Massage Matters, Summer 2012 by David DeWitt

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Massage Therapy is a Natural Fit with First Nations Culture MTABC Research Department Fortifying the Credibility of Massage

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President’s Message

he pace of change can be swift and it’s easy to see how some

may feel they are being left behind. This is as true for RMTs as it is

for any primary healthcare provider.

As most healthcare providers move toward advanced post-

Massage Therapists’ Association of British Columbia

Massage Matters A Journal for Registered Massage Therapists

secondary credentials, including Master’s degrees, our own College has instead bucked the trend and shied away from a statement of

minimum curricular hours. As the 3,000 hour requirement fades, our

collective commitment to best practices in lifelong learning must strengthen, under our own steam.

I’ve heard from other RMTs that evidence-based practice (EBP), which is what most

Please direct your comments to dave@massagetherapy.bc.ca, subject heading “Letters,” where they will be forwarded to the MTABC Board for review.

of directives that requires practitioners to shun what they know and have experienced.

Editor in Chief David DeWitt

bodies and patients love them, so at the end of the day, they are doing pure, good work.

Editor Lori Henry

practitioner. It instead urges the practitioner to challenge their own traditional beliefs and look

Published by: BIV Media Group 102 East 4th Avenue, Vancouver, British Columbia V5T 1G2 Tel: 604-688-2328 Sales Victoria Chapman 604-741-4189 vchapman@biv.com Design Soraya Romao Editorial Board Bodhi Haraldsson Anita Wilson Brenda Locke Dee Willock Damon Marchand Michael Reoch Christin Sandler Mission Statement This publication is intended to provide a voice to BC’s Registered Massage Therapists, a source for the latest research and a vehicle for the general population to understand and respect the valuable work of our RMTs. Massage Matters is published three times a year for Registered Massage Therapists. Funding is provided from the MTABC and advertising revenues. Massage Therapists’ Association – MTABC 180 - 1200 West 73rd Avenue Vancouver, British Columbia V6P 6G5 Tel: 604-873-4467 Fax: 604-873-6211 Toll Free: 1-888-413-4467 Email: mta@massagetherapy.bc.ca

healthcare professions are adopting, scares them. They feel the healthcare move toward EBP

feels like Big Brother telling them what to do every step of the way. They believe that EBP is a set The proof, they say, is in the pudding. These RMTs know their hands work well on patients’ In fact, this isn’t necessarily true. EBP doesn’t discount the skill and experience of the

at current, relevant research, and then bring that into decision-making and treatment planning. EBP means not putting all your eggs in one basket. This is key. You wouldn’t read only

one consumer review before buying a cappuccino machine, why consider only one stream of knowledge when providing therapy to a patient?

EBP is as steady as a three-legged stool. It supports the weight of massage therapy practice.

But if you remove two, or even one leg, the whole thing collapses.

The three legs are the patient and his or her expectations and values; real research; and the

therapist’s own clinical experience. It’s pretty clear to see that any therapist who ignores the

patient does so at their own risk. Equally important, but likely less obvious, is that a therapist

who ignores the best available research, meaning research that has passed critical appraisal,

also eliminates the opportunity to challenge his or her own paradigm and confront statements and beliefs he or she may have historically held as true, and communicated to patients.

In other words, this is scary stuff. Learning that a long-held therapeutic belief is suddenly no

longer true means you have to find a different way of delivering treatment. It isn’t the research

itself that is so frightening, when you really think about it. Research is simply a tool to uncover

and deliver information. It’s how we as RMTs use that knowledge and translate it into patient

care that may unnerve us.

The decision to adopt EBP today is our own, but this may not be the case in the future. BC’s

2008 proposed Primary Health Care Charter says that evidence-based best practices should be

the core process behind providing patients with accessible, appropriate, efficient, effective, safe

quality care at the right time in the right setting by the right provider.

By assimilating best practices from current research, adding in our own clinical experience

earned through thousands of hours of treatment and then individually considering each

patient’s expectations, values and beliefs, RMTs can be at the forefront of providing the best

care to our patients.

To me, it is the only way of remaining a viable, relevant profession as we move forward.

