WINTER 2014 VOL 7 ISSUE 1
M AT T E R S M A SSAG E TH E R A PIST S’ A SSOC IATIO N O F B RITISH CO LU M BIA
GOLD STANDARD WINTER ATHLETES GIVE TOP MARKS TO REGISTERED MASSAGE THERAPY WINTER OLYMPIANS & CASUAL ATHLETES BENEFIT FROM RMT | 5 PAIN EVENT: SNEAK PEEK AT PAIN MANAGEMENT CONFERENCE 2014 | 9 ENTER OUR
THE BEST IN BMM: AN INTERVIEW WITH RMT NATALE RAO | 14
LEGAL MATTERS: PRIVACY & SECURITY CONCERNS FOR ALL RMTS | 18
CONTEST FOR A CHANCE TO WIN! | PAGE 24
CONTENTS | WINTER 2014 PRESIDENT’S MESSAGE 4 READER LETTERS 16 CLASSIFIEDS 25
5
COVER STORY GOLD STANDARD
From Olympians like alpine skier Anastasia Skryabina to casual participants, every winter sport athlete can benefit from RMT
9 THE PAIN EVENT
Our exclusive preview of the upcoming 2014 Pain Management Conference features insights from several keynote speakers
BIODYNAMIC MYOFASCIAL MOBILIZATION
Natale Rao talks about a unique approach to myofascial release called biodynamic myofascial mobilization and discusses how other RMTs can use it to help their own patients heal
14 PHOTO: CANADAPANDA/SHUTTERSTOCK.COM
18
20
Scott Nicoll on patient health information rules every RMT should know
Industry updates and the latest from the MTABC
PRIVACY & SECURITY
NEWS & BRIEFS
LAYAR THIS MAGAZINE’S PAGES ‘TO LIFE’ IN FOUR EASY STEPS K ADDITIONAL
EDITORIAL AND AD CONTENT AVAILABLE VIA YOUR MOBILE DEVICE’S LAYAR APP
EDITORIAL Gold standard Pain event News & briefs Winter contest
5 9 20 24
RMT Matters uses “augmented reality” to further improve the contents of our magazine. This exciting new technology lets users of Apple and Android mobile devices, including smartphones and tablets, scan specifically created pages within this publication to see additional “popup” content, like videos related to a story, relevant websites or background material and information about the experts we interview. Just look for the Layar logo on the top of the page!
1 Go to get.layar.com to install the app on your smartphone
3 Open the app, get the whole page in view and press the ‘Tap to view’ button
2 Look for pages and content with the Layar logo
4
24
LAYAR CONTEST
Meet our latest winner and enter our new contest for a chance to win a $100 Visa!
Discover an amazing extra layer of related content
RMT MATTERS WINTER 2014 | 3
PRESIDENT’S MESSAGE MASSAGE THERAPISTS’ ASSOCIATION OF BRITISH COLUMBIA
IT’S HARD TO SAY GOODBYE
T
ime flies when you’re having fun – one minute you’re checking out a board meeting and, next thing you know, 10 years have passed and you’re typing your last post as MTABC president. At our next AGM on March 28, 2014, I’ll step down from an experience that’s been far more enjoyable than I ever could have imagined. While our profession’s growth has been incredible, certain challenges can’t be ignored. The number of RMTs has nearly tripled in the last decade – more than any other allied health profession. Is the removal of educational prerequisites or lowering of training hours to blame? What’s this profession’s saturation point? Sustainability should be a concern to everyone, including the regulator. Economic viability is directly tied to best practices, ethical conduct and standards of care, none of which can be compromised in an increasingly competitive marketplace. That said, our growth and unrealized potential is exciting and full of promise, and the MTABC is honoured to take part in that process. Case in point: not long ago, finding and integrating relevant research into practice was met with trepidation. The task, I hope, has been made easier by our research department’s efforts. In fact, the MTABC has the only fully funded research department for massage therapy in Canada – something we can all be proud of. We can take similar pride in Team MTABC’s organization of the 2012 Fascia Research Congress – an unforgettable event that continues to draw international accolades. The last six years have, too, seen a concerted effort by the MTABC to develop relationships with the insurance industry. We’ve actively worked through the Canadian Massage Therapist Alliance to better understand that sector’s concerns, help bring our concerns to light and address issues regarding billing and fraud. We’ve also worked to expose the RMT brand to the public via trade shows, an outstanding brochure series, poster campaigns, radio and TV spots. The future holds
4 | RMT MATTERS WINTER 2014
more exciting advertising plans for the 2014 Winter Olympics and beyond. Unfortunately, we’ve also seen the issue of sexual misconduct in the field emerge during this time. In response the MTABC formed a patient relations committee to develop tools for members and patients regarding ethical conduct and communication. On a more positive note, our board recently sequestered itself for two days to create a strategic plan for the association and profession as a whole. A high point in my career, this was an opportunity to envision potential; I thank each member who took part for providing unabashed commentary and thoughtfulness in the development of “the plan,” which can be reviewed on our website. Intended as a living, breathing document, your continuous input is more than welcome. One challenge, however, that holds back our profession is a poor, outdated scope of practice definition. Though the government recommended this be changed in 2001, it has yet to happen. As I prepare to depart as president, I urge the MTABC to continue to make this change a priority as we move forward. Of course, serving our members will always be the MTABC’s first priority; our constant goal is to be a “first stop” for all of your professional concerns. Whether legal, financial, administrative or clinical in nature, the ability to have your professional questions answered is, I hope, helpful to you and your business, and I encourage every member to take full advantage of all that the association has to offer in this regard. That said, it’s been an honour to meet so many dedicated RMTs. I love this profession and feel privileged to work with my patients and colleagues. I know many of you feel likewise, and it’s that commitment to the job and, importantly, to patient care, that makes registered massage therapy an integral part of B.C.’s health care continuum moving forward. Thank you, and farewell. RMT – Damon Marchand, president, MTABC
RMT Matters is published three times a year for Registered Massage Therapists (RMTs). This publication intends to provide a voice for B.C. RMTs and to act as a source for the latest research plus a vehicle for the general population to understand and respect the valuable work of RMTs. Funding is provided by the MTABC and advertising revenue. Editor in Chief Noa Glouberman 604-608-5179 nglouberman@biv.com Managing Editor David DeWitt 604-873-4467 dave@massagetherapy.bc.ca Sales Victoria Chapman 604-741-4189 vchapman@biv.com Project Administrative Assistant Michelle Myers 604-608-5122 mmyers@biv.com Design Randy Pearsall, Soraya Romao Editorial Contributors Lisa DeVita, Jan Dommerholt, Laura Dunkley, Diane Jacobs, Scott Nicoll, Neil Pearson Editorial Board Bodhi Haraldsson, Brenda Locke, Dee Willock, Damon Marchand, Michael Reoch Copyright © 2014 by BIV Media Group. No part of this publication may be duplicated or reproduced in any manner without the prior written permission of the publisher. All efforts have been made to ensure the accuracy of information in this publication; however, the publisher accepts no responsibility for errors or omissions. BIV Media Group 102 East 4th Avenue Vancouver, B.C. V5T 1G2 Tel: 604-688-2398 Fax: 604-688-1963 www.biv.com Massage Therapists’ Association of BC Suite 180-1200 West 73rd Avenue Vancouver, B.C. V6P 6G5 Tel: 604-873-4467 Fax: 604-873-6211 Toll-free: 1-888-413-4467 mta@massagetherapy.bc.ca www.massagetherapy.bc.ca
COVER STORY
GOLD STANDARD Registered massage therapy provides numerous benefits to winter athletes – Olympic contender, seasonal enthusiast and casual participant alike
W BY LISA DEVITA
ith the XXII Winter Olympic Games set to take centre stage in Sochi, Russia, in February, the countdown to one of the season’s most anticipated sporting events begins. Ninety-eight events in 15 cold-weather sports will summon worldclass athletes from across the globe to give the performance of their lives – and, as usual, a number of expert registered massage therapists (RMTs) will ride right along with them in the race for glory and gold. As registered massage therapy garners credence as the most widely accessed complementary alternative medicine in Canada, its effectiveness has been decidedly embraced by winter athletes of various skills and abilities around the world – including those who endure rigorous training in bone-chilling temperatures and some of the frostiest elements imaginable. Among registered massage therapy’s most fervent athletic advocates is former winter Olympian-turnedgold-medal ski guide Anastasia Skryabina, who fondly remembers her foray into the highest level of alpine skiing at the 2010 Olympic Games in Vancouver. “I was standing at the start gate of the super-G course in Whistler and I could hear the crowd all the way from the finish line,” Skryabina, who was born and raised in Ukraine but now calls Whistler Blackcomb her home, recalled. “It was amazing to realize that I had finally achieved my dream.” Though representing her home country at the Olympics was a considerable accomplishment – not to mention, one that did her mother, a ski champion, and father, a coach for Russia’s national ski team, extremely proud – Skryabina had another goal in mind: to help other athletes heal through massage. “My mother did it on me during training,” she said. “I kind of became addicted to it. It eventually fuelled my interest in … the field.” Skryabina, who is currently pursuing a career in massage therapy but has yet to be registered as an RMT with the College of Massage Therapy of British Columbia, credits an intense training program for her success on
As a professional athlete, your body takes quite a beating. You deal with a lot of stress, so getting massage treatments helps you to recover and perform at your best – Anastasia Skryabina 2010 Olympian, alpine skiing
RMT MATTERS WINTER 2014 | 5
COVER | WINTER ATHLETES BENEFIT FROM MASSAGE THERAPY
Anastasia Skryabina competed in the super-G at the 2010 Olympics
the ski hill. But, she also acknowledges regular therapy as an invaluable tool in helping her to reach her optimal athletic performance. “As a professional athlete your body takes quite a beating,” she explained. “You deal with a lot of stress, so getting [registered massage] treatments helps to recover and perform at your best.” In fact, overtraining, in combination with a nasty spill on a mountain course, meant Skryabina at one point sustained a lower-back injury that culminated in frequent spasms. She credits regular manual treatments with allowing her to continue to pursue her athletic goals rather than throw in the towel to the pain and discomfort – and that, she says, is something she never takes for granted. Massage Therapists’ Association of British Columbia (MTABC) member and CEO/clinic director of Legacies Health Centre in Surrey Matt Furlot has worked extensively with Olympians and corroborates their loyalty to registered massage therapy. “Olympic athletes have used therapies to get to a level where they can really see the value,” confirmed Furlot, who has been a practising RMT since 1997 and was instrumental in creating the Vancouver Organizing Committee for the 2010 Olympic and Paralympic Win-
6 | RMT MATTERS WINTER 2014
ter Games (VANOC) integrative health team, which included RMTs, chiropractors, physicians and surgeons. “Olympic-level athletes are very in-tune with their bodies, their diet, their nutrition,” he explained. “They have a very disciplined workout regime and they’ve usually sustained injuries and have gone through training fatigue, so they tend to have a high respect for therapies.” Though recreational skiers are susceptible to the same strains and sprains as Olympians, Furlot says they aren’t always as compliant with regard to prescribed therapy or treatment frequency. He adds that, since they may not have the same access to the type of health experts or resources afforded to the pros, “everyday” athletes commonly lack the knowledge needed to discern what the body really needs. “The education that you end up giving to the regular athlete as a therapist is much greater,” Furlot said, emphasizing the critical role that an RMT plays in even a casual skier, snowboarder or other winter-sport lover’s life. Quick to support Furlot’s assessment is fellow MTABC member Erin Reid. “Registered massage therapy provides athletes with benefits in both recovery and prevention,” said Reid, an RMT at Fortius Sport & Health in Burnaby, who counts BC Lions and Vancouver Whitecaps among her clients.
