines.

However it must be understood that the field of plant systematics is increasingly dynamic, with the emergence of molecular evidence and cladistic analysis of these and other data. In other words,we are routinely confronted with proposals to change existing classifications and/or nomenclature. Therefore, for this exercise, I have chosen as my reference the just published World Economic Plants with its up-to-the-minute botanical nomenclature. This is the point at which we may have to re-write some of the literature!

Boswellia carteri (not carterii) Birdwood is now classified as synonymous with Boswellia sacra Flueckiger and Boswellia glabra Roxb. with Boswellia serrata Roxb. ex Colebr. For those who prefer trivial names, B. sacra is frankincense or olibanum-tree; B. serrata, Indian frankincense or Indian olibanum-tree; B. frereana Birdwood is variously called African elemi, elemi frankincense or yigaartree; and B. papyrifera (Delile ex Caill.) Hochst. is called elephant-tree or Sudanese frankincense. The eagle-eyed will note that there is no reference to B. thurifera, which for many years was the chosen nomenclature for frankincense by many essential oil suppliers (including us!). In fact, I think that thurifera is synonymous with frereana.

Where do they all originate?

Your guess is probably as good as mine but, officially, sacra from N.E. Tropical Africa and the Arabian Peninsula; frereana is also from N.E. Tropical Africa (generally assumed to be Somalia); papyrifera occurs from N.E. Nigeria to Ethiopia; and serrata is definitely from India. I have not been to Somalia for many years (there always seems to be a war going on) but the local people, to collect the gum, used to cut the bark of the tree to release the white resin which congealed into the famous "tears". They picked the tears off the bark or from the ground. I doubt that they knew one tree from another, but if they did, how did these pastoral wanderers communicate this vital information to the traders?

I thought that I had it all worked out. A research paper by Shuichi Hayashi et al., published in The Journal of Essential Oil Research, 10, 25-30, 1998, confirmed that B. frereana contains alpha-pinene as the main compound, while B. carteri (as it was still described) contains octyl acetate and octanol as main constituents.

All agreed that the composition of the volatile oil is dependent upon its geographic location. They concluded, based upon older scientific work, that Somalian oils contained quite high levels of alpha-pinene (42%) and, interestingly, Turkish, Israeli and Egyptian oils contained very little, but were high in octyl acetate (28.5-68.5%).

All was fine until the GC/MS analysis of my cherished Omani B. sacra returned: it contained 63.062% alphapinene. By the way, Shuichi and his chums achieved the same results with their Omani oils. Therefore, in the new scheme of things, it seems that my sacra may be frereana; but where is the true sacra or carteri? All my socalled Somalian oils also contain alpha-pinene and no octyl acetate or octanol. One thing I can confirm, however, December/January 2007 M|W

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is that serrata contains a whopping 65% of alpha-thujene, as it should. On reflection, we were probably right all along to call our frankincense thurifera. Maybe a closer look at papyrifera might reveal something, but that will have to be another story.

Meanwhile I am calling Turkey, Israel and Egypt in my quest for sacra!

A Little History

4000 years ago, the Ancient Egyptians used Frankincense in the embalming of their dead Pharaohs. It is said that when Tutankhamun’s tomb was opened after five thousand years, there emerged "the unmistakable whiff of frankincense" because of the vast quantities burned during the embalming of the young pharaoh.

The very word ‘embalming’ derives from the word "balsam" or "resin". It has been used (and is to this day) in the sacred rituals of most religions around the world.

The Ancient Greek name for Frankincense was "libanos", which gives us the alternative name for frankincense; "Olibanum" (for the resin).

It has been known for thousands of years that this material is preservative and has cleansing and purifying properties.

Frankincense is still used today to treat a number of conditions including ulcers, bronchitis, snakebites and jaundice. There is even a special frankincense used as chewing gum.

It has been "burned" for centuries to produce fragrant smoke. Technically speaking it is not "burned" but ‘destructively distilled’ by laying it onto burning charcoal. Incense resin is in fact very difficult to ignite, on it’s own.

The belief in the ‘purifying’ properties of frankincense smoke is manifest today in the ritual "purification" of the altar and its furniture (and in particular the Holy Scriptures) during the Roman Catholic rite and litanies, where the smoke from the "burning" of incense is directed at them.It is still believed that the smoke of "burning" incense takes our prayers to heaven -Holy Smoke indeed. The historian alTabari wrote "The smoke of incense reaches heaven as does no other smoke". Our modern term "perfume" comes from the Latin "per fumum", through smoke.

Tonnes of incense resin must have been used for this purpose over the centuries.

In Europe, the Roman emperor Nero burned an entire year’s production at the funeral of his wife Poppea. At ravensara the height of the trade, around the time of the birth of

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Christ, some 3,000 tons of incense a year were exported from the Dhofar region, all around the known world. But from where did it all originate?

Land of Punt

One view is that it came originally from the "Land of Punt".