Damon Marchand, President

www.massagetherapy.bc.ca

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contents in this issue: Cover

Book Review Research

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Congress Overview

Fortifying Credibility

Classified

Massage Therapy is a natural fit with First Nation Culture by lori henry

by bodhi haraldsson

by cathy ryan

Cover photo credit: iStock

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FRC3: Fortifying the Credibility of Massage/Manual Therapy

The Third International Fascia Research Congress (FRC3). PostConference Overview by cathy ryan

MTABC Research Review

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Massage Therapy is a Natural Fit with First Nations Culture

by lori henry, editor In Campbell River, there is a strong First Nations population and much collaboration has been established between the health services provided on and off reserve. Linda Lavender has been working as an RMT since graduating in 1988. In 2004, she was approached to do massage therapy for the Quinsam/Cape Mudge Band members living on reserve. She says, “I felt like this was a wonderful opportunity to learn about another culture in my own back yard. This service expanded into a position of an Arthritis Chronic Care Coordinator with the ITHA (Inter Tribal Health Authority) and the KDC (Kwakiutl District Council). I had not only a chance to collaborate with the services provided on reserve, but off-reserve as well, following the Expanded Chronic Care Model. This gave me the opportunity to incorporate administration duties, as well as being in the community to be a part of the education of massage and health services. I was also available to community members and their families living with the chronic condition of arthritis.” After her contract was completed, the ARC (Arthritis Research Centre of Canada) hired Linda in 2008. “Arthritis was identified by the First Nations Regional Longitudinal Health Survey as being a burden in First Nations Communities,” she explains. “Using research methods, ARC and KDC Health are working together to develop a culturally sensitive, family-based self-management program.”

photo: Samantha Jones

ARC works in collaboration with KDC Health, which provides preventive and health promotion services for sevenmember nations on-reserve on northern Vancouver Island (Kwakiutl, Mamalilikulla

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Qwe’Qwa’Sot’Enox Band, Da’naxda’xw First Nation, Wei Wai Kai First Nation, Wei Wai Kum First Nation, K’omoks Band, and Kwakiah Band). They reach approximately

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Linda Lavender in front of her RMT clinic.

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2,100 eligible people from five health centres: Campbell River, Cape Mudge on Quadra Island, Quinsam (south of Campbell River), Comox, and Fort Rupert (south of Port Hardy). Linda says that “collaborating with ARC and KDC Health have proven beneficial to community members, as it continues to provide opportunity for residents to not only access information on arthritis, but also to obtain massage services at reserve health offices. This service has expanded over the years, as there are three RMTs that go regularly into the KDC Health communities.” The RMTs that currently work in the KDC Health offices are non-First Nations, so Linda says they “have learned and continue to learn and observe First Nation culture, which we all do with great respect. As massage therapists, we feel very fortunate to be included in the hospitality provided by the KDC Health offices. They are well equipped to provide, not only space for massage services, but also with modern technology to allow the opportunity

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to take continuing education updates by way of teleconferencing and video conferencing. “Over time, as massage therapists, we learn to listen to the stories of the Elders and community members. It is so important to build a lasting relationship of respect and trust. This is something that cannot be hurried. There is great tradition in First Nations cultures, not only in its people but also in its land, and in the balance of life and nature. As in all clients in all cultures, we as humans are individuals and deserve and expect to be treated with respect and dignity. As registered massage therapists, I feel it is our job to maintain this standard of service, no matter who we work on.” Kim Goetzinger, an RMT in Haida Gwaii, sees this same interconnection between her culture and her practice. “First Nations and massage therapists are a lot alike. Very much needed and very much a part of this planet. We are helping people get to where they want to go, but are often the voices that aren’t heard.”

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Kim is half Haida of the Ts’aahl Eagle Clan and wears a five-finned sea monster as a family crest on her mother’s side, and is half Yugoslavian on her father’s side, born in the small Haida village of Daajingiids (eight minutes from Skidegate). Although her early plans to attend massage therapy school in Vancouver were foiled, she never let go of her dream to be an RMT (and a class one truck driver, which she also accomplished) and was finally able to go to school at Victoria’s West Coast College of Massage Therapy. She now has a practice in Skidegate. But there are some differences between her practice and a non-Haida clinic: “There is a lot to the culture about being respectful to each other and oneself. For example, normally when you walk into a massage therapy clinic, you’ll likely see a skeleton, great structures like that sitting around to aid the therapist and patient. However, the Haida view bones as sacred and not to be shown. “I’m [also] aware of some of the bigger issues at hand and some of the bigger challenges here, and my local knowledge allows me to have an acute awareness of people’s daily activities. Like when someone says, ‘Oh, I’ve been getting octopus all day and I hurt my shoulder,’ I’ll know exactly what’s involved in that, whereas a massage therapist who hasn’t experienced stuff like that, or hasn’t experienced pulling in a halibut line, for example, which is grueling, or if someone has danced traditional Haida dances all night at an 18-hour potlatch, I’m going to be in-the-know of exactly what muscles are overused and susceptible to repetitive strain. That is the basis of my practice, to always speak up for those overused soft tissues.” Her life as an RMT is deeply connected to her life as a Haida, as seen in the changing seasons on the island. “In a little town where people are fishing and hunting and climbing trees, and digging in the sand and soil, the extreme weather (25 hurricane force storms last season) makes it a tough place to survive. But those who call this place home have it built into their DNA to thrive ( just like the