REGISTERED MASSAGE THERAPISTS (RMTS)
NOW HIRING.
We have a growing, loyal client base and to service them we must hire additional RMTs to an already dynamic, qualified team of 60. Full-time and part-time positions are available in each of our 3 locations; Langley, North Vancouver and at the Pan Pacific Hotel, Vancouver. Spa Utopia™ is the largest employer of RMTs in the province with an extensive directory of health and wellness treatments. Build experience, gain advanced education, enjoy competitive wages, extended health and dental benefits, advancement and a positive and fun work environment and more. - the time to apply is NOW. We are pleased to invite RMTs who wish to pursue a rewarding career with Spa Utopia, please send your resume to:
Langley location - amya@spautopia.ca or fax: 604-533-8472 North Vancouver location - diane@spautopia.ca or fax: 604-980-3922 www.spautopia.com
Pan Pacific location - julie@spautopia.ca or fax: 604-687-7879 RMT MATTERS WINTER 2014 | 7 *certain conditions apply.
COVER | WINTER ATHLETES BENEFIT FROM MASSAGE THERAPY
“Whether it’s pre-treatments or post-event therapy to deal with an injury, it’s about keeping the tissue mobile, strain-free and making sure all areas are working well, not just the prime movers.” Reid’s interest in sports therapy has taken her around the world, from the 2008 Paralympic Games in Beijing to world championships in Brazil, Germany and the U.K. As part of the core medical team during the 2010 Vancouver Games, she stresses the idea that treatment in the leadup to everything from the coming ski season to an Olympic event is just as vital to athletic performance. “It’s so important in the off-season to continue to build a plan with an athlete,” she said. “Then, during the season itself, treatment will be able to keep building on that individual’s current foundation. That’s key.” Furlot, meantime, has seen a parade of treatment styles over the span of his 20-year career. Flashy new therapies and idiosyncratic approaches flourish for a moment in the limelight but, like most trends, they inevitably fizzle out and subside. In this day and age, Furlot maintains that a “getting back to basics” approach is key. “A lot of therapists don’t realize when they graduate from school that they are already equipped with such a strong base and aptitude for doing sport massage,” he said, adding that, when it comes to technique, the basics – having really stood the test of time – work best for the winter athlete. “Certainly that’s not all you need but, generally, with a few orthopedic courses, you have the makings of a good sports therapist.” From pro athlete to part-time ski enthusiast, many Olympians and RMTs agree: no matter the performance level, registered massage therapy should be part of every winter-sports lover’s training and health regime. “Not only does it help with muscle recovery, it’s going to ensure muscle health in both flexibility and nutrition to the tissue,” Furlot stressed. Skryabina adds that increasing range of motion, speeding up recovery time and managing injuries are just a few of the many benefits she’s experienced firsthand from registered massage therapy. “It helps you recover, which enhances your performance because the quicker you can recover the more you can train and then the better you’ll perform in the end,” she explained. The merits of registered massage therapy, she adds, go beyond the physical, too, furthering its enticement when it comes to athletes. “Mentally, it helps you to relax and de-stress,” Skryabina said. “When your mind is relaxed you sleep better,
8 | RMT MATTERS WINTER 2014
it releases endorphins. And it helps you to focus more on your athletic performance. It’s all connected.” Although winter and summer athletes share a great deal of the same ailments and afflictions when it comes the aches and strains of strenuous sports training and competition, the challenges that set the former apart are often bio-mechanical. This, says Furlot, stems in large part from the close relationship that a winter athlete shares with his or her equipment – skates and skis, boards and bindings, pads and poles that are virtually a non-issue in summer sports. “Take a hockey player … the height of the skate increases leverage on the ankle so he is more susceptible to different injuries there,” he explained. “A combination of holding a hockey stick and back strain affects the player’s posture, his hip flexors.” While injuries vary from sport to sport, the most common complaint among winter athletes is muscular strain. Furlot gives the example of a skeleton rider, who incurs a larger percentage of neck injuries: “[Registered] massage therapy helps with post concussion and a lot of back extensor strains and soft tissue injuries. The effects of therapy can also help speed recovery with these types of injuries.” Registered massage therapy, however, should not be limited to remedial purposes. Whether it’s once weekly or three times a week, registered massage therapy for the winter athlete should be an ongoing treatment. This, all of our experts say, serves to promote flexibility as well as increase nutrition and waste elimination to and from the muscle tissue, thereby sustaining the athlete’s performance at an optimal level. Furlot goes on to emphasize the role of registered massage therapy as primarily a supportive one: “[Registered] massage therapy should always be part of the athlete’s health and support program and should never exclude other practices. It should always be partnered with other professionals, whether it’s a physiotherapist or a surgeon – they all work together for the athlete.” A strong believer in an integrative approach, Furlot carries the integrative health-team model he helped institute at the 2010 Winter Olympic Games to his clinical practice in order to continue cultivating an environment where practitioners work side-by-side with the best interests of the athlete in mind. “It’s about learning all of our strengths and accepting that we all want to get the athlete to a higher level of excellence,” he said. “We want to work together to achieve that goal.” RMT
It’s about learning all of our strengths and accepting that we all want to get the athlete to a higher level of excellence – RMT Matt Furlot Legacies Health Centre,
CONFERENCE COVERAGE
THE PAIN EVENT The 2014 Pain Management Conference (PMC), March 28-29 at the Delta Vancouver Airport Hotel, promises to be the biggest and best yet
P
MC 2014, open to health care professionals who wish to increase their skill in the management of chronic pain effectively and safely through manipulative and movement therapies, will feature presentations by international pain experts on the latest available pain treatments. We’re pleased to present exclusive insights from keynote speakers and post-conference workshop facilitators Jan Dommerholt, Diane Jacobs and Neil Pearson in the lead-up to the event. To start, Laura Dunkley, vice-president of MTABC’s Pain Professional Practices Group, provides notes from Pain BC’s recent annual interdisciplinary conference as part of our PMC 2014 preview. Pain and the brain BY LAURA DUNKLEY
Pain BC’s recent annual interdisciplinary conference (“Pain and the Brain: Beyond Neuroscience Toward an Integrated Approach”) featured neurologist Charles Argoff, who stressed the need for clinicians to prioritize pain management. Unlike MS or Parkinson’s, pain isn’t managed by any branch of medicine: it’s a patient-specific biopsychosocial experience mediated by numerous mechanisms, and presently it isn’t possible to identify all of them. Recognizing this and treating the person in pain using a multimodal approach, said Argoff, is essential. Pain educator Neil Pearson discussed teaching selfmanagement (SM) for pain. SM, Pearson said, works best when taught in the acute stage. The patient should understand that pain is a perception – a physiological process occurring in the body and the nervous system, not a psychological one. It must be emphasized that pain isn’t “all in your head.” Evidence shows that knowledge
changes the nervous system, and pain education decreases pain and disability over the long term. When pain persists, structural changes occur in the central and peripheral nervous systems and, when it’s resolved, these changes are reversed. An example of SM is having a patient with allodynia set a timer as a reminder to touch the affected area, acknowledge the pain and remember it isn’t dangerous. This teaches the nervous system to gradually “turn down the volume” of the pain rather than attempting to turn it off. Another example: teach the patient to interrupt a pain cycle by finding an area of tension in his/her body, contracting it minimally while inhaling and then relaxing while exhaling. I will be presenting a more detailed account of these two speakers’ research and clinical practice at this year’s MTABC AGM on March 28. I hope you will join us for a lively discussion. The art and science of myofascial pain BY JAN DOMMERHOLT
Since people who experience muscle pain frequently consult with massage therapists and body workers for relief, familiarity with the current scientific evidence and practice guidelines is essential. The initial explorations of former White House physician Janet Travell around myofascial trigger points (TrPs) and pain have become an extensive body of scientific evidence that supports use of TrP therapy in clinical practice. Myofascial pain can exist in isolation without involvement of other structures or be associated with other musculoskeletal disorders. Several studies have shown patients with osteoarthritis, tension-type headaches and migraines have more clinically relevant TrPs than healthy
Laura Dunkley is vicepresident of the MTABC Pain Professionals Practices Group and a member of the International Association for the Study of Pain. She currently practises as an RMT at Vida Wellness spa in Vancouver
Soft Tissue Release (STR) Training originated in the mid 1980’s and is the foundation of recent release techniques. STR has developed into the fastest acting therapy for all acute and chronic soft tissue pain - providing permanent results. Clients injured in sports, at work, or with injuries incurred over time, can all benefit from STR. This 2-day practical hands-on workshop is extremely beneficial for health care professionals. The entire body is covered in this one workshop. Accredited with most provincial organizations including: (CMTBC) – Cycle 9, 14 PE/A2, (MTAM) – 16 Credit, (MTAS) - 16 Credits, (MTAA) 14 credits
SPRING/SUMMER 2014 COMING TO: Vancouver, BC - August 23-24 Langley, BC - June 7-8 Victoria, BC - June 28-29 Winnipeg, MB Edmonton, AB Saskatoon, SK
Visit SoftTissueRelease.ca for specific dates and the entire
2014
workshop schedule.