What we do not know is the precise location of the Land of Punt. We know that Queen Hatshepsut (the only known female Pharaoh of Egypt), who reigned between 1473 and 1458 BC, sent a delegation to the Land of Punt, to bring back Incense trees. There is an excellent depiction of this expedition on the walls of her funerary temple in the Valley of the Kings in Egypt. The baggage train is seen to contain several fully grown incense trees, with their roots wrapped in cloth sacks, being brought to Egypt presumably for transplanting in her Temple gardens.

Was she a Queen of Sheba? Did she also visit King Solomon, taking this treasure with her as so many believe?

In the Middle Ages, Prester John was popularly believed to have been King of Punt. The Land of Punt then being variously described as the "Land of Gods", "India", and "Ethiopia".But the precise location of Punt has never been established.

Certainly areas around the Horn of Africa have been candidates, Ethiopia, Somalia and Eritrea, however, trade between these areas and the south and east coast of the Arabian Peninsula (what we now call Yemen and Oman) has been vigorous for many millenia. In his excellent book "The Sign and The Seal", Graham Hancock offers evidence that Punt was not in Ethiopia or anywhere on the Horn of Africa, but further east, across the Red Sea, on the south coast of Arabia.

Today, Salalah in Dhofar, on the very southern coast of Oman lays claim to having been a major source of this trade, throughout antiquity.

It is just a few miles from the modern border with Yemen.After the harvesting of Frankincense in Dhofar, the arduous journey of the ancient traders could begin.

Many thousands of tons of Fankincense were shipped from the ancient port of Sumhuran to Qana in Yemen and then across the mountainous ranges on camels. The domestication of camels in the first century BC undoubtedly played a vital role in the development of trade routes throughout the Middle East. Frankincense and myrrh were the cornerstones of the economy of ancient Arabia. Villages,

where customs duties for these two prized aromatics were collected, as well as hamlets offering hospitality to traders on the long and hazardous journey north from southern Oman to Syria and Iraq, and west to the Roman and Greek empires, grew into rich influential cities such as Petra in Jordan and Sa’ba in Yemen, as the incense trade flourished.

Tear Drops

The climate in this region is harsh, hot and arid, except for tamanu the annual monsoon which uniquely, but briefly, drenches the areas in mists and abundant rain. The dry wadis fill with torrents and the land miraculously becomes green and verdant. These conditions are ideal for the incense trees.

When I was there, the monsoon had passed. I saw a parched and rocky desert with deep, steep gorges and canyons, just north of the southern coastal strip of Dhofar and south of the totally "empty quarter", shared with Saudi Arabia, where beautiful wind sculpted dunes pile sand up to heights of hundreds of meters. Here there are Incense trees known since antiquity.

In the valley of Dawkah, our guide, Musallam Hassan, and his father and uncle, who own large numbers of trees in nearby M’dut canyon, welcomed me. As they and their forebears have done for generations, they patrol the trees regularly harvesting the "tear-drops" of the precious resin.

They expertly cut thin slices of bark from the trees, allowing the white incense latex to ooze from the wounds, reminiscent of the way rubber is harvested.

Three weeks later, the water from this white latex has dried, leaving behind a clear, plastic, sticky globule of incense resin. Eventually, over several months, this plastic material loses much of its volatile oil and becomes the hard and brittle resin, with which we are all familiar, but of course, in so doing, it declines in quality. These brittle "tear-drops" are the articles of commerce. The best quality frankincense became known as "the silver incense". Pliny the Elder, the 1st century Roman scholar, described it as "brilliant white, gathered at dawn in drops or tears in the shape of pearls".

The souks of Salalah are still packed with traders selling various grades of incense.

Up To Date

In the 21st century Frankincense still plays an important part in everyday life in parts of the Middle East, particularly Oman, where its smell can be detected in ordinary homes as well as in the five star hotels and the narrow, bustling lanes of the souk.

Most families use it, as Omanis have for centuries, to perfume newly washed clothes, which are hung out to dry on beehive-shaped baskets over a smouldering frankincense burner. Sailors often burn it at the beginning of a voyage, to bring good look.

Yemeni Jews incorporate the burning of frankincense as an act of purification when preparing a bride for her wedding night. Frequently, women will stand or squat over an incense burner, allowing the scent to waft up under their skirts, thus, according to popular superstition, helping them regain their purity or enhance their natural body aromas.

Archaeologists are now excavating the beautiful, longabandoned port of Sumhuran, situated on a (now landlocked) freshwater lagoon, where it is believed that seagoing ships had tied up centuries ago, before the mouth of the lagoon was closed off from the open sea, by a natural sandbar, to load cargoes of incense for transportation to the west. Could this quiet and unspoilt region of southern Oman have been the (or part of the) fabled Land of Punt?