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great trees) with much-needed assistance of a registered massage therapist. It tends to be cold and damp, and the perfect recipe to aggravate trigger points.” Kim continues: “It’s beautiful and majestic [in Haida Gwaii], and we are blessed to be able to live here and harvest traditional foods, which keeps us quite busy. Right now is spring salmon and halibut fishing season, and herring, roe and kelp season, and then there’ll be potlatch season, and there’ll be all these different seasons that allow us to do exactly what we need to do as Haidas. If we want sockeye, we have to go and get that fish, as well as being massage therapists, as well as being community members, thus making this a busy, unique universe all on its own.” RMT Samantha Jones, who is also of Haida descent and grew up in both Skidegate and

Kim Goetzinger

Queen Charlotte (and now has a practice in Vernon called Balanced Harmony Massage Therapy) agrees that her beliefs are quite complementary to her practice as a massage therapist.

“As an RMT, you’re educating about your own health and educating people about their bodies and how they work,” she explains. “As a First Nations person, you’re always educating people about your culture and your beliefs, and not taking comments [from uninformed people] as a slight, but knowing that they just don’t know and they’re curious. I love getting asked questions about my First Nations background and my upbringing, just like I enjoy people asking me questions about their body and my education and my background in the medical profession.” Samantha sees that connection even in the way that Haida people think. “In the Haida culture, we believe there’s a higher being and a higher power, and it’s all about respecting the earth and having respect for yourself. I do

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photo: A button blanket designed by Jesse Jones (Samantha’s cousin). At the top is a cedar bark weaved hat.

From page 7

that a lot with people who have been injured, because they can get on that negative train. I always joke around, saying, ‘No negative Nancy’s around the treatment room. We’re all about Positive Patty.’ It’s teaching people how to love themselves and connect with their soul and their spirit, which is a lot of Haida culture. “We firmly believe there is a greater being out there, the Creator, and having respect for Mother Nature, and having respect for yourself and your family. And that’s what it’s all about. I try to get that back into people because we get so disconnected from Mother

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Nature and from ourselves, and that’s the reason why people are in such chronic pain, because they’ve totally disconnected themselves.” She believes that massage therapy is needed everywhere, and that includes First Nations communities. “I know there is a great need for it and I believe there needs to be more education and opportunity for people everywhere to experience the power of massage therapy. In my experience, I observe that First Nations people who live on Reservations are often overlooked, so I personally try educating and getting my patients involved in their health.”

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Samantha credits the Massage Therapists’ Association of BC for helping to spread awareness of the importance of massage therapy to all people, whether Firsts Nations or not. “I think that the MTABC is doing an amazing job to educate and inform people of what massage therapy is capable of doing for people. I think that the field of massage therapy is only going to keep growing and expanding from here on in. I couldn’t be prouder of the trade that I am privileged to be involved in. I love waking up every morning and knowing that I get to make a difference in my little part of the world.” •

Book Review

“Massage Therapy Integrating Research and Practice” Edited by Christopher A Moyer and Trish Dryden Review by Michael Reoch, RMT For many of us the idea of reading or writing research is intimidating. But whether you spend hours each week on Pubmed, or you have no idea what a “pubmed” is, this book is a must for you. Massage Therapy: Integrating Research and Practice (MT:IRP) opens with an interesting history of massage in western culture followed by a chapter that touches on the differences between evidenced-based and outcome-based approaches to massage therapy. Next are three comprehensive but easy to follow chapters on what quantitative (anything you can count), qualitative (word-based experiential and observational data) and mixed methods measurements are and why we should use them. The book also has a chapter that clearly explains statistical measures, and what the heck mean median, mode and P values are. MT:IRP then switches to an overview on the best research for different populations and conditions. Although all were of good value, I found these chapters to vary somewhat in quality with some of the information misleading or outdated. Some of the highlights for me were: Pediatrics, Pregnancy, Athletes, Neck Pain, Anxiety and Fibromyalgia. Each chapter finishes with a case

study that shows how we can use research to treat a patient of the population presented within that chapter. Part four of the book is about connecting research and practice. There is a great chapter on how to integrate research in education followed by another fantastic chapter on how to bring research into the clinic. If you are interested in submitting case reports or writing journal articles this is laid out for you as well. Part five ends the book with a look at the future directions for MT. There is some good insight here. I agree that we need to start to shift from an empirical model to a measurable and

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repeatable method of treatment. But by no means should we drop the art of what we do. The book argues that research will deepen our knowledge and understanding so we can consistently repeat what we do well, and help discern why we don’t always succeed. A repeated theme of this book is that we do not have enough information on what adverse effects massage therapy can produce. If we do not start to show that a skilled clinician is the safe and effective bet for rehab, how can we maintain our position against unregistered body workers? I think this book is a must for any clinician. As a profession, we need to better integrate