For registration and more info visit www.softtissuerelease.ca or contact Jim Bilotta, P: 289-686-8926 or E: info@softtissuerelease.ca RMT MATTERS WINTER 2014 | 9
3/-!4)# %80,/2!4)/.3 )3 ! 5.)15% (5-!. '2/33 !.!4/-9 &!#),)49 02/6)$).' !##%33 &/2 !,, -!33!'% 4(%2!0)343 4/ 345$9 (5-!. &5.#4)/. !.$ 3425#452% Some of the offerings in the Lab: Pro-section: The viewing and study of anatomy utilizing a pre-dissected forms. s 5PPER %XTREMITY (7 credits CMTBC) s 0OSTERIOR 4HORAX (7 credits CMTBC) s !NTERIOR 4HORAX AND 6ISCERA (14 credits CMTBC) s (EAD .ECK "RAIN (7 credits CMTBC) #OMPLETE $ISSECTION Participant driven & performed dissection of a human form over six days of Lab time. (42 credits CMTBC)
“It felt like every treatment I gave this week was influenced by what we had done in the Lab! I’ve never experienced continuing education that contributed so much to my work as this has!� – Heidi O. “It was stunning to finally SEE what I have been touching and working on for the last 6 years. My approach to treatment has totally shifted.� – Janice M.
!,, #/523%3 !2% &5,,9 !002/6%$ "9 4(% #-4"#
somaticexplorations.com š 604.519.0555 10  |  RMT MATTERS  WINTER 2014
CONFERENCE | THE PAIN EVENT
Dutch-trained, Marylandbased physical therapist Jan Dommerholt will speak to the current scientific understanding of myofascial trigger points and the implications for clinical massage therapy practice at PMC 2014
controls. Recent research indicates TrPs are persistent sources of peripheral nociceptive input that can lead to peripheral and central sensitization. Referred pain, a common feature of myofascial pain, is a characteristic of central sensitization. In 2008, researchers at the U.S. National Institutes of Health confirmed that TrP contractures can obstruct the circulation in their immediate vicinity, leading to hypoxia (a lack of oxygen), an immediate reduction of the pH and a release of multiple chemicals normally not found in high concentrations in muscle tissue. Other research has found significantly increased concentrations of certain substances in the immediate vicinity of pain-producing TrPs that can become a source of nociceptive input and contribute to the experience of muscle pain. Besides pain, TrPs also lead to muscle weakness, inhibition, increased motor irritability, muscle imbalance and altered motor recruitment in either the affected muscle or in functionally related muscles; latent TrPs are associated with impaired motor activation patterns. In the past decade an increasing number of researchers have shown an interest in the etiology and clinical relevance of latent TrPs. In clinical practice the minimum acceptable criteria for TrP diagnosis are the presence of a hyperirritable spot within a palpable taut band of a skeletal muscle com-
bined with the patient’s recognition of the referred pain elicited by the TrP. When applied by an experienced assessor, these criteria have obtained good inter-examiner reliability (kappa) ranging from 0.84 to 0.88. More recent studies show that taut bands exhibit higher stiffness, reduced vibration amplitude, higher peak systolic velocities and negative diastolic velocities compared with normal muscle sites. Treatment of patients with TrPs can reverse peripheral and central sensitization, normalize motor activation patterns and restore strength and flexibility. Massage therapy and other bodywork practice are important aspects of a comprehensive management approach. The ABCs of DNM BY DIANE JACOBS
Dermoneuromodulation (DNM) is an explanatory model for manual treatment and a pain-free technique that places little physical demand on the client or therapist. Used as a standalone or blended into other techniques, DNM is based on neuroscience and basic neuroanatomy, where pain and tight muscles are seen as protective responses produced by the nervous system in response to threat.
Continued on page 12
KINESIO TAPING seminars Victoria - BC - February 22-23, 2014 Vancouver - BC - April 26-27, 2014
Kinesiotape.ca Visit us at www.Kinesiotape.ca
RMT MATTERS WINTER 2014 | 11
CONFERENCE | THE PAIN EVENT
Continued from page 11
“Dermo” refers to skin, “neuro” to nervous system and “modulation” to change – the simple kind of change we hear if we turn a volume control up or down. We are attempting to help the nervous system modulate its pain output by contacting it directly via skin and the peripheral sensing nerves that plug into skin from beneath, without creating more discomfort for the client. The goal: relief of pain felt by the patient as if located in a physical place. Tight muscles are seen as nervous system defense – mere noise – not culprits, defects or causes. They are not addressed directly at all and will soften automatically with successful treatment. Pain is an output by the brain in response to a perfect storm of context and life lived. Nociception is a sensory input from – and along – peripheral nerves to the spinal cord. DNM addresses both, simultaneously. Consider this: nerves span the entire distance between spinal cord and skin, suspended by and passing through many tissue layers, around bones, across joints, through small contiguous gaps or tunnels. These layers and levers move and shift, ensuring constant movement of and adequate drainage out of the nerves. The spinal cord is a reflexive first responder; its instinct is usually to
contract some muscle group somewhere to change the forces operating on some neural structure signalling distress. This may work for a while but, eventually, chronic tension may not resolve. Some other portion of the 72 kilometres of nerve may become compromised and pain may arise. Myofascial pain may more correctly be attributed to tunnel syndromes. DNM includes placing limbs in positions that can alleviate mechanical deformation of, and subsequent ongoing nociceptive input from, nerve. Following treatment, movement therapy can maintain improvement. One needs to probe a little into how clients lead their physical lives, especially their default resting positions; a good bit of lifetime spent in a favourite chair with left leg crossed, leaning on the right elbow and turning the neck slightly to watch TV may require some awareness and behavioural modification. The nervous system uses a fifth of all available metabolic energy all of the time, waking or sleeping, to conduct its affairs. That energy is only available through blood flow into peripheral nerves and drainage out of them; that flow can only be maintained by regular and adequate movement. Motion is lotion. DNM includes education that can be conveyed to clients in a simple fashion. Once patients understand the importance of their own nervous system, they can be recruited to help it function optimally. Pain is a great teacher.
Saskatchewan-based physiotherapist and manual therapist Diane Jacobs will discuss the difference between operator models of manual therapy and interactor models, the phenomenon of pain perception and pain science at PMC 2014
Curties-Overzet is pleased to announce the launch of COPI Notebooks, an exciting new line of short books focusing on topics of interest to manual practitioners. Skin: A Manual Practitioner’s Overview of Functions and Common Disorders Print Book: $19.95 eBook: $11.95 Buy the Combo: $29.95 54 pages with colour illustrations
This new type of short book provides functional information in a quick-reference coil-bound format.