What a fantastic story! This exciting expedition to Oman was led by Rhona Wells who, in the name of the British Society of Perfumers, worked tirelessly and enthusiastically, with great tact and skill, to ensure that everyone had an unforgettable and unique experience and plenty to write about! Thank you very much Rhona and Peter. I can barely wait for some Omani frankincense!

You can contact Charles Wells at: Essentially Oils Limited 8-10 Mount Farm, Junction Road, Churchill, Chipping Norton, Oxfordshire OX7 6NP Email: sales@essentiallyoils.com Tel: +44 (0) 1608 659544 Fax: +44 (0) 1608 659566

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faqs!faqs?faqs!faqs?

STUDENT Q&A

Let me introduce myself, I am Isabelle Hughes and will endeavour each month to answer all those questions that never seem to get answered or that you forgot to ask.

You can write or email me at Massage World. Here is a selection of recent enquiries and their replies: Q. I pose this question because I want to be certain that I don't leave my client’s the way I am left by my favourite massage therapist who provides a quality massage. When she is finished with my shoulders, she washes her hands, tells me to take my time getting up and to help myself to a glass of water as she is racing out the door. It is almost like she is nonverbally saying, "I am done with my work. I then get dressed and meet her at the reception.

With respect to my work, I haven't perfected my departure from final strokes to out the door yet and am interested in hearing about how others do this.

A. If the client ends face up, finish with strokes to the neck and shoulders, alternatively you may want to end with some rocking & compressions on the arms, hara, & legs, ending with a firm hold on the draped feet. Tell them their session is finished and take away the bolster. Advise them to take a few minutes to themselves before they get up and you will meet them outside when they are ready. Make sure there is a glass of water available for them in the room. Be available for postassessment and to make a follow-up appointment with them and walk them out and say your goodbyes, thanking them.

Q. I have been a massage therapist for four years. I have suddenly increased the number of massages I do and I feel so sore and weak (even writing this is difficult). My hands have that chronic feel about them, similar to when you first wake up in the morning. I also have crepitus in the wrist joints and I'm terrified of osteoarthritis. Should I think about saving my wrists for the future by leaving massage?

A. Start practising self massage, have chiropractic & paraffin baths to help and reduce the number of massages temporarily. It may be that you increased your workload too much too suddenly. Check your own stretching and nutritional programs and rather than leave the profession, look at other modalities and ways of working that reduce the use of the hands. Massage World presently has a series of articles by Darien Pritchard focusing on self-help. The bottom line is that if you want to do massage over the long haul, you must take care of yourself. Protect your hands!

Q. I do not know how to approach this delicate subject but no matter how I drape clients, there are unpleasant odours that waft from time to time what do you suggest?

A. One tip is when you do hamstrings and gluteals, exhale as you stroke toward the heart and turn your head away from the body. With forearm and elbow work you naturally work closer to your client, essential oils under the nostril prior to starting the treatment tend to help. Often the worst is smokers morning breath with coffee, a bowl of mints in the treatment room might act as a prompt. There would be nothing wrong with a polite notice in your treatment room asking clients to prepare themselves for a massage, particularly in the heat of the summer months.

Q. I've got a client whose one scapula is glued down and has no movement whereas the other is free moving.

This results in restricted range of movement in the related shoulder.

ROM is limited to 90 degree lateral extension, forward extension is for the most part unrestricted and the arm does not move very far posterior.

He is a golfer, Type A personality, mid-50s, has had arthroscopic surgery to clean out some bone spurs about four weeks ago. I would like to try and bring him more relief what do you suggest?

Isabelle Hughes has been practising and teaching massage since 1989 and is also an external examiner for massage therapy.

Drawing on her experience as an ante-natal teacher with the National Childbirth Trust, she currently runs workshops for practitioners on Massage for Pregnancy and Labour and has contributed to books on the subject.

A. The following may be helpful: Have the client sidelying and try to scoop under the scapula with thumb and fingers.

Any work to try and get more space between the ribs and scapula is great.

Try to pin and stretch the serratus anterior, then pin in and move the arm in forward, upward, and backward motions. This is really powerful work.

Try to stretch the muscle by going to the barrier and wait for the muscle to release.If there is great resistance to the fingers moving under the scapula, be gentle and very slow, as you said, it is glued down.

QA If you would like your questions answered, please send them by post or email to our address on page 3, marked Student Q&A.

December/January 2007 M|W

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researchroomresearch I had the privilege recently to be invited to present to our local therapist group here in York on research and complementary therapies. It was an interesting evening and I’d like to share with you some of what we discussed. I’ve also reviewed a recently published paper dealing with massage therapy’s effects on the immune system in children with HIV.

Introducing Research to a Complementary Therapist Group We started the evening off with brief introductions, and a show of hands from people who had been/were involved with research. Three (from an audience of seventeen) had some research experience but only one was relating to CAM. This left our initial questions of what is research, and does it matter to therapists, nicely open for discussion.