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research into our practice. We must better understand how we can effectively use this growing evidence that is available to us or we may, as a profession, become redundant. By having a good eye for quality research, we can better ourselves for those hard cases ahead. As an educator at a massage college, I feel this imperative tool will help future RMTs understand how to not only read research but to incorporate research into practice. This book is available for members, to borrow for free, from the MTABC library as are many other great books pertaining to Massage Therapy. •

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MTABC CEC CoursEs 2012 RegistRation at MtaBC 604.873.4467 oR mta@massagetherapy.bc.ca. oR Mail to MTABC 180-1200, WesT 73rd Ave, vAnCouver, BC, v6P 6G5. PRovide naMe, Phone and eMail. CanCellation within 3 weeks of a CouRse Results in 20% Penalty; within 2 weeks, 40%; and within 5 days oR “no shows”, no Refund. all PRiCes in Can.

Massage Therapists’ Association of British Columbia

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MTABC Research Review

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FAsCiA: iTs sTruCTurE & FunCTion ThE shouldEr wiTh MArk FinCh, rMT 14 CrEdiTs holidAy inn 711 wEsT BroAdwAy VAnCouVEr oCtoBeR 13-14, 2012 - sat and sun 9aM to 5 PM FAsCiA: iTs sTruCTurE & FunCTion PElViC GirdlE wiTh MArk FinCh, rMT 14 CrEdiTs holidAy inn 711 wEsT BroAdwAy VAnCouVEr oCt 20-21, 2012 - sat. and sun 9aM to 5 PM PriCes: Mta one Month eaRly $322 RegulaR $350 non-Mta one Month eaRly $450 RegulaR $495 End-rAnGE loAdinG - hEAd & nECk wiTh dr. dAVid dECAMillis, d.C. 12 CrEdiTs nEw wEsTMinsTEr sePt. 29-30, 2012 - sat. 10:00 – 4:30 and sunday 9:00 – 3:30 End-rAnGE loAdinG - BonEs & JoinTs wiTh dr. dAVid dECAMillis, d.C. 12 CrEdiTs oCt 21 - 21, 2012, sat. 10:00 aM - 4:30 PM, sun. 9:00aM - 3:30PM PriCes: Mta one Month eaRly $280 RegulaR $310 non-Mta one Month eaRly $390 RegulaR $430 Ann slEEPEr ’s CoursEs For MorE CoursEs, sEE Ann’s wEB PAGE www.AnnslEEPEr.CoM inTroduCTion To osTEoPAThiC TEChniquEs 12 CrEdiTs VAnCouVEr – holidAy inn sat and sun sePt 15-16, 2012 ViCToriA - PACiFiC riM CollEGE sat and sun oCt 13-14, 2012 vAnCouver PriCes: Mta one Month eaRly $275 RegulaR $300 non-Mta one Month eaRly $385 - RegulaR $425 viCToriA PriCes: Mta one Month eaRly $340 RegulaR $375 non-Mta one Month eaRly $445 - RegulaR $485 MikE dixon, rMT And sTEVE AndErson, rMT ThorACiC And luMBAr BAlAnCinG 14 CrEdiTs wCCMt new westMinsteR oCt 20-21, 2012 PriCes: Mta one Month eaRly $322 - RegulaR $350 non-Mta one Month eaRly $450 - RegulaR $495 For more course details, see MTABC weB siTe www.massagetherapy.bc.ca

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by bodhi haraldsson This year much of the work of the Research Department was focused on the Third International Fascia Research Congress. It was a privilege to work with this exemplary group of international researchers on the Scientific Committee. The congress has developed longlasting relationships that will pay dividends for future MTABC projects. I am pleased to announce our newest project – the Case Study Repository. This year the MTABC and Sigma Applied Research LLC (Martha Menard-Brown) developed a partnership to create a Case Study Repository. The repository project seeks to use the open-source/openaccess model of cooperation and trust, in which authors retain ownership of the intellectual property and can safely share this information with others. This model offers greater visibility within the research community. We anticipate launching the Repository this summer. For more information, please contact the MTABC research department. Further, developing a massage therapy degree option for our members continues to be a high priority. When we asked our members if a baccalaureate degree (B.Sc) in massage therapy would advance the Profession, a strong majority (85%) answered yes. The MTABC Research Department continues to work on other projects such as: • Electronic Health Library • Case Study Awards • Seed Grants Awards The Research Department is always looking for new opportunities to achieve our goals of:

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• Building knowledge in the profession by sharing and funding research that informs and improves clinical practice and clinical effectiveness. • Building research capacity in the profession by providing novice researchers with opportunities, including funding, to enhance their research skills and experience. I am proud that the MTABC and its members believe strongly in research and, in fact, have the only Massage Therapy Research department in the country. We would love to hear from you: email, Facebook, Twitter or simply by calling the MTABC office. The Research Department is available Tuesday through Thursday. Please do not hesitate to contact us if you have any issues / ideas you would like to explore. •

