spring 2011 issue

ConTenTs
Features
A Wake-up Call to
Better Sleep
6
p6
United Front 11

p16

departments
p24 Editorial 5
News 10, 15,
20, 21,
Post-surgical Therapy 16 25,
for Mastectomy 13
RMT Tech Talk
and Implants, Part 1
Massage Therapy 15
Understanding Stress, 22 Canada Online
Part 2
Resource Directory 28
Forearm for the Feet 26

Massage Therapy Canada spring 2011 3

 60 th September 22-24
Vancouver, Canada

e rs a r y
n niv
A

Parker Seminars Comes to Vancouver!

The world over, Parker Seminars is committed to bringing you the best speakers, tools, and motivation to help you
grow your practice and business!

From an expo packed with cutting-edge products, to speakers and coaches who can guide your creative vision,
everything you need to rededicate yourself to the healing art of chiropractic is at Parker Seminars Vancouver 2011!

Our Vancouver seminar is designed to:

Impart practice building techniques

Demonstrate how to run a more effective, efficient office Early B

saving ird registrati
s avail o
Share insight from world-renown speakers and experts able th n
J uly 18, rough
Help you maximize your potential and live your best life!
2011!

Register today!
Visit www.parkerseminars.com
or call 888.727.5338

Become a fan of Parker Seminars on Facebook Follow Parker Seminars on Twitter

at www.facebook.com/parkerseminars at www.twitter.com/parkerseminars

ONE VOICE FOR CHIROPRACTIC

 Spring 2011 - Volume 10, iSSue 2

from the editor

Editor
Jill Rogers, RMT jrogers@annexweb.com
(905) 516-8793

Managing Editor

I
Maria DiDanieli mdidanieli@annexweb.com
(289) 259-1408 (888) 599-2228 ext. 247
n September 2010, for massage therapy awareness week, I was invited
Sales Manager by two radio shows in my home city of Hamilton to speak on behalf of
Christine Livingstone clivingstone@annexweb.com
(519) 429-5173 (888) 599-2228 ext. 239 the profession. I spoke about the benefits of massage therapy and took
Sales Assistant calls from listeners.
Sandra Mels smels@annexweb.com The main question asked by the radio broadcast hosts was do people
(519) 429-5183 (888) 599-2228 ext. 219
still think of massage as a luxury?
Production Artist
Kelli Kramer The answer, unfortunately, is yes. There is still a very large population
Group Publisher that sees massage as a nice thing to do a pampering, stress-down treat.
Martin McAnulty mmcanulty@annexweb.com
As true as those benefits are, a great number of people still do not perceive
President massage as a frontline modality or a component of a team approach to
Mike Fredericks mfredericks@annexweb.com
rehabilitation.
Mailing Address
P.O. Box 530, 105 Donly Drive South, Our clients are the converted, or at least on the way to being so. They
Simcoe, ON N3Y 4N5
have an understanding of the benefits of massage they are already in
PUBLICATION MAIL AGREEMENT #40065710
RETURN UNDELIVERABLE CANADIAN your hands. But, how can we make an impact on those who have not yet
ADDRESSES TO CIRCULATION DEPT., experienced the benefits of massage therapy?
P.O. BOX 530, SIMCOE, ON N3Y 4N5
e-mail: cnowe@annexweb.com Our associations do a great job promoting us as a profession, but what
Massage Therapy is published four times a year: can we do as individual therapists to assist with this task? What can we do
January, April, July, November. Published and printed by
Annex Publishing & Printing Inc., 105 Donly Drive South,
as individuals to increase awareness of the benefits of massage through-
Simcoe, ON N3Y 4N5 out the year, as opposed to relying solely on association messaging and/or
Printed in Canada annual campaigns?
ISSN 1499-8084
We need to challenge ourselves to do more. We could commit to doing
Circulation
e-mail: cnowe@annexweb.com a few public awareness talks per year. We could offer each client, on an
Tel: (866) 790-6070 ext. 207 individual basis, information regarding benefits of massage, through the
Fax: (877) 624-1940
Mail: P.O. Box 530, Simcoe, ON N3Y 4N5 use of handouts, pamphlets, websites, or just one-on-one chatting.
Subscription Rates Wed like to hear from you if you have been involved in, or know of, any
Canada 1 Year $29.95
2 Years $49.95
interesting public awareness projects being undertaken by registered mas-
3 Years $64.95 sage therapists. We will then share those ideas with readers.
(includes GST - #867172652RT0001)
For USA and Foreign rates please contact Cheryl Nowe Everyone can jump on board with this effort, so that we will be working
Occasionally, Massage Therapy Canada will mail informa- for our profession, together!
tion on behalf of industry-related groups whose products
and services we believe may be of interest to you. If you Send your comments, feedback and ideas to jrogers@annexweb.com.
prefer not to receive this information, please contact our
circulation department in any of the four ways listed above.