Place your order now! Curties-Overzet Publications Toll-Free: 1-888-649-5411 Fax: 1-416-923-8116 info@curties-overzet.com curties-overzet.com
12 | RMT MATTERS WINTER 2014
CONFERENCE | THE PAIN EVENT
Educating people in pain BY NEIL PEARSON
Patient education falls into at least two categories: teaching about tissue pathophysiology and teaching about pain neurophysiology. Pathophysiology continues to be taught in pre- and post-licensure courses, though there’s substantial evidence that such education does not improve outcomes. Rather than remember the details of what’s taught in pathophysiology education, people are left with a narrative that promotes fear and disability. Pathophysiology education ignores outcome evidence and promotes dualistic, linear and unidirectional views of human experiences such as pain. Yet it’s hard to imagine not educating people at all about the state of their tissues. Pain neuroscience education is rarely taught in universities. Despite a trend among Canadian faculty, toward acknowledging relevant research, our training continues to focus on tissue, mechanics and pathology. When the people we treat learn about pain and chronic pain from a nervous-system perspective, outcome studies show decreased fear and decreased perceived ability. Some research even shows improvements in measurable function
and decreased signs of sensitization after this education. We know that people can learn this information, retaining it for months after an education session. It must, according to social scientists, have significant value. As clinicians we have few interventions to offer people in pain that are supported by Level 1 evidence. Educating patients about pain neurophysiology, about persistent pain and neuroplasticity, and how to move in the face of pain has been studied for over 10 years. In a recent systematic review, the authors concluded that there was compelling evidence for the use of neuroscience education in a number of pain conditions. They also discussed gaps in research, including the issues such as dose, timing, and generalizability of this education across pain conditions. One of the striking things about this education is that the manner in which it is provided seems vitally important to successful changes in pain, and function. Patient stories have been shown to be particularly effective, to engage interest, and to offer a chance to think about what we think about pain. They also provide an opportunity to vicariously experience that there may be a good reason to consider changing our beliefs about pain and recovery. When the knowledge we provide our patients creates experiences that are inconsistent with beliefs about pain and recovery, this opens the door for improved outcomes. As such, we as professionals should not only learn more about it, but also consider that the success of pain neurophysiology education may be a guide-post, from which we should align the intention of all our patient interactions. RMT
PMC 2014 will feature Penticton physiotherapist and pain educator Neil Pearson, who will discuss changing the paradigm through which patients with persistent pain are educated
The 2014 Pain Management Conference, presented by Pain BC and the MTABC, takes place on March 28 and 29 at the Delta Vancouver Airport Hotel in Richmond, B.C. Postconference workshops, which are only available to registered conference delegates, will take place on March 30. For complete event details, including speaker bios, FAQs, registration and reservations, please visit www.pain2014.ca.
Your Source for Oils, Tables, Accessories...& More Visit our store, phone or shop online
611 9th St. East , Saskatoon 306-382-4673 1-800-478-4998
www.saskmassage.ca Also Supplies for: Acupuncture, Aromatherapy, Breast Health, Lymphatic Drainage, Craniosacral, Spa, Physiotherapy, and Complementary Therapies. Plus Custom Linens.
Personal Service
R.M.T.-Owned
Quick Delivery RMT MATTERS WINTER 2014 | 13
RMT Q&A
BIODYNAMIC MYOFASCIAL MOBILIZATION Natale Rao discusses a unique approach to myofascial release that other RMTs can use to help their patients heal
RMT Natale Rao is a BMM expert
B
BY NOA GLOUBERMAN
ased in Enderby, B.C., RMT Natale Rao is known for his easy manner, intuitive nature and exceptional knowledge of anatomy. Combined, these talents make him a much-soughtafter therapist and teacher. We recently had the pleasure of speaking with Rao about some of the highlights of his 35-year career as well as his expertise in a unique approach to myofascial release called biodynamic myofascial mobilization (BMM). RMT: What have some of the highlights of your 35-year career as an RMT been? NR: I graduated from the Canadian College of Massage and Hydrotherapy in Toronto in 1979. Completing my
14 | RMT MATTERS WINTER 2014
massage therapy training was probably one of the best things I could have done. I had no idea what hands were capable of doing, or how my life would change as a result. After passing the B.C. boards I settled in the Interior. For the next 10 years my major therapeutic influences came from what I’d been able to digest at college, my yoga practice and a chiropractor who kindly taught me connective tissue massage techniques. Attending courses and workshops was also a source of inspiration. In the early ’80s I volunteered as a regional rep with the Massage Therapists’ Association, which kept me in touch with the profession. In 1989 I moved to Vancouver, where clinic space and work was plentiful. As a clinical supervisor at the West Coast College of Massage Therapy (WCCMT), I was able to use the knowledge and experience I’d gained as a therapist in the Interior. During my entire instructional career, I’ve always maintained a
Q&A | NATALE RAO clinical practice – I never let it go. My practice helps my teachings and my teachings help my practice. I’m grateful for all the students who’ve been under my hands, for all manner of clients, people and events that led me to where I am now.
I had no idea what hands were capable of doing, or how my life would change as a result
RMT: How did you become an expert in biodynamic myofascial mobilization (BMM)? NR: My introduction to myofascial therapy was a threeday workshop by Claudia Scrivener in 1996, followed by a course with John Barnes in Arizona. I fell in love with myofascial release therapy and decided to continue learning about the “fascial body” and fascial anatomy in its three dimensions with Claudia, who taught us to “work with the body” to help free it from restrictions from the outside to the inside. While learning this new approach, I applied the principles and techniques literally “the next day” on my clients, knowing we’d both benefit. I practised on myself, too, in order to learn to distinguish depth and pressures on my own body as well as locate and define the structures I was looking for. I’d never give up trying my best, knowing the client leaving my clinic was changed by the treatment. RMT: What is BMM? How is it connected to registered massage therapy? NR: BMM is a unique approach to myofascial therapy, and the name I have given it to distinguish it from other myofascial release instruction and courses available to RMTs. I believe its uniqueness deserves recognition within the realms of massage therapy and myofascial therapies. The particular style of myofascial therapy I instruct originated from Claudia. I don’t claim ownership of this style; this form was taught at WCCMT and, when Claudia left, I “took up the torch,” so to speak. BMM is applied to the “soft structures” of the human body that have a fascial or connective tissue component, i.e., muscle, tendon, ligament and the structures inside joints. Anatomically, all these tissues are interconnected, contiguous, and, I believe, should be addressed in order to have positive change. The fascia is responsible for a number of things; most simply, it helps provide the “slide ‘n’ glide-ability” of virtually all of our tissues/structures. BMM can easily be included within a therapeutic massage session – it’s a modality known to enhance change more rapidly than ordinary massage techniques. The “trick” is not to use lubrication. I’d also stress the importance of accuracy, i.e., correct placement of hands, as well as the importance of engaging the tissue at the correct depth/level and not forcing the tissue to release. RMT: How does BMM work? NR: Prior to any form of therapy, a proper assessment to locate and define restriction is in order. I prefer to instruct RMTs to observe first (keenly, with their “soft” eyes) the “big picture,” and then manually assess/palpate (with as much kinesthetic awareness as possible) to locate and define restricted tissue. Restrictions may
present in a number of different ways, and movement can also be used to help identify where there’s an obstruction or pain with movement. BMM considers the way in which the tissues of our anatomy are “layered” and the importance of the 3-D environment of, for example, a muscle unit. Each layer depends on the layer above, below or beside it to slide and glide smoothly. The innermost environment of a muscle unit is of equal importance: the fibrils must also slide and glide smoothly. Helping the entire environment of the three-dimensionality of a muscle unit in this way has a direct effect on the nervous system via mechanoreceptors situated within all of the fascial sheaths and tendon. BMM also works at the level of the extracellular matrix (ECM) – the “liquidly” environment for the cells, fibres and water necessary for the nutrition/health, function and stability of our fasciae. Releasing a restricted structure in 3-D has a profound effect: the nervous system acknowledges the change; pain can noticeably disappear; blood vessels within the area will be freer to slide and glide; and the ECM will have the chance to “be refreshed” and return to a more healthful and stable environment. In following this approach, the hydration factor of the fasciae and its ability to respond can be detected by the practitioner. The practitioner should note change almost immediately, as should the client. RMT: What are some of the main benefits of BMM? NR: To discuss the virtues of BMM, it must be said that it is a “fascial modality.” And, for the sake of simplicity, I’ll refer to BMM strictly as a modality to release fascial restrictions as they might present within the muscle unit
RMT MATTERS WINTER 2014 | 15
Q&A | NATALE RAO and/or the fascia of the structures surrounding a restricted muscle. Now, in order to understand the principles that underlie fascial therapies and its behaviour, we need to ask: What is fascia? What is its anatomy and physiology, i.e., its make up? Its functions? What mechanical properties does it have and what does it respond to? Also, what does it require? Why does fascia restrict and releases in its own special manner? The theory researchers say “appears to be the better explanation of response to treatment” is the sensory receptor/autonomic nervous system theory, which informs us that fascia is replete with mechanoreceptors and other receptors that connect to the autonomic nervous system. These receptors are scattered along the fascia of a muscle fibre along the fascia of a muscle bundle along the fascia of an entire muscle and, most importantly in my humble opinion, within the fascia of the periosteum – most fasciae find their way to attach onto periosteum. These receptors constantly relay information of the “activity” or non-activity occurring with the muscle unit first to the tendinous junction and then to our nervous system (brain). Once learned, BMM may be used to release the fascial wrapping/envelope of a muscular tissue, be it muscle fibers, muscle bundles or the entire muscle. As well, restriction at the level of the periosteum can be identified. The bone
itself may also be restricted and not mobile. Freedom of “a muscle” from its surroundings gives that muscle unit, and area, that “slide ‘n’ glide” I previously mentioned; an increase in vascularity and nerve supply; and better capacity to stretch or strengthen. Once these things have occurred, pain is decreased, movement is increased, etcetera. Basically, BMM has a very direct effect on facilitating the “slide n’ glide” ability that all structures should have in relationship to each other. The techniques I employ are ones that engage the tissue/structure at its barrier of restriction, in three dimensions – usually an adhesion or fixation. RMT: What type of client or patient could benefit most from BMM? NR: Conditions categorized as “systemic” usually tell us the body is somehow lacking the ability to reproduce the cells or fibres needed to maintain the integrity or stability of fascia and other connective tissues. As such, clients that stand to benefit from BMM exhibit common musculoskeletal disorders and seek relief from decreased joint range of motion issues, common muscular aches and pain, low-back pain/dysfunction ... I could go on, but I should say the approach has helped me significantly to identify tissues that have issues. I also have clients in their late 50s/early 60s
with osteoporotic-type conditions, who received little benefit and not much success with previous manual and physical therapies. Over a short period of time, the therapeutic sessions I provided let them exercise more, with less repercussion. The most significant stories, though, are the ones to help correct leg length and pelvic issues. A number of people with low-back pain, hip-joint issues, knee issues and, sometimes, chronic neck issues present in this manner. I recall two patients in particular, “diagnosed” with one short leg or one longer leg, depending on how it’s translated. Each allowed me to work with them and, within a few sessions, their body, from the feet and up, began to display signs of solidity and stability. The benefits, after at least three or four treatments, are increased stability in a specific area or in general, enhanced quality of movement, a lot less pain/discomfort, an increased capacity to exercise (therefore, healthier) and a better quality of life – I can’t count all those people that I meet and remind me of how much my work has helped them in their life. RMT Learn more about Rao and view dates for his upcoming courses, including future Mexican retreats and two-day offerings at the West Coast College of Massage Therapy in New Westminster and the Okanagan Valley College of Massage Therapy in Vernon at www.natalerao.com.