Congress Overview

The Third International Fascia Research Congress (FRC3)

Post-Conference Overview The Squamish Nation officially opening the FRC3 ceremony, with Dr. Tom Findley holding the traditional Talking-Stick photo: Sebnem Ozpeta

by cathy ryan The International Fascia Research Congresss (FRC) is a continuing series of conferences dedicated to the emerging field of fasciae studies, delivered in an innovative platform that fosters the bidirectional collaboration between clinicians and researchers across a diverse array of disciplines. Over 800 attendees from 37 countries (representing all continents except Antarctica) gathered together for the 3rd International Fascia Research Congress (FRC3): What do we notice, What do we know – Continuing the Scientist/ Clinician Dialogue. The 3 day conference was preceded by a 2 day dissection workshop and followed by full and half day post-conference [practical] workshops. Delegates from the Squamish Nation; descendants of the Coast Salish Aboriginal Peoples

opened the ceremonies with an official welcome. A traditional Talking-Stick (ceremonially and spiritually significant to indigenous peoples) was graciously presented to Thomas Findley MD, PhD - FRC Chair. Eight Keynote Speakers, four Panel sessions, eight Parallel sessions, several poster presentations and vendors provided a cornucopia of fascia-nating information. A welcoming reception provided delegates with an opportunity to socialize and revel in their communal appreciation of all things fascia and the multimedia night wowed the crowd with stunning fasciae imagery. The Massage Therapists’ Association of British Columbia (Hosting Sponsor), Ida P. Rolf Research Foundation (FRC administrators), Planning Committee (Chair, Harriet Hall PDP, RMT), Scientific Committee (Chair, Geoffrey

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Bove PhD), volunteers and venue staff did an outstanding job attending to every detail of this conference. It is work and dedication of many and the

generosity of the sponsors that make such an event possible. The FRC3 featured a broad selection of fascia research; Fluid Dynamics, Cytology

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& Histology, Mechanotrandsduction & Biomechanics, Gross Anatomy, Postsurgical Scars, Pathology, Pain & Intervention, Clinical Applications, Imaging and New Hypotheses. How to construct, conduct and translate meaningful research was also covered. To help further assist the field of fascia research, the Ida P. Rolf Research Foundation (IPRRF) provided a Research Training and Project Funding Symposium. Something new and exciting comes out of each consecutive FRC: At the FRC3 the launch of The Fascia Research Society (FRS) was announced by Dr. Findley (a project spearheaded by the IPRRF). The FRS is intended to facilitate a continuous flow [between the triennial FRCs] of bidirectional collaboration and support for all disciplines with a shared interest in the field of fasciae studies. In conclusion, another note worthy aspect of the FRCs is the approachability of the speakers/presenters. The graciousness with which they interacted was appreciated and commented on by many – the opportunity for such personal interaction is considered one of the highlights of this event. The collective consensus: “one of the best conferences ever attended”! •

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FRC3 Review

Fortifying the Credibility of Massage/ Manual Therapy

The 3rd International Fascia Research Congress - Keynote and Panel Session Overview by cathy ryan This is one of my favourite conferences to attend for reasons beyond my fascia fascination. The FRCs provide ample opportunity for multidisciplinary Clinicians and Researchers (with a vested interest in fascia) to share experiences, learn from each other, support and further each other’s work. The collegial atmosphere of the FRCs [in and of itself] makes the experience significantly worthwhile. Another important aspect is that the research coming out of and being influenced by the FRCs is a vital component in the movement forward in establishing a solid body of evidence to support Massage/ Manual Therapy (MMT), thereby fortifying the credibility of our practices. Notably: • determining mechanisms of

action (how our work – works); •g aining clearer understanding of the etiology of various softtissue conditions (e.g. chronic low back pain) •a dvancements in imagery and measurement tools (to better identify normal/ abnormal soft-tissue presentations and verify/ track post-treatment changes); • i dentification and delivery of measurable/consistent dosage related variables (e.g. duration, pressure); • s ubstantiating efficacy in relation to certain conditions and populations; • f urthering our understanding of fascia and its role in soft-tissue functioning and pain/ dysfunction. Numerous individuals have painstakingly put the research

Information coming out of the FRCs enhances our ability to focus our treatments to target specific fascial layers to derive specific results (e.g. treatments directed at the superficial fascia are useful in the treatment of lymph edema and treatment targeting deeper fascial layers can be useful to impact proprioception, locomotion and pain modulation (C. Stecco FRC3) - Harriet Hall PDP, RMT.

presented at the FRCs together over many years. There is no possible way to feature it all in a single article – to this amends I preface; acknowledging the accomplishments and excellence of one in no way diminishes the importance and validity of another. The contribution of every individual involved is paramount to the far-reaching, collective value of the FRCs.

