K - Knowledge - Do you have a thirst for knowledge?
J- Justify - Do your records justify your actions?
Everyone learns in different ways, however, often we find ourselves neither seeing, hearing or asking questions! We don’t want to be just one of ‘three wise monkeys’ we want to be the ‘whole’ package or the best we can be in our chosen careers.
In order to achieve our goals we must have knowledge to underpin our skills, actions and interventions. Listening, watching, doing & asking questions about recent and relevant knowledge, skills & research is so important to our practice and our desire to ‘meet client needs’ in the most effective way.
The following links are just some of the ways you can improve your knowledge whether through courses, publications, journals or other methods. These might include working with more experienced colleagues, having ONE-TO-ONE sessions or reflecting on an intervention, event or incident within your own practice.
Have you considered the following:
I - Individual - "Always remember you are absolutely unique, just like everyone else"
In order to justify your actions you must ensure that your records adequately explain your ‘thought’ process and ‘how’ you came to the conclusion for the treatment or intervention applied and to which the client consented.
I often encounter therapists/practitioners who have no notes or records of the massage and soft tissue therapy they have just delivered. This seems to be particularly true of those working at events or away from their ‘normal’ base or clinic.
It appears to be a misconception on the part of many masseurs that they do not need to keep records or only take and keep records in certain situations……each & every session requires a ‘record’, regardless of location, situation & type of massage or soft tissue therapy.
Let me dissuade you from this school of thought that records aren’t required. You must keep records even if you are not a ‘regulated’ professional. These must demonstrate the you have gathered all relevant information on which to base your chosen intervention and that the client/patient has consented to your proposed course of action/treatment prior to delivery. It is advisable but not essential to have the consent in writing.
These records must be kept for 8 years and longer if the client was under 16 at the time of your massage/soft tissue therapy or deemed to have a mental capacity of less than 16. In these situations the notes would also show who the parent or legal representative was at the time and that they remained present throughout any consultation and / or treatment.
To ensure you understand how to justify your actions look at the following advice check-list:
H - Hands - Everyones hands tell a story, what do yours say?
Margaret Mead (American Cultural Anthropologist, President of the American Association for the Advancement of Science in 1975) quote that starts this blog and a sentiment that encapsulates for me the role of the healthcare professional. Everyone is an Individual and therefore ‘one size’ or one type of therapy does not ‘fit all’. It is irrelevant the title you use and the therapy you supply if you do not tailor your ‘ability’ to meet a clients/patients needs at a particular “moment in time”. Every individual is different anatomically, physiologically, psychologically & emotionally and the same individual has different needs on each and every occasion they meet with you.
Remember you are also a unique individual and therefore it is not reasonable to assume that you can meet everyones needs all of the time . Knowing when to collaborate or pass a client to a more appropriate practitioner is one of the keys to being an autonomous professional therapist.
To ensure you understand their needs and work within your scope of practice you should consider the following:
Which area of therapy do I want to excel in?
Do I have the skills I require to practice safely and effectively?
How will I ensure I continue to develop my skills for the community/group/sport/location in which I work?
How will I gain experience in those skills?
How will I ensure my health & safety as well as the clients?
G - Golgi tendon organs - Why are receptors so important to us?
Hands are taken for granted by the majority of people, used and abused. We look after our cars, computers and machinery with services, MOT’s and general maintenance on a regular basis so why don’t we look after our hands? The “tools of our trade” are more precious than any machine and therefore the most important part of our kit and yet insufficient time is spent maintaining and looking after them.
Painful damaged joints are responsible for many therapists and practitioners ceasing to practice. Joints that are not looked after whether in your hands, neck, lower back, hips or knees lead to disability. Keeping them in “full working order” for as long as possible is the key to longevity in our massage and soft tissue industry.
We cannot prevent age related wear and tear however we can prevent and minimise adverse mechanical strain to joints through poor posture, poor practice and skill/technique delivery.
So how can we look after our hands in particular? Well firstly we must consider the anatomy and biomechanics of the hand to understand where the force is directed, thereby understanding where over use and repetitive action of our work focuses the stress.
For those who wish to revisit their anatomy look at the following presentation By:Dr.Amit Kr. Choudhay RIMS,Imphal
Now we have a clear indication of the anatomy we can look at some considerations.