READER LETTERS In professional publications, from our former journal to Maclean’s, readers have a forum to express their opinions in the magazine and not separately online. This allows the reader to reach all RMTs, not just those that go online. This is not about writing an article on a topic. It may only be several lines to express personal opinions on any subject they want concerning our profession. Being an “informative educational publication” that doesn’t receive letters to the editor is an oxymoron. The excellent journal that we had for many years – before being divided by the politics of
16 | RMT MATTERS WINTER 2014
the MTA and CMT – was a wonderful example of disseminating educational information to the membership while also having a letters to the editor section so all RMTs’ voices could be heard. While it is admirable that you “do more for RMTs then than just a magazine,” to omit such a valuable forum renders the magazine incomplete. So, democracy allows all people to have an opinion that is not controlled or redirected by the editor. I am all for a “letter to the editor column.” Perhaps call it the “Inbox,” like in Canadian Living magazine. I will look forward to seeing
this letter in your next issue. – Scott Larke, RMT
We welcome all readers to submit their letters by email to dave@massagetherapy.bc.ca or by post to Suite 180-1200 West 73rd Avenue, Vancouver, B.C. V6P 6G5. Please be sure to supply your name, address and daytime telephone number along with your comments. Please note that letters may be edited for space, style and clarity.
Upledger
CranioSacral Therapy ;OL TVZ[ [Y\Z[LK PUUV]H[P]L YLSPHISL ZV\YJL MVY *:; [YHPUPUN ‹ 7HY[PJPWH[L PU [OL TVZ[ KP]LYZL *:; J\YYPJ\S\T [OH[ MLH[\YLZ V]LY \UPX\L JV\YZL [P[SLZ ‹ ([[LUK H ^VYRZOVW PU VUL VM JP[PLZ PU V]LY JV\U[YPLZ ‹ 3LHYU MYVT H IHSHUJLK TP_ VM SLJ[\YLZ KLTVUZ[YH[PVUZ HUK Z\WLY]PZLK OHUKZ VU WYHJ[PJL" [HRL OVTL H JVTWYLOLUZP]L PSS\Z[YH[LK Z[\K` N\PKL ‹ )LJVTL JLY[PÄLK I` HU VYNHUPaH[PVU ^OVZL WYVNYHTZ HYL RUV^U ]HS\LK HUK YLZWLJ[LK ^VYSK^PKL John Matthew Upledger, CEO and John E. Upledger, DO, OMM, developer of CranioSacral Therapy
‹ 3L[ V\Y ZRPSSLK ,K\JH[PVUHS :LY]PJLZ *V\UZLSVYZ OLSW `V\ JOHY[ `V\Y M\[\YL ‹ ,HYU JVU[HJ[ OV\YZ [V ZH[PZM` JVU[PU\PUN LK\JH[PVU JYLKP[Z ‹ 1VPU H NSVIHS HS\TUP UL[^VYR VM WYHJ[P[PVULYZ YLZPKPUN PU JV\U[YPLZ
Upcoming Classes: (KKP[PVUHS KH[LZ HUK SVJH[PVUZ PU 5VY[O (TLYPJH H[ <WSLKNLY JVT *YHUPV:HJYHS ;OLYHW` *:
Calgary, AB Vancouver, BC Edmonton, AB Winnipeg, MB
Mar 20-23, 2014 May 22-25, 2014 Sep 18-21, 2014 Oct 23-26, 2014
*YHUPV:HJYHS ;OLYHW` *: Toronto, ON Vancouver, BC
START TRAINING
100
$
May 22-25, 2014 Nov 29-'HF 2, 2014
:VTH[V,TV[PVUHS 9LSLHZL :,90 Winnipeg, MB
Oct 23-26, 2014
:VTH[V,TV[PVUHS 9LSLHZL :,9 Calgary, AB
Oct 16-19, 2014
(K]HUJLK *YHUPV:HJYHS ;OLYHW` (+= Edmonton, AB
Oct 7-11, 2014
Ask about our Core-Pak ;YHPUPUN HUK *LY[PÃ&#x201E;JH[PVU 7HJRHNL
PER :H]L 4VYL ;OHU à ® *V\YZL^VYR :H[PZMHJ[PVU .\HYHU[LLK MONTH
*HSS VY *SPJR! <WSLKNLY JVT
To register, use Priority Code RMT 2-14
RMT MATTERSâ&#x20AC;&#x192; 2014â&#x20AC;&#x201A; |â&#x20AC;&#x201A; 17 The Upledger InstituteWINTER International is endorsed by the International Alliance of Healthcare Educators
LEGAL MATTERS
PRIVACY AND SECURITY CONCERNS FOR RMTS
T
BY SCOTT NICOLL
he privacy and security of personal information are fundamental to the confidentiality and trust of the practitioner-patient relationship. If your patients feel their privacy won’t be maintained, it may cause them to hold back critical information – or not seek treatment at all. A 1999 Canadian Medical Association survey found 11 per cent of the public held back information from a health care provider due to concerns about who it would be shared with or what purposes it would be used for. Patients are particularly concerned about the wrongful release of their information to third parties. Needless to say, release of personal information to the wrong people can result in harm to a patient’s reputation, livelihood, relationships and personal privacy generally. Canadians have a constitutionally recognized right to be free of the psychological stress that can result from the unauthorized disclosure of their personal information. The law is clear: the security of your patients’ information must be taken seriously. Balancing act
When dealing with personal health information, RMTs must balance two competing interests: •the need to appropriately access and share patient information in order to ensure an effective and safe continuity of care; and •the need for effective protection of privacy of patients’ personal health information. Balancing these two can be done, whether through administrative and security safeguards (e.g., employee training, policies, confidentiality agreements) or technical solutions (e.g., roles-based access control, auditing, authentication mechanisms, encryption). But doing so properly can be a complex and challenging process for busy RMTs trying to run a successful practice. The legislation, new information technologies/models for information sharing, collaborative teams, partnerships and mergers of practices can all make it more challenging to keep the balancing act. Still, your responsibility
to appropriately protect personal information remains paramount. Hackers are often viewed as a major security threat to electronic record-keeping systems, but experience shows (and the fact is), your patients are most at risk of having their privacy breached by staff within your clinic with legitimate and authorized access to patient records. Regular and thorough staff training will most successfully protect against privacy breaches. Privacy laws that matter to RMTs
RMTs are governed by the professional requirements dictated by the College of Massage Therapy. For private practitioners (including their staff), obligations concerning the privacy of information are also set by the Personal Information Protection Act (PIPA). For practitioners operating in public health care organizations (hospitals, health authorities), the applicable privacy protection measures are contained in the Freedom of Information and Protection of Privacy Act (FIPPA, or FOIPPA). PIPA governs how the personal information of patients, employees and volunteers in the private sector may be collected and managed, but does not apply to personal information collected and stored by public health care organizations. Those are instead governed by FIPPA. PIPA also does not apply to information to which FIPPA or the Personal Information Protection and Electronic Documents Act (PIPEDA) applies. For the purposes of PIPA, “personal information” means both information that can identify an individual (name, home address, home phone number, ID numbers) and information about an identifiable individual (physical description, educational qualifications, blood type). Personal information, then, includes employee personal information. But it does not, for instance, include business contact information, work product information or anonymous/aggregate information. The core principle of PIPA is that personal information should not be collected, used or disclosed without the prior knowledge and consent of the patient. But that consent may be implicit. In fact, implicit consent to disclosure of information is a significant part of PIPA – more on that in a moment.