Generally our therapist group felt that research was about measuring things carefully, seeing if something worked, eliminating bias, and in some cases proving that a therapy

Box 1 - Reasons against CAM research (Ernst 2002) 1. If it helps my patients, I don’t need science to tell me that it works.

This argument assumes that we are accurate in our description of a therapy as helpful, and potentially obstructs evolution of treatments.

2. Years of experience and tradition are more important than modern clinical trials.

Experience and tradition are useful and different forms of evidence which do not replace the need for rigorous investigation of hypotheses. We can see from conventional medicine that patients are capable of getting better even when our interventions are potentially harmful.

3. The nature of my therapy is such that it defies the clinical trial.

This point reflects issues around outcome measurement rather than trials per se. If you can clarify what the expected outcome is, it is then a matter of finding a reliable was to record and reflect change in these variables.

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was effective. No-one said that research wasn’t important but doubts were expressed as to the relevance to individual therapists, and some questions were raised about the methods and how appropriate they might be to CAM therapies generally.

We went on to explore the principles of equipoise (where one is uncertain of the outcome or effectiveness for example) and the importance of having an open, critical mind. One of the challenges for therapists moving into an evidence-based practice model is that sometimes the research results may require us to change our practice!

An interesting discussion paper by Professor Edzard Ernst (one of the more prominent CAM researchers who heads up a team based at the University of Exeter) summarises the reasons often given by both CAM and conventional practitioners as to why research is unimportant was outlined.

Although Ernst’s approach can sometimes seem somewhat adversarial, in this paper he accurately details some objections to research and the contrasting opinions which I have summarised for you in Box 1.

4. The clinical trial is based on categorising individuals while CAM sees each person as unique.

There are methodologies for carryong out rigorous studies using individualised treatment protocols, single case trials and others. Many CAM’s do in fact categorise or diagnose patients although using different terminology from conventional medicine – again creative trial design can incorporate this.

5. No placebo exists for my therapy and blinding is impossible.

The currently accepted "gold standard" of research is the randomised controlled trial – the placebo is not an essential component and indeed is inappropriate in studies of surgery or psychotherapy.

6. My therapy h as no immediate effects but helps people stay healthy in the long term While this presents challenges in terms of long term followup and cost there are established designs within epidemiology that can cope with such assertions and enable the testing of suitable hypotheses.

Adapted from Ernst (2002) What’s the point of rigorous research on complementary/alternative medicine. JRSM, 95; 211-213

researchroomresearch Perhaps one of the more common mis-conceptions about CAM research is that there is very little of it. It is certainly true that in comparison with some other medical disciplines there are comparatively fewer published papers, but that is not the same as a complete absence of research. I ran some quick and simple searches to illustrate the numbers of potential papers available.

These research papers are of course of varying levels of quality – although results from a variety of reviews have indicated that CAM research is not actually of generally lower quality than conventional medical research, despite frequent claims in the media and by prominent researchers. Indeed the controversial meta-analysis by Shang et al. which was heralded in the Lancet as the end of homeopathy (Shang, Huwiler-Muntener et al. 2005) actually found that homeopathy trials were of significantly higher quality than similar conventional studies.

Assessing study quality is a skill, and I suggested that we could certainly run study sessions to teach therapists how to evaluate a paper at a later date.

We have already touched on the subject of using research in our last article – a quick straw poll of how many participants had been exposed to research during their training produced only one positive response. An acupuncturist who had attended the Northern College of Acupuncture which is known for its progressive teaching approach and has benefited from a strong research base here in York as headed up by Hugh MacPherson. One massage therapy student reported that she had repeatedly asked her lecturers for research papers and evidence base information but was told there was none, and anyway it wasn’t relevant. This kind of response is very unhelpful, particularly given the excellent books available collating the research for massage therapy available.

On the topic of individuals getting involved in the research culture and process, we discussed using audits (monitoring and recording the progress of our clients/patients prospectively) as a way of building the foundations for later trials and evaluations. While these systems can be timeconsuming to initiate, they are usually very straightforward to use in daily practice and can provide a wealth of information.

The Kinesiology Federation has successfully audited a sample of their practitioners and the Irish Association of Physical Therapists are about to launch a similar project in 2007. Ideally such projects would be co-ordinated and supported by registering bodies, although many do not seem to see the

value of such work and place it relatively low compared to regulation issues and insurance discussions. Several members expressed surprise that their organisations were not supporting such initiative, and we can but hope their expressions of interest might help to promote the research agenda generally.

To conclude, I think that all the participants agreed that research could have something to offer them, and that it wasn’t such an inaccessible area ass they might have initially felt. There is a need for more education for therapists, governing bodies and lecturers within CAM and Massage Therapy to facilitate therapist-driven research agendas and engage practitioners in the research process.

References Ernst, E. (2002). "What's the point of rigorous research on complementary/alternative medicine." Journal of the Royal Society of Medicine 95: 211-213.