to deliver the Opening Keynote; Mary F. Barbe PhD. Barbe’s presentation: Changes in Fascia Related to Repetitive Motion Disorders (RMDs), clarified the timelines and fallout of the 2-stage process commonly seen with RMDs; inflammation followed by fibrosis. Barbe emphasized the importance of timing of appropriate intervention to attenuate the physiological and psychological impact of impact of such injuries. The following Keynotes: Adaptation of Tendinous

Day One The planning committee did an excellent job in selecting a dynamic and engaging speaker

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FRC3 Review

From page 13

Above: Geoffrey Bove DC, PhD and Susan Chapelle RMT at work in the lab. Image

Fig. 1: The loose CT [microvacuolar bubble ] configuration that permits sliding of

adjacent structures or tissue layers; thereby augmenting movement. Image used with

used with kind permission from Geoffrey Bove DC, PhD.

kind permission from Dr. J.C Guimberteau and Endovivo Productions.

Connective Tissues to Exercise (Michael Kjaer MD, DMSc) and Mechanical Loading & Fascial Changes (Albert J. Banes PhD), furthered our understanding of how fascia responds to strain, compression and fluid shear stress (e.g. daily demands, overuse demands, trauma and manual therapies). Kjaer covered some interesting tendinous gender differences. Banes noted that [via mechanotransduction] mechanical strain is a faster activator of cellular response than agents (e.g. hormones, drugs). Here we can see the potential for manually applied strain to instigate various cellular/tissues changes and quickly so. MMT: minimal [if any] adverse side effects, noninvasive and fast acting – I like that!

Since [manual therapy] mechanisms of actions are still ‘at large’ – this is an extremely important area of research for MMT clinicians, showing great potential to help substantiate the credibility of our practices. The Scars and Adhesions Panel (Geoffrey Bove DC, PhD – moderator, Hal Brown DC, ND, RAc, Susan Chapelle RMT, Michael Diamond MD and J.C. Guimberteau MD): Brown discussed postsurgical scars as a potential source of Autonomic disturbance (e.g. SNS hyperstimulation) and his use of prolotherapy (at the scar site) to ‘reset’ SNS membrane potential and restore normal neural functioning. Guimberteau shared another of his stunning endoscopic explorations: Skin,

Scars & Stiffness. Differences in normal tissue and tissue during and post scar/adhesion formation were shown. Notably the lack of microvacuole bubbles (a component of the intra/inter fascial sliding mechanism) seen with poor/unhealthy scar formation. Additionally, Guimberteau noted that ‘normal’ scar formation does not occur where reconstructive hardware is present. Dr. Guimberteau’s presentations are always a FRC highlight. Diamond relayed that 55-100% of abdominal surgical patients experience postsurgical scar/adhesion complications (e.g. pain, impaired mobility, bowel obstructions)

Continued on page 15

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FRC3 Review

From page 14

– not immediately recognizable and potentially [over-time] other health issues may arise and mask the scar/adhesion complications. Chapelle presented finds from a recent paper [published in JBMT - a collaborative research project with Bove] demonstrating the effects of manual therapy on postsurgical intraperitoneal adhesions. The findings support that early [manual] mobilization (3-5 days post surgery) is a safe and effective means by which to prevent or attenuate postsurgical scar/adhesion complications. Chapelle’s accomplishments are noteworthy simply given the merit of the collaborative research being conducted with Dr. Bove. Additionally, it was exciting to see a Canadian RMT colleague presenting at the FRC; a first for this conference – hopefully not the last. My hat is off to you Susan, thank you for ‘representing’ - your success benefits us all. And thank Dr. Bove for bridging across to one of our own. Day Two Keynotes: Fluid Dynamics (Rolf Reed PhD) and Interfascial Fluid – The Secret Life of Water (Gerald Pollack PhD) explored the role of fluid streaming in connective tissue remodeling and the potential of water (near a hydrophilic surface - e.g. collagen) to be a source of energy capable of driving biological processes. This endogenous current can be charged by light (infra red wave), thermal and mechanical energy. Both keynotes implicate fluid dynamics as a plausible mechanism of action for some

manually mediated tissue changes. Fluid Dynamics - Clinical Implications Panel (Michael Kuchera DO – moderator, Lisa M. Hodge PhD, Rolf Reed PhD and Paul Standley PhD): provided evidence to support manually mediated effects associated with Abdominal Lymphatic Pump (e.g. inhibition of solid tumor growth, improved immunity - Hodge) and Myofascial Release (e.g. ameliorating the problematic aspects of the inflammatory cascade associated with RSIs Standley). Technique application and dosage considerations were also addressed. Reed further clarified the plausibility of manual therapy to influence fluid dynamics and subsequently; impact flow in vessels, improve joint and other tissue lubrication and attenuate inflammation/fibrosis. This was an exciting panel session for the clinicians in the crowd as this is another area of research that is providing significant insight into some plausible mechanisms of action for MMT. In particular, how manually applied pressure/force (via the