Scott Nicoll, partner, Hamilton Duncan Armstrong Stewart
The law is clear: the security of your patients’ personal information must be taken seriously
18 | RMT MATTERS WINTER 2014
LEGAL | PRIVACY & SECURITY First, while there is a core principle for PIPA, every good core principle has exceptions (even if they’re somewhat limited). In PIPA’s case, the exceptions are: •where the collection, use and/or disclosure is clearly in the patient’s interests and consent can’t be obtained in a timely way; and •where the collection, use and/or disclosure is necessary for the medical treatment of the patient and the patient is either unable to give consent or does not have the legal capacity to give consent. PIPA provides for the consent for collection, use and disclosure of personal information for direct health care purposes primarily through an “implied consent” model – in other words, those individuals who form part of a patient’s “circle of care” can access, use, disclose and retain patient information for the purposes of ongoing care and treatment without obtaining the patient’s express consent each time. However, implied consent must be informed consent. To ensure your patient’s consent is informed, you must provide “adequate” information to patients on how you manage the privacy of patient information – namely, by distributing your written privacy policy (contact the MTABC if you still don’t have one) to each
new patient upon his/her first visit, in writing. Implied consent is signified by that wellknown “reasonable person” accepting the collection, use and disclosure of his/her information for an obvious purpose. It must also be clearly understood by the patient that he/ she can indicate if he/she does not accept the terms of your policy (the “opt-out” model). So, for implied consent to be meaningful, the individual has to know that he/she has the right to expressly withhold or withdraw consent at any time without fear of retribution. Expressed consent (the ‘opt-in’ model)
Expressed consent from a patient is required when identifiable personal information is to be collected, used or disclosed outside of the “circle of care” (or for secondary purposes such as research). Express consent is signified by the patient willingly agreeing to the collection, use and disclosure of personal information for a defined purpose. And it can be given verbally or in writing. I recommend that expressed consent be obtained in writing whenever possible and that a copy of that consent be retained in the patient’s file. If you simply cannot obtain it in writing, make a note in your file of the fact that you obtained expressed consent
verbally, including the date and time. Under PIPA , you (the practitioner) have custody of the personal information you’ve collected and physical ownership of corresponding documents/electronic data. You’re also accountable for any privacy breach that occurs to patient information in your custody and control, including a breach committed by an employee under your authority. The individual patient, however, has the right to control the collection, use and disclosure of that data, with limited exceptions as set out in the act. This can be a daunting area, particularly for those new to the practice or the administration of the practice. But, with proper training, it is possible to create and maintain systems for the collection and management of your patients’ personal health information that comply with all your professional and legal obligations. Training is the key. If you need assistance, contact the MTABC. If they can’t answer your questions, you will be directed to someone who can. RMT Scott Nicoll is a partner at Hamilton Duncan Armstrong Stewart Law Corp. and acts as legal counsel for the MTABC. Reach him by phone at 604-5814677 or email at sln@hdas.com.
Proven and fast results... L.A.S.T. will help you treat patients more specifcally, effectively and effciently with longer lasting results.
NEW ONE DAY COURSES! Postural Correction Techniques Techniques for the Thorax Techniques for the Shoulder Contact rob@lastsite.ca if you would like a course instructed in your area.
I’m stunned at the amazing results I’ve been getting with L.A.S.T.! - DM, RMT Ligament Pain Referral Pattern Posters! Order Online! www.lastsite.ca
2014 COURSE DATES Date Feb. 16 Mar. 2 May 30 Jun. 22 TBA TBA
Location Vancouver - Postural Vancouver - Thorax Prince George - Lower Body Vancouver - Shoulder Calgary/Edmonton Saskatoon/Regina
Register Online!
www.lastsite.ca (space is limited)
I can’t convey enough to you how nice it is to feel like my practice has elevated. - PM, RMT
L.A.S.T. Ligamentous Articular Strain Technique
RMT MATTERS WINTER 2014 | 19
MTABC NEWS Pain Management Conference 2014 March 28-29 @ Delta Vancouver Airport Hotel, Richmond, B.C.
One in five Canadians suffers from chronic pain. In fact, estimates place direct national health care costs at $6 billion-plus per year and productivity costs related to job loss and sick days at $37 billion per year. Astoundingly, veterinarians receive up to five times more training in pain than medical doctors and three times more training than nurses. The 2014 Pain Management Conference (PMC), presented by Pain BC and the MTABC, features two days of exciting speakers, keynote sessions, interactive workshops, networking oppor tunities and more. Open to health-care professionals who wish to increase their skill in the management of chronic pain effectively and safely
through manipulative and movement therapies, this year’s conference is not to be missed. Watch as international pain experts present work on the latest available pain treatments; attend post-conference workshops to pursue aspects of pain that appeal to your interests; and discover the knowledge, attitudes and skills necessary to respond effectively, safely and with empathy to those living with chronic pain. Keynote speakers include: •Jan Dommerholt, PT, DPT, MPS, DAAPM, on the current scientific understanding of myofascial trigger points and the implications for clinical massage therapy practice; •Diane Jacobs, PT, on the difference between operator models of manual therapy and interactor models, the phenomenon of pain perception and pain
science; and •Neil Pearson, MSc, BScPT, BA-BPHE, CYT, RYT500, on changing the paradigm through which patients with persistent pain are educated. The conference registration fee is $495; post-conference work-
Take Your Career to the Next Level by becoming a Certified Manual Osteopath
Cutline |
Become the leader of the health care team by increasing your knowledge and expertise treating acute and chronic conditions so you can help your clients more effectively. Join the ranks of more than 1100 Manual Osteopathic Practitioners currently practicing in Canada.
Visit www.nmoc.ca for more information 20 | RMT MATTERS WINTER 2014
shops, only available to registered PMC delegates, will be held March 30, 2014, at a $250 fee. Register at www.pain2014.ca. Conference details, including speaker bios, FAQs and hotel-reservation instructions are also available on the website.
MTABC NEWS New video resources
Revised fee schedule
We recently f licked the “on” switch, bringing MTABC members access to two new online video collections: •Sports Medicine & Exercise Science in Video; and •Rehabilitation Therapy in Video. Access to both video collections is available online through the MTABC Library: simply log in
The recommended professional fee schedule has been revised, effective January 1, 2014. Clinical time included the following five steps: > administration; > assessment; > evaluation; > treatment; and > patient education. Clinical visit times are as follows: •30-minute clinical visit: $55; •45-minute clinical visit: $80; and •60-minute clinical visit: $100. Group rates (based on 60 minutes) are as follows: •exercise group programs come from the regular rate plus costs, plus $40 for every additional participant; and •hydrotherapy group programs come from the regular rate plus costs, plus $60 for every additional participant. Finally, the breakdown for administrative fees is as follows: •interest should be compounded
at www.massagetherapy.bc.ca with your MTABC username and password, then scroll to find the videos under “Databases by Title.” These video collections were tested on some browsers, an iPad and an Android phone, but please let us know if you have any questions, concerns or comments: you liked it, we got it, but do stay in touch!
at 12 per cent per year or 1 per cent compounded monthly; •24-hour notice is required for missed appointments or full charge will apply; •home and institutional visit mileage is charged at the Canada Revenue Agency rate, which is currently at $0.54 per kilometer; and •travel time is charged per the RMT fee schedule noted above Note: taxes are not included in the above pricing. Visit www.massagetherapy.bc.ca for a printable poster of this fee schedule for your clinic.
M AT T E R S M A SSAG E TH E R A PIST S’ A SSOC IATIO N O F B RITISH CO LU M BIA
Massage Therapists’ Association of British Columbia
If you have a product, service or course to advertise call Victoria Chapman at:
1-604-741-4189 vchapman@biv.com RMT MATTERS WINTER 2014 | 21
INDUSTRY BRIEFS Changes to ‘cop’ coverage Effective January 1, 2014, members of the RCMP no longer receive 25 units of massage therapy per calendar year. Instead, they will have $4,800 (this does NOT include taxes) to spend in total, per calendar year, for their supplementary health benefits including chiropractic, physiotherapy, mas-
sage therapy and acupuncture. Rather than direct-billing RCMP members, which will lead to significant delays and backlogs for both provider and MTABC member reimbursements, we recommend RCMP-registered providers bill Blue Cross directly. Also, as of January 1, 2014, the benefit code
249435 will no longer exist. The only way to find out a patient’s coverage is to call RCMP health services at 778-290-3326 or for the patient to keep track of all dollars spent. For more important information for health care providers, please visitthe MTABC online at www.massagetherapy.bc.ca.