Shang, A., K. Huwiler-Muntener, et al. (2005). "Are the clinical effects of homoeopathy placebo effects? Comparative study of placebocontrolled trials of homoeopathy and allopathy."

Lancet 366(9487): 726-32.

Weblink: Exeter University CAM Research Unit www.pms.ac.uk/compmed/

Morag’s academic background in Psychology (MA hons) and an MSc in Research Methods is now being expanded with a 3-year fellowship at the University of York (homeopathy for ADHD) funded by the Department of Health.

Morag can be contacted on researchmatters@moondrop.co.uk Morag trained in Therapeutic Massage with the Scottish School of Herbalism in 2000 and has been in clinical practice since then.

Turn over to page 36 for an example of a recent research paper and Morag’s comments.

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researchpaper comment by Morag Coulter

Impact of a Massage Therapy Clinical Trial on Immune Status in Young Dominican Children Infected with HIV-1 Shor-Posner G, Hernandez-Reif M, Miguez M-J et al. (2006) Journal of Alternative and Complementary Medicine, 12(6): 511-516.

Purpose The effectiveness of massage therapy on immune parameters was evaluated in young Dominican HIV+ children without

massage-treated older children (p=0.04) but not in the control group. In younger massage-treated children, (2-4yrs), a significant increase in natural killer cells was shown.

current access to antiretroviral therapies.

Methods Eligible children, who were followed at the Robert Reid Cabral Hospital (San Domingo,

Conclusion Together these findings support the role for massage therapy in immune preservation in HIV+ children.

Dominican Republic), were randomised to receive either massage treatment of a control/friendly visit twice weekly for 121 weeks. Blood was drawn at baseline and following the 3-month intervention for determinations of CD4, CD8, and CD56 cell counts and percentage, along with activation markers (CD25 and CD69).

Results Despite similar immune parameters at baseline in the two groups, significantly more of the control group exhibited a decline in CD4 cell count (>30%, p=0.03), post interventions. The decrease was particularly evident in older children (5-8yrs) in the control arm, who demonstrated significant reductions in both CD4 and CD8 cell counts compared to massage treated older children who remained stable of showed immune improvement. Additionally, a significant increase in CD4+CD25+ cells was observed over the 12-week trial in 36

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Comments This paper is one of several published in the last 5 years demonstrating the considerable effects of massage therapy on immune function. Previous research, which provided some of the background to this study, has shown that regular massage has significant beneficial impact on white blood cell and neutrophil count in children with leukaemia, and in HIVinfected adults massage boosted several immune system markers.

One of the interesting angles about this piece of research is the use of a lowtechnology intervention in a country where HIV and related disease is very prevalent and there is limited access to antiretroviral drugs. So this is not a case of providing massage instead of or even along side conventional care – there is little alternative for this population in terms of treatment. As the authors point out, suitable drugs are expected to

researchpaper comment by Morag Coulter

become widely available in the next few years but there are significant challenges to do with provision and adherence to treatment regimes due to the long-term nature of treatment and associated sideeffects.

Design The research was carefully designed using a combination of established protocols taken from the Touch Research Institutes (TRI) of Miami and consultation with local health professionals. This was essential to create a treatment format that would be easy to implement and culturally appropriate. Participant children were randomised to either the massage group (who received twice-weekly massages from a trained nurse) or friendly visit control group (who were visited twice-weekly by a nurse who engaged them in play activities). The control group accounted for the extra attention and time without introducing any conflicting variation.

Data The data collected in this study consisted of blood samples which were taken at the same time of day to minimise variation, and then sent to a laboratory at the University of Miami for analysis. It would not have been possible to blind the children to the randomisation, however the authors do not clarify if the analysis of blood samples was carried out blind to allocation (which it should have been) or the later statistical comparisons (likewise).

Questions A number of intriguing questions are raised by this study, most of which would

require either further reporting of data or follow-up studies. For example, the article does not discuss how acceptable the massage therapy was for the children or their parents, or if there were any difficulties encountered in training the nurses. They do report that frequent site visits were carried out to ensure the intervention was proceeding according to the protocol – but not on any problems or adjustments encountered. Research papers are always limited in length by journals therefore reporting only some aspects of a study, so this is not a major criticism.

It would be useful if future studies could account for the cost of the intervention and compare this with the levels of care being offered normally. Training takes time, expertise and resources and having nurses administer the massage is an additional burden on the health professional teams. In other studies the TRI have taught parents, grandparents and other carers to administer the massage providing benefits both in terms of cost and increasing the self-esteem and self-confidence of the family member providing the treatment.

Final Comment Overall this was a well designed study with relatively clear reporting indicating important benefits for the immune systems of children with HIV+ status. This provides some evidence for the provision of simple massage therapy in countries where antiretrovirals are not yet available.