No part of the editorial content of this publication may be

reprinted without the publishers written permission. 2011
Annex Publishing & Printing Inc. All rights reserved. Opinions
expressed in this magazine are not necessarily those of the editor
or the publisher. No liability is assumed for errors or omissions. Jill Rogers, RMT
All advertising is subject to the publishers approval. Such jrogers@annexweb.com
approval does not imply any endorsement of the products or
services advertised. Publisher reserves the right to refuse
advertising that does not meet the standards of the publication.

www.massagetherapycanada.com
Massage
MassageTherapy
TherapyCanada
Canada suMMer
spring 2009
2011 5
Feature
A Wake-up Call to
Better Sleep
How the RMT can assess and promote healthy slumber
A
lthough sleep has been a human preoc-
cupation through the ages, the scientific
study of sleep is surprisingly recent, and
sleep medicine is an even newer area of
study. The book Le Problme Physiologique du
Sommeil, published by French scientist Henri Pieron
in 1913, is viewed as the first examination of sleep
from a physiological perspective. Dr. Nathaniel
Kleitman, the Father of American Sleep Research,
began his work in the 1920s. Basically, the current
understanding of sleep health has been evolving
over fewer than 100 years.
The reason for this lag in curiosity with regard to sleep, as com-
pared to other areas of human health and activity, appears to be
the historical view of sleep as merely an absence of wakefulness.
Until the latter 19th century, prevailing theories postulated that
sleep resulted from stoppage or suppression of brain function
through, for example, some inhibitory mechanism that turned
off the brain or that neurons were paralyzed during sleep and
could not communicate with each other. It is not surprising, given
6 Massage Therapy Canada spring 2011
by debra CurTies, rMT
the belief that the brain is simply not working while a person
sleeps, that interest in what transpires during sleep remained at a
low ebb for so long.
Although modern sleep science is still young and contains many
open-ended questions, the current view of sleep has completely
overturned these earlier ideas. Sleep is now understood to be a
highly regulated neuroactivity during which processes essential
to life and health take place. It is perhaps ironic that scientific
understanding of the importance of sleep is expanding rapidly in
an epoch when cultural trends toward devaluing the need for sleep
are very strong. But in fact, new information is being released all
the time about the short-term and long-term health implications
of insufficient sleep.
It is also very interesting that massage has been emerging as a
powerful sleep-promoting tool. Massage therapys impact on sleep
is a fairly well-researched subject, representing one of the biggest
areas of focus on massage therapy effectiveness in the medical-
scientific literature. However, we as massage practitioners have
traditionally not learned much about the subject.
The purpose of this two-part article is to make valuable infor-
mation about massage therapy and sleep known to massage
therapists. In this first part, sleep, itself, and its role in health will
be discussed. In part 2, the focus will be to describe the compo-
nents of high quality sleep, and the evidence supporting that
massage therapy helps to achieve them.
SLEEP DESIGN AND CYCLES
Sleep is divided into two principal stages: REM (rapid eye move-
ment) and NREM (non-REM). Over the course of a normal
adult sleep, 75-80 per cent of sleep time is spent in NREM and
20-25 per cent in REM.
NREM sleep occurs in levels of increasing depth that, in the
simplest sense, can be divided into light sleep and deep sleep. As
NREM sleep depth intensifies, eye and body movements dimin-
ish to almost none, body temperature decreases (essential for
certain metabolic processes) and blood flow to the brain lessens
substantially. The body descends into a strong parasympathetic
state with slow, stable vital signs.
NREM sleep, particularly deep sleep, is crucial to nutrient uti-
lization, tissue maintenance routines, glucose/glycogen regulation
and production/release of glandular secretions and hormones,
as well as functions such as immune resilience, blood pressure
stabilization and injury healing. There is also brain maintenance
work done: for example, increased protein synthesis in the central
nervous system, cleaning up of redundant or excess synapses
and updating of factual memory. To list just a few of many pos-
sible examples of hormone production and release ramifications
of insufficient deep sleep: the neurotransmitters needed for mood
stability and pain modulation drop in volume; growth hor-
mone is not released in sufficient quantities; metabolic rates are
not properly controlled; and sexual interest and fertility can be
impaired through reductions in sex hormone release.
REM sleep is characterized by intense brain activity during
which cerebral blood flow increases and the occupations and
challenges of the day are processed neurologically. The brain is
operating in an energy state similar to that of being awake. As the
brain works, physiological manifestations occur that include
bursts of rapid eye movements and irregular patterns of blood