Stop the spread With stuffed-up-nose and sorethroat season in full swing, RMTs can help prevent the spread of colds and flu in their clinics by taking a few simple precautions. In a TouchU.ca report entitled Evidence-based Strategies for the Prevention of Influenza in Massage Therapy Practice, B.C. RMT Isobel McDonald gives RMTs the following advice: •stay current with knowledge of H1N1 and seasonal influenza, transmission and treatment, and
educate patients via brochures and postures in your clinic; •get the H1N1 vaccination and the seasonal influenza vaccination (it’s safe, McDonald says, to get both at the same time); •stay home from work when you’re sick and don’t treat patients with symptoms of influenza (screen your patients by phone, if possible); and •employ infection-control principles in patient and staff
areas (waiting room, clinic room, restroom, for example). Among her suggestions, McDonald recommends cleaning high-traffic areas and frequently touched office surfaces often and even asking patients to fill out forms with their own pens. The report offers many online sources of information that can help RMTs stop the spread, including WorkSafeBC.com, ImmunizeBC. ca, PICNet.ca and FightFlu.ca.
PHOTO: PUBLIC HEALTH AGENCY OF CANADA
E-mail : robert@massageessentials.ca
22 | RMT MATTERS WINTER 2014 Massage Essentials Winter 2014_2h.indd 1
1/2/14 12:26:51 PM
Learn . . .
John F. Barnes, PT, LMT International lecturer, author, and authority on Myofascial Release.
LEARN from the EXPERTS ! Recent research verifies the principles that have been taught the past 40 years by John F. Barnes, PT.
Pediatric Myofascial Release Hamilton, Ontario. . . . . . . . . . . . . . . . . . . . . . . . . . . . April 5 & 6, 2014 Myofascial Release I Winnipeg, Manitoba. . . . . . . . . . . . . . . . . . . . . . . . April 4- 6, 2014 Calgary, Alberta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . September 26 -28, 2014 Fascial-Pelvis Myofascial Release Ottawa, Ontario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . April 11 -13, 2014 Vancouver, British Columbia . . . . . . . . . November 7-9, 2014 Develop Your â&#x20AC;&#x153;Hands-Onâ&#x20AC;? Expertise . . . To Register Call 1-800-FASCIAL
INDUSTRY BRIEFS
LAYAR CONTEST
Vancouver student wins national award
Enter our Layar contest for a chance to win!
Two top winners and an honourable mention in the 2013 Student Case Report Contest, presented by the U.S.-based Massage Therapy Foundation, hail not only from Canada but from British Columbia. Vancouver’s Jennifer Nielson took gold in the international cont e s t for he r c a se re por t , Therapeutic Massage in Treatment of a Chronic Hyperventilator with Irr i t able B owe l Syndr ome. S he could receive a $2,500 cash prize following a peer-review process with the International Journal of Therapeutic Massage & Bodywork or another peer-reviewed scholarly journal. Morag Wehrle, also from Vancouver, e arned silver for her report, Manual Lymph Drainage and Therapeutic Massage in Treatment of a Professional Violinist, and
R MT Matters uses “augmented reality” to further improve the contents of our magazine and offer our readers a chance to win! This exciting new technology allows users of Apple and Android mobile devices to scan specifically created pages within this book to see additional “pop-up” content, like videos related to a stor y, relevant websites or background material, plus information about the experts we interview. To enter the contest , install Layar on your smartphone (instructions on page 3), read this issue of RMT Matters and find the correct answer to our skill-testing question: What race did Anastasia Skryabina compete in during the 2010 Winter Olympic Games in Whistler? Once you know the answer, simply open the Layar app on your
could gain $2,000 contingent on the same process. In third place was Edmonton’s Linda Ching. An honourable mention went t o M e gh an Re id of O soyoos , B.C., for her report, The Effects of Massage Therapy on Pain Associated with Spinal Cord Injury: A Full Body Approach. The contest is open to students 18 years or older, enrolled in a 500-hour (min.) massage therapy program anywhere in the world. Visit www.massagetherapyfoundation.org.
The lucky winner of our last Layar contest was RMT Catherine DiCecca of Millstone Massage Therapy in Nanaimo
phone, scan this page and follow the instructions that pop up. The ninth (9th) person to email us with the correct answer will win a $100 Visa card from the MTABC. Good luck!
Lumbar Spine and Sacroliac Joints Joint Play, Contractile Myofascial Release, Nerve stretches, Muscle Energy, Orthopedic testing and Neurological Exams will be the focus.
Course Dates and Location Vernon: April 12th, 13th Victoria: May 31st, June 1st New Westminster: Sept 27th, 28th Join Mike Dixon RMT for a comprehensive look into these areas. Learn protocols for Treatment of Sciatica and Sacroiliac Dysfunctions. 14 CECs (Pending CMT approval)
Register online at www.jointplaytherightway.com or call: 604 802 9322 100% money back Guarantee $349.00 (GST not included) early registration add 50.00$ late registration (less than one month before) 24 | RMT MATTERS WINTER 2014
CLASSIFIEDS | WINTER 2014
ADVERTISMENT ONLY. NO ENDORSEMENT BY THE MTABC INTENDED OR IMPLIED.
ANATOMY & YOGASANA I & II CUBA RETREAT, FEBRUARY 15TH TO 22Nd, 2015 CEU APPROVEd
Dr. VODDEr MLD COUrSES All levels in Victoria, BC
M AT T E R S M A SSAG E TH E R A PIST S’ A SSOC IATIO N O F B RITISH CO LU M BIA
April/May 2014 October/November 2014
Massage Therapists’ Association of British Columbia
WWW.VODDErSCHOOL.COM
800-522-9862
If you have a product, service or course to advertise call Victoria Chapman at:
1-604-741-4189 vchapman@biv.com
Massage Therapists’ Association of British Columbia
MTABC CEC Courses 2014 Registration at MTABC 604-873-4467 or mta@massagetherapy.bc.ca. Or mail to MTABC 180-1200 West 73rd Ave., Vancouver, B.C., V6P 6G5. Provide name, phone and email. Cancellation within three (3) weeks of a course results in 20% penalty; within two (2) weeks, 40%; and within five (5) days or “no shows,” no refund. All prices in Canadian dollars. Fascia: Its Structure & Function–the Shoulder, with Mark Finch, RMT (14 PE/A2 Credits) Holiday Inn, 711 West Broadway, Vancouver Feb. 22-23, 2014, Sat. & Sun., 9 a.m.-5 p.m. Fascia: Its Structure & Function–the Pelvis, with Mark Finch, RMT (14 PE/A2 Credits) Holiday Inn, 711 West Broadway, Vancouver June 7-8, 2014, Sat. & Sun., 9 a.m.-5 p.m. Prices: MTA One Month Early $322 Regular $350 Non-MTA One Month Early $450 Regular $495
CUBA! Learn and earn credit while studying remex via the yoga body. Program combines anatomy, assessment, kinesiology, yoga practice and research you will be able to apply directly in your massage therapy client care and yoga practice. Combine 24 direct study hours with vacation time. You will be doing plenty of yoga, also includes Havana day trip, fabulous meals and seven night’s beachside accommodation. Previous yoga experience an asset but not essential. Leigh Milne RMT, E-RYT500 is an experienced RMT, Iyengar certified yoga instructor and educator. For course and instructor details and registration information visit www.thesadhanacentre.com leigh@thesadhanacentre.com Leigh at 902-273-9642
Enter our Layar contest for a chance to win a $100 Visa card from the MTABC See page 24 for details
Fascia: Its Structure & Function–the Spine, with Mark Finch, RMT (14 PE/A2 Credits) Pacific Rim College, Victoria Apr. 12-13, 2014, Sat. & Sun., 9 a.m.-5 p.m. Prices: MTA One Month Early $390, Regular $430 Non-MTA One Month Early $545, Regular $600 Mechanical Reduction of Pressure in Nerves for the Head & Neck with Dr. David DeCamillis, D.C. (14 PE/A2 Credits) New Westminster Feb. 22-23, 2014, Sat. & Sun., 9 a.m.-5 p.m. Mechanical Reduction of Pressure in Nerves - General with Dr. David DeCamillis, D.C. (14 PE/A2 Credits) New Westminster Sept. 27-28, 2014, Sat. & Sun., 9 a.m.-5 p.m. Mechanical Reduction of Pressure in Nerves for Bones/Joints/Cartilage with Dr. David DeCamillis, D.C. (14 PE/A2 Credits) New Westminster Oct. 25-26, 2014, Sat. & Sun., 9 a.m.-5 p.m. All Dr. DeCamillis Prices: MTA: One Month Early $322, Regular $350 Non-MTA: One Month Early $450, Regular $495 Ann Sleeper’s Courses (more courses at www.annsleeper.com): Introduction to Osteopathic Techniques (11 PE/A2 Credits) Holiday Inn, Vancouver Mar. 8-9, 2014, Sat. & Sun., 10 a.m.-5 p.m.