Furthermore massage therapy may be a useful intervention before drug treatment is started to boost the immune system and then in later stages to reduce some of the side effects and increase compliance with the medication regimes which are likely to be life-long.

one of the interesting angles about this piece of research is the use of a low-technology intervention December/January 2007 M|W

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The Role of the CAM Practitioner in the Future Healthcare of the Nation A personal perspective for a practical solution

By Edith Maskell

Integration

I want to have : •

CHOICE for the patient, client, user. It doesn’t matter what we call them, terminology isn’t important. By choice, I mean that I do not wish for the doctor to be the "gatekeeper". I want to have responsibility for the care of those people. Choice also means that patients too can take responsibility by choosing how they want to be treated without fear that their doctor will disapprove. The same GP I mentioned earlier also stated that 50% of his patients seeking CAM "don’t want their GP to know".

•

RECOGNITION of my hard work and investment, in terms of time, effort and finances over the last 15 years; the specialist skills, knowledge and professional development gained through experience and training over that period. On a personal level, as a multi disciplined practitioner, the training has never stopped. It’s insulting to lump all CAM practitioners into the same category and continue making assumptions that we are not trained properly.

•

In my vision, we must also be paid for our contribution and not feel guilty about it - just like everybody else is paid a fair wage for a fair day’s work. One of my biggest "hang ups" is CAM practitioners remaining unpaid for work which is clearly acknowledged as valuable by the sick and others who care for them. _ I understand all the reasons why so much of our work is carried out on a voluntary basis but whilst we continue to do it for nought, we devalue that work and it will continue to be taken for granted. I’m also intrigued that whilst there are fears within the medical profession about the safety of CAM and the people who carry it out, we continue to be allowed to work in what I consider to be the most vulnerable areas of medicine, ie palliative care.

•

There seems to be something about not paying for CAM that somehow deems it safe? This fact remains a mystery to me.

The idea of integrating CAM into orthodox medicine was initiated by the Prince of Wales around 1999. It has been a pipe dream for practitioners for many years. Despite, what sometimes, seems like insurmountable obstacles remaining in the way, I believe there are solutions if only those involved would just take a peek outside of the box. I believe my vision and perspective offers practical solutions.

Whilst it has been the dream of CAM practitioners to participate, contribute, be respected and hence make a difference to the health of the nation for eons, do we deserve it and have we properly prepared ourselves?

A Telling Tale If there is any truth in the myth that CAM and its practitioners are dangerous or there is no hard evidence that it works – why is it becoming so popular? We aren’t witches casting spells over the public.

At a recent conference I attended, a GP (who incorporates CAM into his practice) stated that the outcome of a study he conducted, was that 75% of his patients want to be referred to a CAM practitioner. The public are nobody’s fools. They’re learning fast … and this is borne out in my own practice … it’s clear that their needs aren’t being met by the NHS and CAM is filling the gap.

Mutual Respect As a multi disciplined CAM practitioner my dream I want to be fully integrated into medicine as a respected member of a healthcare team but not necessarily working within the health service environment or by being employed by them.

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businesstools the role of the CAM practitioner in the future healthcare of the nation •

HEIRARCHY and INTEGRATION go hand and hand for me. It has been estimated that there are in excess of 120 000 CAM qualifications in the UK, not all at the same level. Until differentiation is established - the myths will continue in terms of doubt as to our ability and professionalism. Hence, I believe, CAM practitioners don’t have a hope when it comes to integration – regulated or not. The standards required to be regulated are National Occupational Standards (NOS) which are so low – it will do nothing to evoke confidence by the medical profession. We need to be highlighting our specialist skills and higher level qualifications. To stand proud and demonstrate the difference between the serious CAM practitioner and the "buff and shine" brigade.

professional association and our logic is that we only have one or two clients a month, so it’s not worth it; then there is the old chestnut that there is no evidence that CAM works; we don’t know when to make or won’t make appropriate referrals; we’re charlatans because we take money from vulnerable people when they’re ill; there are insufficient funds within the NHS for seriously ill patients to receive orthodox medicine never mind investing in CAM. •

CAM is only useful if used to give a "nice hand or foot massage" to make people feel better

•

Last but not least : historical politics and pharmaceutical companies

OBSTACLES are many and varied. So what Evidence is it that stands in the way of my dreams?

•

•

The lack of knowledge from different perspectives. There is a level of CAM practitioners where there is a font of knowledge and expertise but there is inertia and general lack of confidence within the profession and a reluctance to get involved in research as a result. Negative assumptions that there is no point. Little support from academics, lack of funding and support with training in how to carry out appropriate research studies.

There is another level of CAM practitioners where the inertia is such that change is resisted. Even a requirement to carry out continual professional development (CPD) like simple reflective practice is bemoaned. CPD is a subject (in my experience) which causes most unrest among practitioners. "I can’t afford to do courses".