A Fascia-nating Trio: Leon Chaitow, Gil Hedley and Carla Stecco. Image used with kind permission from Dr. Chaitow - www.leonchaitow.com

ingrin/mechanotransduction mechanism) can influence fluid composition and fluid movement (e.g. the sponge-like squeezing and refilling of fascia following stretch- Schleip et al.). Some of the challenges and potential solutions to designing [meaningful] research methods for Massage/Manual Therapy were eloquently covered by Dr. Sherman in the final Keynote of the day: Developing Clinical Trials for Bodywork and Massage – or as she called it; “A fireside chat with Aunt Karen” [Dr. Sherman’s refreshingly witty-

Acknowledgements Thank you to Harriet Hall PDP, RMT, Geoffrey Bove DC, PhD and Leon Chaitow ND, DO for their time and editorial input. The research presented at the FRC3 encompassed several types and methods, more information can be found at: http://www.fasciacongress.org/2012/ and abstracts can be found at: http://fasciacongress.org/abstracts_2012.php Both the FRC3 proceedings book and DVD will be available for purchase at: http://www.fasciacongress.org/2012/dvdrecordings-and-proceedings-books/

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take on research methodology]. MMT currently lacks a solid body of evidence to support its practices – constructing and conducting meaningful research is paramount to bridging this evidence divide. Day Three The opening Keynote of the final day: Fascial Anatomy Overview (Carla Stecco MD, Orthopedist) concluded with a raucous standing ovation for Dr. Steeco’s: Extreme Makeover; Soft-Tissue Edition! Superficial and deep fascia layer differences and varied regional presentations were covered. As was the intra/ inter fascial sliding layers [rich in hyaluronan] that augment movement or when compromised can impair movement and result in soft-tissue pain and dysfunction. Adapted from A. Stecco, Fascial Manipulation Workshop notes, III Fascia Congress, 2012) The work of Stecco et al. [and others] is paramount to

Continued on page 16

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FRC3 Review From page 15

furthering our understanding of fascia’s construct and functional role in human biomechanics. In gaining a better understanding of fascia’s functional role we can better comprehend the implications of its dysfunction and involvement in the milieu of musculoskeletal issues commonly seen by MMTs (e.g. sprain/strain, RSI’s, nerve compression syndromes). This is a revolutionary area of research that insists that we reconsider soft-tissue anatomy/physiology as we knew it and reconsider what [for the most part] is still being taught within the realm of soft-tissue related health

Image used with permission from Geoffrey Bove DC, PhD and Susan Chapelle RMT.

sciences. When it comes to body and brain; Movement Good – Stasis Bad! In the concluding Keynote of the day; Ultrasound and Microanalytical Techniques (Jay P. Shah MD) Dr. Shah exclaimed “Ever heard – I don’t believe they exist? It’s not a religion – let the data speak.” Utilizing objective, repeatable and reliable (interprofessionally recognized) diagnostic tests, Shah et al. have effectively put to rest the questioned existence of Myofascial Trigger Points (MTrPs). Using ultrasound, Shah et al. were able to determine that MTrPs

Continued on page 17

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FRC3 Review From page 16

can be distinguished from unaffected muscle (e.g. MTrPs are stiffer). Additionally, active MTrPs can be differentiated from latent MTrPs and unaffected muscle by an identifiable biochemical milieu (e.g. inflammatory mediators and pain/sensitization substances) and unique blood flow waveform characteristics. Fascial Imaging Techniques Panel (Leon Chaitow ND, DO – moderator, Helen Langevin MD, Diane Lee FCAMPT, Raul Martinez-Rodriguez PT, DO and Antonio Stecco MD): Collectively the panelists relayed how ultrasound imaging can be utilized to diagnose various aberrant fascial presentations and track pre/post treatment tissue changes. Ultrasound imagery can visualize force vector distortions (due to scars/ adhesions) and areas of thickening/stiffness

(due to scars/adhesions or increased viscosity in the sliding layers). Lee’s presentation (along with Guimberteau’s work) supports the idea that although superficial scarring may look and function ‘normally’ [relatively speaking] this may not be the case in deeper layers of tissue. “Imagery can provide evidence and affirm outcomes” – Chaitow. In the concluding Panel Session: Art & Science/Research & Practice (Brian Degenhardt DO, A.T. – moderator, Geoffrey Bove DC, PhD, Robert Schleip PhD, Paul Standley PhD and Maureen Simmonds MCSP, PT, PhD) some of the challenges and joys of constructing, conducting and translating research were covered. Dr. Standley who brought the challenges created by variances in interdisciplinary

terminology to our attention exclaimed:“We need a Rosetta Stone of Manual Therapy.” Dr. Simmonds discussed the difficulties rooted in variances in interdisciplinary; perspectives, belief systems, research methodologies and measurement tools. Dr. Schleip (clinician turned researcher) reiterated the [mechanism of action and effect] significances of fluid dynamics and provided information on [clinically] practical measurement tools (Myometer and Algometer) and assessment procedures. Dr. Bove (clinician/researcher) passionately reflected on bridging the evidence divide through bidirectional collaboration. A final note: Advancement in MMT research is being aided by various imaging and measurement tools that can be used to Continued on page 18