F - Fascia or Food for thought?
Golgi Tendon Organs (GTO’s) are among the many receptors responsible for sending information to the central nervous system (CNS) and brain which once integrated into our neural anatomy and a response sent influence ‘how’ our soft tissues are perceived not only by the individual but by the therapist.
How this influences your practice every much depends on your understanding of the relationship of the receptors to the required ‘outcome’ and therefore to the individual and to your ongoing practice.
E - Why do we use Effleurage?
Fascia and how to ‘release’ it is at the top of many therapists list of skills to learn and a structure to understand……yet it is still in its therapeutic infancy and provides much food for thought…..
Are you a devotee of direct , indirect or combined skills? A Stecco, Myers or Schleip methodologist or a follower of another practitioners work?
As a practitioner of massage and soft tissue skills it is seldom one skill, one method or one style but a combination of skills, experience and a ‘what works’ for me unique practitioner/therapist technique that develops.
So how do we know if we are effective? How do we know if the combination of skills and style of application is the best it can be?
D – To Drape or not to Drape that is the question (very Shakespearean)
We could spend all our time dissecting what constitutes “Effleurage” as we all utilise a variety of techniques and skills under this umbrella method. The bigger “E” question is what evidence is there to support its use?
Evidence for practice has become the all consuming agenda within healthcare in the modern era. This is predominately driven by cost and its perceived relationship to effectiveness.
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. They are charged with providing
“Our guidance, advice, quality standards and information services for health, public health and social care. Also contains resources to help maximise use of evidence and guidance.”
If ‘massage’ is searched for in the NICE website you will achieve 35 results, “https://www.nice.org.uk/search?q=massage" within which the most obvious area of use is in the treatment of low back pain where NICE States “the guideline says massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone.”
NICE are the arbitrators of what is and isn’t deemed appropriate based solely on evidence and cost. This is the agenda for all modalities within the national health service (NHS), however, the majority of our clients are in the ‘private sector’.
How do we answer our critics and support our clients/patients who seek our skills for their known efficacy (practice based evidence) within the private sector?
C – There are many Cs in our alphabet
Why Drape? Simply put all therapists have a duty of care to the individual receiving the massage and a part of that is to ensure that every intervention they use is delivered in a ‘safe & effective’ manner. The use of towels or ‘drapes’ is to ensure that your client feels safe and protected.
B – Breathe
C….There are many “C’s” in our alphabet - Care,Communication, Consent, Contraindications
Care, - Care could be summed up in the therapy world as a “Sensitive, Reliable & Responsible” approach towards others - both clients & other professionals.
It goes without saying that this is a fundamental attitude that all therapists should exude…..but I’m going to say it again anyway as it still amazes me how often basic care and consideration when managing clients/patients is either ignored or considered unnecessary!
For example - support and comfort for the face & neck. Ankles that don’t ‘hang off’ the bed should be supported (fill the gap with a towel)
A – Assess, Assess, Assess
We should all take a moment to concentrate on our breathing.
Inspire for a count of 4 and expire to a count of 4………doesn’t that feel better? After reading A - Assess you probably need to take a moment!
It’s amazing how little time we spend just calming our minds and bodies with a few controlled breaths. It is not only you who isn’t breathing optimally but often your clients through anxiety or stress are also holding their breath more often than is healthy for them!
We would all love to be like Mary Poppins pulling something out of the bag when necessary.
Like Mary we carry everything with us and metaphorically speaking we need to pull the right tool or hand-skill out when required. But perhaps more fitting is the Sound of Music song ‘Do-Re-Mi’ – ‘let's start at the very beginning a very good place to start, when we sing we begin with ‘‘Do-Re-Mi’’ and when we read we begin with A,B,C. Whereas when we massage, it seems we start with "E" for Effleurage! Starting here is forgetting all that comes before so I’ll be writing the Massage Alphabet and there is no better place to start than "A" for Assessment. Assess, Assess, Assess! Sorry was I shouting, forgive me, so often I see massage commenced without any sort of basic assessment or understanding of the clients, patients, athletes, friends, or family members needs being taken into account before "E" is administered liberally!