•

As far as credibility is concerned, CAM practitioners don’t help themselves when they bury their heads about what’s happening within their profession

•

Complaints that they only work part time or as volunteers and therefore can’t afford to pay to be regulated only serves to publicly confirm doubts about our professionalism

•

Other myths with which we have to contend with and must overcome are concerned with the safety of CAM and those who practice it. Our training is not understood; has been too varied with no recognisable or common standards; professions have taken too long to regulate themselves and are disparate; we are not accountable to anyone.

•

It is not understand what we do behind closed doors; this isn’t helped by the fact that some of us persist in working in darkened rooms with candles (image is poor, never mind the safety aspect), playing romantic music; there are concerns that we practice outside of our scope, experience and do not work to specific codes of ethics; make promises of cure; mix and match therapies. Some practitioners even dress inappropriately; some practice without insurance or membership to a

So what can we do to dispel the myths? Much has already been done. In the past 5 years, evidence has been mounting that the use of CAM within the NHS provides credible savings 3, so much so, the studies more than paid for themselves and had very interesting outcomes.

•

Saved GP time – enabled them to spend more time with those who were terminally ill

•

Cut hospital and surgery waiting lists. 10% of patients utilise 90% of NHS resources.

•

Less drugs administered, diagnostic/investigative tests and surgical procedures deemed necessary

•

Suggested this could have a lasting effect on economy

•

GP’s admitting they are empty handed – they have nothing to offer patients with chronic conditions – the persistent and mystery illnesses where symptoms present for more than 12 months. It was felt that these are the areas where CAM is most effective.

•

That is not a surprise to the CAM profession. Our aim has never been to cure. We work with complex problems which are not symptom related. We objectives are to deal with prevention (bringing about awareness of what it means to be healthy), dysfunction (the bit between when symptoms first present and disease/ degeneration is eventually diagnosed by the medical profession) and maintenance of well being, once it is achieved. In other words, a truly holistic approach to healthcare.

•

Better quality of life – the GP I mentioned earlier, reported that he and his partners were

•

Happier and "less burnt out"

•

The community as a whole was healthier

I believe that if GP’s referred patients to CAM it would give the GP and the patient choice …. not just about which treatment they receive but whether to pay for it or not and also whether to wait or not.

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businesstools the role of the CAM practitioner in the future healthcare of the nation With scarce funding and appointments available say, to see a physiotherapist, I believe some patients would happily pay privately rather than wait 6 weeks or longer, if their GP were to give them the choice and "rubber stamp"/approve a local reputable CAM practitioner. This would mean more availability for those who could not afford or did not want to pay privately. The health outcome would improve too. It is common knowledge that for best results, there is a 3 week window between the onset of symptoms and when treatment should begin for neck, back and shoulder problems.

•

Professional associations have a duty to foster and encourage research and support the practitioners in this work by promoting it.

•

A movement and acknowledgement that qualitative research is more valid and valuable with the CAM profession than random controlled or double blind trials and I am aware of work taking place by academics in this field.

•

An acceptance that It is the role of the professional associations not the regulator to promote registered practitioners to the public and the medical profession. Does the GMC promote GP’s to the public? How many of the public check whether their GP is on the register before joining a particular surgery?

My general conclusions therefore, are that CAM is a valuable "addon" service and that rather than be a burden on the NHS, on the contrary, the provision of CAM could actually provide funding for the medical profession to spend on other vital services for patients or for those who need expensive drugs for survival.

So what can CAM practitioners actively do in the immediate future to dispel the myths and provide resolutions?

It is going to be an uphill struggle to get past all the myths and so practitioners must continue to invest in themselves – be prepared to take risk, be focused and make clear decisions to: •

Continue to hone skills already acquired and continue to develop by gaining new skills and specialise in the areas CAM is acknowledged

It’s clear to me that the evidence is already in place and we need to ensure it continues :

•

Be prepared to build a career and be business like. We must lose the "buff and shine" image.

•

Consider CAM as a profession instead of something that’s done for pin money or a hobby when the children leave home or something to give back to society after a mid life crisis. CAM is a serious profession offering skills which are a valuable and vital commodity.

•

This doesn’t necessarily mean spending vast sums of money on attending numerous workshops and courses which give no proper qualifications.

•

Change attitudes and perceptions – our own and others. Take what we do SERIOUSLY. Value ourselves and our work – demand to be paid

•

Learn to put aside all our own fears, myths and beliefs, especially when it comes to regulation and the potential costs.

•

Register when the time comes. We must all take risks if we want to go forward. The journey of a thousand miles begins when we take that first step.

• CAM practitioners must get involved in research. Particularly in studies for chronic conditions for which the medical profession have no drugs or run out of services to offer. Many GP’s have suggested to me that their "worst nightmare" is when patients come in with a list of symptoms and GP’s have nothing to offer them. The chronic conditions mentioned were ME, Osteoarthritis, IBS and other what I term as general "mystery" illnesses. The patients who have been everywhere, seen everyone and done everything. Been told there is nothing wrong but are clearly unwell; have had their symptoms for well over a year and are getting progressively worse physical and eventually, on an emotional level. They feel abandoned and desperate.