pressure, heart rate and respiration. The majority of dreaming
occurs in REM sleep. In order to prevent potentially dangerous
body movements from taking place as an automatic consequence
of such brain activity, this stage of sleep is accompanied by sleep
atonia (pseudo-paralysis), a skeletal muscle inhibition state like
that induced pharmacologically during surgery to prevent uncon-
scious patients from lashing out or recoiling physically.
Figure 1. SLEEP ARChITECTURE
Wakefulness (alpha waves)
Stage 1 NREM (moving to theta waves) a.k.a.
somnolence, drowsiness, shallow sleep
Stage 2 NREM (theta waves) light sleep
Stages 3-4-3 NREM (delta waves) deep sleep
Stage 2 NREM
REM Sleep (alpha waves)
1-2 minute wakefulness episodes
Stage 1 NREM, etc.
Final REM Stage
Person wakes up
REM sleep is vital to brain development and to learning.
Individuals who are learning a new skill during the day spend
more time in REM sleep that night. Infants spend about 50
per cent of their sleep time in REM (premature infants even
more). REM sleep is also essential for limbic system process-
ing and restabilization we are all familiar with the benefits
of sleeping on it, and with the emotional shakiness that
comes from insufficient sleep.
Deep sleep and REM sleep are the two major workload
times in a sleep cycle, and although it is overly simplistic, one
could say that deep sleep is tissue needs time and REM is
brain processing time. Each constitutes 20-25 per cent of a
normal adults nights sleep.
After the age of three, normal NREM and REM sleep seg-
ments occur in cycles as illustrated in Figure 1.
The NREM-REM cycle rotates every 90-110 minutes.
Deep sleep stages are proportionately longer in the first half
of a nights sleep. As the night progresses, deep sleep por-
tions shorten and REM portions lengthen. It is significant
to note that when people get an hour or two less sleep than
they should, it is the long, final REM segment that is sac-
rificed. While it can function as a stress reducer, napping
cannot compensate for a shorter nights sleep because the
nap cannot recoup the REM stage that occurs at the end of
a major sleep. In other words, the person who naps for 1.5
hours and sleeps for 6.5 at night is still going to be REM
sleep deprived.
There are homeostatic factors at work in sleep, however. It
is possible to make up for shortened sleep stages on a sub-
sequent night. Just as some sleep segments can be increased
according to need for example, REM sleep in a student
learning new skills there is scope for adjusting the relative
length and duration of specific stages over the course of a full
nights sleep. In this way, individuals can be underslept for a
day or two and then pass out for an unrestricted recupera-
tive sleep. (It should be noted that the ability to do this suc-
cessfully diminishes with age.) The health issues that arise
from sleep deprivation are the result of not ensuring, or being
unable to have, this recuperative type of sleep to compensate
for losses over time.
Sleep is also connected to the bodys circadian rhythms
and is entrained to the alternation of light and dark in our
external environment. Melatonin, a hormone produced by
the pineal gland as part of the circadian system, is one of the
most important sleep promoters. Its maximal secretion time is
at night, stepping up at dusk and increasing as the person seg-
ues toward sleepiness and through the first half of the nights
sleep. Another area of concern for sleep specialists is the
extent to which people now interfere with normal circadian
responses by over-utilizing light sources at night, especially
backlit ones, such as computer monitors, close to the eyes.
SLEEP REGULATION
The hypothalamus is the key sleep-regulating area of the
brain. Aided by various chemical and neurological inputs, the
hypothalamus:
directs the homeostatic aspects of sleep
integrates with and modulates circadian processes
harmonizes sleep/wake cycles with autonomic functions
Massage Therapy Canada spring 2011 7
 such as body temperature regulation and sympathetic versus
parasympathetic status
ensures efficient transition between asleep and awake states
It is true that there are morning and night people this is
referred to as chronotype. There are differences in the way sleep is
regulated in the two groups, including timing of peaks and lows in
their body temperature.
It is also true that there are individuals who need less sleep than
average (and some who need more). Experts are adamant that most
people who believe they are doing well on shorter sleep times are
kidding themselves, stating that only when a person falls asleep and
awakens naturally without needing an alarm and does not have
daytime sleepiness or any adverse indicators pointing to insufficient
sleep, could he or she be seen as naturally being a shorter sleeper. It
is also current expert opinion that the human body cannot evolve
to handle receiving less sleep. Ones sense of doing well on shorter
sleep times is apparently aided by the same type of denial mecha-
nism that allows people to feel much more functional than they
actually are when drinking alcohol.
Figure 2 shows the average required amount of sleep accord-
ing to age. Experts are particularly concerned about the current