E-mail : robert@massageessentials.ca

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FRC3 Review From page 17

identify biomarkers and denote differences in normal\abnormal tissue presentations and thereby track pre\post treatment changes. During one of the breaks I thanked Dr. Shah for his and his colleague’s work – he asked me whether this work was

meaningful to me (as an RMT)? I responded,“validation.” Assessing for and treating MTrPs is nothing new to most RMTs but now the commonly recognizable palpable and patient subjective evaluation indicators can be supported by an additional objective, repeatable, reliable and inter-professionally

recognized diagnostic test. Perhaps this will lessen those occasions when someone is told that there is nothing showing up diagnostically that could explain their pain and dysfunction, additionally such confirmation can support their need for treatment.

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Systemic Deep Tissue Therapy® Workshops (also known as SDTT)

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riginated and developed by Armand Ayaltin DNM, RHT, RMT, and taught by him since the late 1980’s. It consists of its own scientifically-based philosophy, therapist-friendly assessment and treatment. To reduce burn-out, body and hand postures are ergonomically designed. Therapy takes its cue directly from the assessment. This innovative procedure is designed to minimize the mental and physical stress of the Tx room. In these Workshops we will teach: • Philosophy and background • How to treat the underlying cause of pain, often realizing quick and lasting results • How to Structurally Realign the body by collapsing the compensatorymatrix, using specific SDTT techniques at the physical and energetic levels which are: • recognizing the compensatory-matrix • engaging the SNS • manipulating the Fascial-muscle-joint systems • therapeutic intent • treating the relevant meridians • stimulating the patient’s quantum field of healing If as a Therapist, gaining self-confidence, self-sufficiency and effectiveness with reduced chances of self-injury is important, taking these workshops and adopting the Systemic Deep Tissue Therapy® is for you. Testimonials: “Thank you so much for this amazing workshop. It will change my life!” W.M. RMT. “This course surpassed my expectations...” B.C. RMT. “Thank goodness there is a way to read the body and respond to its core needs.” J.W. RMT. “Great coverage of biomechanics and application. I like these instructors, cool guys” J.L. RMT. “With 16 years of massage therapy experience I was still expecting to learn something new- those expectations were exceedingly met. The assessment approach alone was enough of a refreshing perspective- with the addition of completely new hands on techniques, this course was thoroughly worth my time and would recommend it to any seasoned therapist. Excellent course, nothing but praise for these innovative and effective techniques that match a thoroughly progressive treatment philosophy, this is truly Massage THERAPY!” Brad Dow RMT. Introductory: Sept 22 – 23 2012, Feb 16 – 17 2013 (14 CEC’s) Intermediate: October 20 – 21 2012, March 16 – 17 2013 (14 CEC’s) Cost: $399. For more info and to register, phone: 604.984.2611 • web: systemicdeeptissuetherapycenter.com t h e r a p i s t s ’

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Manual Practice Osteopathic studies “Osteopathy is a natural medicine which restores function to the organism by treating the causes of pain and imbalance…” Philippe Druelle, D.O.

Osteopathy, a discipline in demand Osteopathic education emphasizes the transmission of the art of osteopathic palpation. This ability, to treat the human body at a highly sophisticated manual level, is what distinguishes Osteopathy from all other forms of medicine and therapy. Given the increasing need for qualified health professionals, osteopaths benefit from interesting career perspectives. Osteopathy could be the career you are looking for. This 5 year program (6 seminars/year) is designed for health-care professionals to gain experience and evolve their practices while studying. The College of Osteopathic Studies offers - A program tailored to professionals already in clinical practice - A low instructor/student ratio - Experienced faculty with many years of clinical practice The practice of traditional manual osteopathy requires a fine touch, a gentle heart, and a desire to learn. The emphasis at the College is to ensure that the hand-to-hand transmission of traditional osteopathy is preserved. Our lead instructors hold a specialization in certain aspects of the program to ensure that the knowledge passed on is of the highest quality. Successful graduates of the CEO receive a Diploma in Osteopathic Manual Practice (DOMP) and are automatically eligible to become a member of Society for the Promotion of Manual Practice Osteopathy (SPMPO).

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