As the regulation of CAM practitioners gets closer (estimated to be by the end of 2008; and the specialists are highlighted and this news is properly marketed and communicated to the medical profession and to the public, I believe the old beliefs and myths will begin to fade. A good analogy is to look at what happened to plumbers and electricians. The public now choose Corgi Registered Plumbers over others and new laws are in place that property owners must have Gas and Electricity Certificates before a house can be sold. These measures all relate to issues of public safety and the same will happen with the CAM profession but …

Communication is key •

40

Practitioners must take responsibility and help themselves by actively participating in research studies to build the library of evidence.

M|W December/January 2007

A comparative perspective Chiropractors were statutorily regulated about 6 years ago. I’m told there are less than 4,000 in the UK. It is illegal for them to call themselves chiropractors unless they are registered with the General Chiropractic Council. The GCC is not a professional association – it is the body that regulates Chiropractic.

The first year they register it costs them £1 250. Renewal drops to £1 000 per year plus they have to prove that they have done CPD specific to Chiropractic.

businesstools the role of the CAM practitioner in the future healthcare of the nation Additionally, they join a professional association – not obligatory but the majority join because membership demonstrates professionalism, it plays a supporting role if the GCC were to notify them that a complaint was made against them and it keeps them informed of what is going on within their profession on all levels.

For that - they pay in the region of an additional £530 – each year.

Then there is insurance. Like any insurance, where there is more risk, the cost of insurance increases and in the case of chiropractors the risk is deemed (by brokers) to be higher and consequently, the cost is in proportion to the risk. £500 every year.

It doesn’t take a brain surgeon to work out that Chiropractors pay on average, £2,000 each year for the privilege of calling themselves Chiropractors. No wonder they work their socks off to ensure their practices are successful and charge around £30 for 10 minutes! I’ve never met a Chiropractor who feels guilty about charging and they’re not charlatans. They provide a vital service and none do voluntary work.

They’re merely earning a living which equates to the hoops they jump through in continued training professional practise. Annual bills like that tend to focus the mind somewhat!

On the other hand, bearing in mind, there are said to be in excess of 120 000 CAM qualifications in the UK. The cost of regulation will remain in proportion to how many practitioners are on the register. Again, it doesn’t take a brain surgeon to work out that by comparison registration for CAM practitioners should be considerably lower than £1 000 per annum. But it is dependent upon how many register and we are talking about voluntary, not statutory. This means that practitioners will be allowed to work whether they choose to register or not. For the moment. This could change in the future. But if we want to be viewed as serious practitioners of integrity and professionalism with a desire to be fully integrated – I believe we would be well advised to act responsibly.

Because of the lack of complaints and the low risk of harm – insurance is considerably cheaper for CAM practitioners; there are very few complaints, if any, as is membership of professional associations. We don’t yet know the precise model which will become the regulator of CAM practitioners, so there can be no guarantees.

We do know the majority of CAM practitioners are multi disciplined and those I have communicated with, have shared with me, that they don’t want to choose to register in one therapy only; hence in order to encompass the majority of CAM practitioners, the objective of a regulatory body must be to keep the process simple and cheap.

On average, it is estimated that multi disciplined therapists are qualified in 3 therapies. If the cost of regulation was in the region of £25 - £50 with a small additional fee for every therapy within which a practitioner is qualified and may wish to be acknowledged as regulated; the total cost, including insurance, regulation and continued membership to a professional association could be in the region of £150 - £200p.a. Quite a different story to that of the chiropractors.

Trust and credibility If that’s what it takes for CAM practitioners to earn credibility outside of the NHS or to gain employment within the medical profession, the cost could very quickly be recovered by the practitioner. I appreciate it’s a risk but I like to think of it as more of an investment. Unless that risk is taken CAM practitioners will be left behind because when the public start to realise there is a multi disciplinary Register which gives them a level of re-assurance – if marketed appropriately - that is the register from which they will choose their practitioner and (regrettably) those who remain unregistered - because they feel can’t afford it or refuse to pay the fee – could find themselves earning even less and the poor reputation will persist.

It’s probably a fair guess that the majority of us, if not all, are in this profession because we’re passionate about our work. We know we can have a positive effect on the future healthcare of the nation.

So before my vision can come true – may I urge CAM practitioners that if you too have a desire to be truly integrated into the medical profession in your own right and make a real difference in society …..in the words of the song ….

Take your passion and make it happen!

References Dr Michael Dixon Complementary and Alternative Medicine Seminar 5/10/06 House of Lords Science and Technology Sixth Report 3 Christopher Smallwood Report The Role of Complementary and Alternative Medicine in the NHS October 2005

Edith Maskell December © 2006 Multidisciplined CAM Practitioner Complementary Therapists Association Telephone 01689 879280

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December/January 2007 M|W

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