trend toward undersleep in toddlers and teenagers, who are often
sleeping fewer hours than they need, and the prevailing myth that
seniors need less sleep. Adverse physical and mental health find-
ings correlate very strongly with short/poor quality sleep in older
people; the very healthy elderly almost always demonstrate good
night-time sleep patterns.
hEALTh IMPLICATIONS OF SLEEP DEPRIVATION
For babies, children and teenagers, adequate sleep is essential
throughout the stages of their growth and maturation. The physi-
ological processes of brain and body tissue development demand
adequate sleep, as do emotional resilience, ability to learn and
perform in school and capacity to establish normal eating and sleep
habits. Underslept children often display signs similar to learning
disability and/or mood disorder, leading to frequent misdiagnoses.
More recently, scientists have started to assess inadequate sleep in
the pregnant mother as a source of development issues in babies.
Recent research indicates that individuals who sleep less than six
to seven hours per night die younger (reported in Stein, 2005).
Although the reasons for this are not fully understood, there are
powerful new facts about the correlation between chronic under-
sleeping and major health concerns. For example, sleep deprivation
promotes obesity by influencing the release of appetite-regulating
hormones. It is also linked to development of hypertension, heart
conduction abnormalities and vascular changes associated with
atherosclerosis and thrombosis, making it a big risk factor for heart
attack and stroke. Combined with the above factors, disruption of
glucose/glycogen regulation makes chronic sleep deprivation one of
the top five risk factors for developing Type 2 diabetes.
We are quite familiar with the idea that being underslept makes
us more susceptible to getting colds and flus but may be less cog-
nizant that longer-term impacts of a less resilient immune system,
coupled with pro-inflammatory effects and impaired hormonal
regulation, have led to an awareness of sleep deprivation as a pro-
moter of cancer, especially hormone-sensitive cancers such as breast
and colon.
There is also a great deal of interest in the relationship between
sleep and pain. Because key pain-regulating chemicals are pro-
8 Massage Therapy Canada spring 2011
Figure 2. HoW MucH SlEEP Do WE NEED?
Age Average Sleep Needed
Newborn up to 18 hours
1-12 months 14-18 hours (incl. nap)
1-3 years 12-15 hours (incl. nap)
3-5 years 11-13 hours (poss. nap)
5-12 years 9-11 hours
Adolescents 9-10 hours
Adults, incl. elderly 7-8 (+) hours
Pregnant women 8 (+) hours
Source: http://en.wikipedia.org/wiki/Sleep#Optimal_amount_in_humans
duced during deep sleep, pain neuromodulation is impaired by
sleep deprivation. The emotional capacity to handle pain is also
impaired. Pain levels decrease following a restorative sleep regardless
of other treatment interventions. While we tend to think of such
effects as secondary in the pain cycle, it has also been found that
people who are deprived of Stage 4 NREM (deepest sleep) develop
musculoskeletal pain as a result (Davis, 2003).
There is also a connection with mental health: throughout the
lifespan inadequate sleep is associated with increased depression
and anxiety, and being underslept is a significant trigger for people
with mood disorders.
In general, spending less time sleeping means spending less time
in digest and restore mode, promoting digestive problems, stress-
related health changes and poorer quality body tissue. Insufficient
sleep is known to increase proneness to soft tissue injury, for
example, and to reduce the speed and quality of tissue recovery.
At a recent conference, one sleep expert argued that sleep should
be monitored by health professionals as a vital sign, with the same
vigilance as blood pressure, diet and exercise.
In Notes on Nursing, Florence Nightingale wrote sleep is all-
important to the sick.
This poses some interesting questions for massage therapy treat-
ment planning: are we asking enough about sleep as part of our his-
tory taking and regular check-ins with clients? Shouldnt we be mak-
ing sleep promotion a primary aim of treatment, especially follow-
ing surgery, illness and injury? Shouldnt we routinely be considering
a clients sleep status before doing tissue-altering work? And so on.
In the second instalment of this article, we will take a look at
what constitutes good quality sleep and at the evidence for mas-
sage therapy as a highly effective sleep promoter.
Note: References for this first instalment will be included at the end
of Part 2.
Debra Curties is a graduate of Sutherland-Chan School & Teaching Clinic
in Toronto and presently works there as executive director and longtime
instructor of pathology and clinical theory. She has been involved in
multiple professional organizations in Canada and the U.S. and is a
recipient of the Ontario Massage Therapy Associations Meritorious
Service Award and the AMTA COS Meritorious Service
Award. A co-founder of Curties-Overzet Publications,
Debra is the author of Breast Massage and Massage
Therapy and Cancer. She also travels extensively
teaching continuing education courses for massage
practitioners.
REGISTER
JULY 1st! CONFERENCES
Bringing our Professional
Together as ONE!