Prices: MTA: One Month Early $275 Regular $300 Non-MTA: One Month Early $385 Regular $425 Muscle Energy Technique for the Low Back: Part 1 Lumbar & Ilia (13 PE/A2 Credits) Holiday Inn, Vancouver Apr. 26-27, 2014, Sat. & Sun., 9 a.m.-5 p.m. Treating Legs and Arms For Back Pain (13 PE/A2 Credits) Holiday Inn, Vancouver May 3-4, 2014, Sat & Sun., 9 a.m.-5 p.m. Prices: MTA: One Month Early $322, Regular $350 Non-MTA: One Month Early $450 Regular $495 Anatomy Trains with Sherri Iwaschuk, RMT, KMI (14 PE/A2 Credits) Holiday Inn, Vancouver May 31-Jun. 1, 2014, Sat. & Sun., 9 a.m.-5 p.m. Prices: MTA: One Month Early $322, Regular $350 Non-MTA: One Month Early $450 Regular $495 Functional Fascial taping with Ron Alexander, RMT (Credits TBA) Holiday Inn, Vancouver May 31-Jun. 1, 2014, Sat. & Sun. 9 a.m.-5 p.m. Prices: MTA: One Month Early $322, Regular $350 Non-MTA: One Month Early $450 Regular $495 More course details at www. massagetherapy.bc.ca.
ONE DAY WONDERS with
Heather Gittens RMT.
Update your skill level and/or review material in a new and integrative format. Visceral Manipulation & CST focused One Day Courses for the busy RMT. Mar. 22, 2014: VM - Digestion Apr. 13, 2014: VM - Female Pelvis, Female Issues Sept. 28, 2014: CST - The Sphenoid Gateway
6.5 Credits Each, $125 + tax. Max group of 12. 13+ years teaching experience Contact 778-574-1174 or info@bodhitreewellness.ca
The complete schedule of Ann Sleeper classes can only be found at www.annsleeper. com. Muscle Energy, Introduction to Osteopathic Technique, and Treating Legs and Arms courses are offered in Vancouver and Victoria. These classes or review sessions can also be organized privately for 2-5 people at her home in central Vancouver. E-mail Ann at sleeplow@telus.net or call or text 604-671-9172.
Banyan Thai Massage CMTBC
CeU approved Courses
A teaching affiliate with the famous “ITM School” of Chiang Mai, Thailand • Traditional Thai Massage Level 1: iTM Chiang Mai Method: 2-days Vancouver: Sat. Feb. 15 – Sun. Feb. 16, 2014 9:00AM – 5:00PM ea. day • Traditional Thai Massage Level 2: iTM Chiang Mai Method: 3-days Vancouver: Fri. March 28 – Sun. March 30, 2014 9:00AM – 5:00PM ea. day • Thai Massage for the Table: 2-days Vancouver–Gambier Island Retreat Sat. July 12 – July 13, 2014 - 9:00AM-5:00PM • Thai Foot Reflexology Massage: 1-day Vancouver – Gambier Island Retreat 1-Thursday, July 11, 2014 - 9:00AM-5:00PM 7 CeU’s (1-day course) Visit us on-line to see our complete 2014 Courses listings. Paypal registration available at www.BanyanThaiMassage.com More information / contact: Sharon Brown-Horton, Instructor at 604.773.2645
Mastering Cranial Through Mentorship With Robert Hackwood, RMT
Amazing New 120 hour comprehensive course Maximum of 8 students. Starting March 2014.
Enroll now! 604-418-8071 dynamictherapies.com RMT MATTERS WINTER 2014 | 25
CLASSIFIED | WINTER 2014
RMT wanted for our Wellness
Centre on beautiful Vancouver Island
ADVERTISMENT ONLY. NO ENDORSEMENT BY THE MTABC INTENDED OR IMPLIED.
We are searching for a mature, self-directed RMT for our cooperative clinic in Duncan. Our team includes four RMT’s and an Acupuncturist. We are well established (12 years) and receive referrals from satisfied clients, physicians, chiropractors and physiotherapists.
Included in our clinic is a movement room for Yoga, Tai Chi and Somatics – so if you have a movement specialty it would be an optimum fit for you. We are most recognized for helping people with pain but we see clients in all stages of life including children, pregnant women and sports enthusiasts.
Continuing EduCation on LinE
Our ideal practitioner will be helpful in doing laundry, answering the phone and booking appointments as part of our co-operative clinic. Tables, linens, organic oil, clinic forms, yellow page listing and clinic website are included in our rental agreement. Rental agreement can start as a percentage and has a ceiling. Clientele are seeking appointments for afternoon, evening and weekends. We look forward to receiving your resume. Please forward to: info@appliedsomatics.com 303, 80 Station St. | Duncan, BC V9M 1L4 | Toll Free 1-866-748-6600
Applied Somatics Winter 2014 2clx2.indd 1
1/2/14 12:06:20 PM
Systemic Deep Tissue Therapy® Workshops (also known as SDTT)
(Systemic Deep Tissue Therapy® should not be confused with high pressure treatments)
O
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 burnout, 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. Winter and Spring 2014: Introductory: February 8-9, Cost $399. CEC points 14 Intermediate: March 1-2, Cost: $399. CEC points 14 Autumn 2014: Introductory: September 6-7, Cost $399. Intermediate: September 27-28, Cost: $399 For more info and to register, phone: 604.984.2611 • web: systemicdeeptissuetherapycenter.com
26 | RMT MATTERS WINTER 2014
2 hours per course for 2 CEU’s Courses are $50 (incl g.S.t). Easy and efficient way to accrue your CEU’s. ~ no traveling, no time away from work ~ www.cepd.ca • email info@cepd.ca for details
Human Kinetics is making it easier for Canadian Massage Therapists to earn CEU’s online!
NEW $64.95 • CMTBC - 6 PD/4A
$95.95 • CMTBC - 6 PD/4A
$74.95 • CMTBC - 6 PD/4A
Visit the NEW Canadian Massage Therapy education store for a list of organizations that offer continuing education credit through successful completion. Current organizations include: CMTO, CMTBC, CMTNL, MTAM, MTAS, MTANS, and NBMA. www.HumanKinetics.com/CMT or call 1-800-465-7301 for more information.
HUMAN KINETICS
The Information Leader in Physical Activity & Health
Applied SomAticS clinicAl SomAtic educAtion Call Applied Somatics | Toll Free 1-866-748-6600 to register Somatic Immersion – Back to Back Weekend Training in Duncan BC Weekend I: Applied Somatics for Stooping Bodies, Level I Duncan, February 21-23, 2014 Weekend II: Applied Somatics For Arching Bodies Duncan, February 28, March 1-2, 2014 Applied Somatics for Tilting Bodies, Level I Vancouver, May 2-4, 2014 Call Applied Somatics | Toll Free 1-866-748-6600 to register Applied Somatics for Stooping Bodies, Level I Vernon, June 6-8, 2014 | Call OVCMT 1-800-701-8863 Applied Somatics for the Extremities and TMJ, Level II Vernon, October 3-5, 2014 Call OVCMT 1-800-701-8863 All courses $485 early registration, $585 less than 1 month. $100 non-refundable deposit. To reserve your spot in one of our workshops please email info@appliedsomatics.com and send a cheque, post-dated for the beginning of the workshop, to Applied Somatics, 303-80 Station St., Duncan, BC V9L 1M4
Pain Management Conference 2014 March 28-29, 2014 | Delta Vancouver Airport Hotel, Richmond, BC Presented by:
MTABC
IMPROVE YOUR PAIN KNOWLEGE, IMPROVE YOUR PRACTICE KEYNOTES
GENERAL DR. MATT GRAHAM DR. DANIEL GOUWS
DIANE JACOBS PT
NEIL PEARSON MSc, BScPT, BA-BPHE, CYT, RYT500
JAN DOMMERHOLT PT, DPT, MPS, DAAPM
LINDA CATHERINE TURNER TODD HARGROVE
PANEL
COSTS, CREDITS & WORKSHOPS
MICHAEL REOCH, MODERATOR
CONFERENCE COSTS: $495.00 CREDITS:10 PD/A2
VIOLET REYNOLDS JENNIFER MACVICAR MICHAEL HAMM SUSAN CHAPELLE MARK FINCH REGISTER NOW
www.pain2014.ca
WORKSHOPS - MARCH 30 * COSTS: $250.00 CREDITS: 7 PE/A2 * ACCESS TO WORKSHOPS IS ONLY FOR THOSE WHO REGISTERED FOR THE CONFERENCE. CREDITS ARE FOR EACH COURSE. SPONSORS
An
efficient solution for your patients
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.
éopathiques
Osteopathy provides the necessary therapeutic reasoning skills and manual treatment CEO Collège d’Étudesresults. approaches to achieve optimal Ostéopathiques
Osteopathy views the body as a whole. Osteopathic manual CEO treatment focuses on detecting areas of restrictions at any Collège d’Études Ostéopathiques des Ostéopathiques tissue level. Osteopathy functions by assisting the body’s ontréal – natural healing ability, allowing restricted areas to regain as much of their former mobility as the body will comfortably allow. The College offers complete training including myofascial, visceral, cranial techniques, specific osteoarticular adjustments and clinical methodology. Courses are geared towards guided palpation and practice in order for practionners to be able to integrate their new knowledge to the treatment of patients. The educational program is designed with busy health-care practitioners in mind. The 6 yearly seminars are held over weekends to minimize time lost from current employment, with a low instructor/student ratio.
itional The reference in Trad Practice Osteopathy Manual teaching since 1981
College of Osteopathic Studies Canadian College of Osteopathy — CCO Collège d’Études Ostéopathiques — CEO
6 Canadian campuses: Montréal | Halifax | Vancouver | Québec | Toronto | Winnipeg
For information / registration 1-800-263-2816 | info@ceo.qc.com | www.ceo.qc.com