NOVEMBER 4, 5 & 6 2011

BURLINGTON, ON
Join us for Canadas Largest Massage Event
Over 1,000 Massage Therapists Attended in 2010!
Over 100 Hours Of CEU Education To Choose From
Over 50 Booths Featuring The Top Massage Product Manufacturers And Distributors
Free Student Day Thousands In Door Prizes
Fun Networking Events And Much More!

CANADIANMASSAGECONFERENCE.COM

The Canadian Massage Conference is

Canadas largest exhibition of massage
products, continuing education and new
business opportunities for therapists of
all disciplines. In 2011 the Conference
takes place November 4th, 5th and 6th at
the Holiday Inn in Burlington Ontario.

Contact us at canadianmassageconference@gmail.com or
Call Toll Free 1-877-387-9111. Registration opens July 1, 2011.

SubScribe TODAY !
4 Issues
29
MTspring2011.indd 1
$ 95
only
US $44.95 (USD) Foreign $59.95 (USD)
For even better pricing go to
www.massagetherapycanada.com!
Name: ________________________
Clinic Name: ___________________
Address: ______________________
City: _________________________
Prov: _________________________
P.Code:________________________
Tel: __________________________
Fax: __________________________
e-mail: ________________________
TO ALLOW uS TO SerVe YOu beTTer,
PLeASe iNDicATe YOur TiTLe beLOW:
Massage Therapist
Massage Student
Other ______________________
Please Specify
PAYMeNT:
cheque - Payable to Annex Publishing
& Printing inc.
Visa Mc Amex
Account #: ____________________________
expiry: ___________________________
Signature: ____________________________
Date: ________________________________
TO SubScribe:
Tel: 866-790-6070 Fax: 877-624-1940
Mail: Massage Therapy canada
c/o Annex Publishing & Printing inc.
P.O. box 530
Simcoe, Ontario N3Y 4N5
e-mail: cnowe@annexweb.com
www.massagetherapycanada.ca
GST#867172652RT0001
10 Massage Therapy Canada spring 2011
News
Nova Scotia 2011 Spring Conference
T
he Massage Therapists
Association of Nova Scotia
(MTANS), with support
from Lackner McLennan, is
pleased to present the Spring
Conference and Trade Show 2011
to be held at Mount Saint Vincent
28/03/11 10:03 AM
University in Halifax from May 6-8,
Plus GST
2011!
The conference offers a number of
seminars and workshops as well as a
trade show featuring products and
services to enhance your practice.
Speakers include:
Dr. Michael Majaess Dr Majaess
will provide a full day lecture/
workshop titled The Scanning
Examination Why, When and How.
Dr. Michael Majaess has been in prac-
tice since 2000 and is an instructor at
the Canadian College of Massage and
Hydrotherapy (CCMH). Recently,
he has started an orthopaedic review
seminar series for massage therapists.
His workshop will include scanning
peripheral joints to aid the thera-
pist in ruling out pathology beyond
that of the cervical or lumbar spinal
regions or to note areas that may
require a more detailed assessment.
louise Danieli, RMT Louise
Danieli is a Massage Therapist, a
Dr. Vodder Combined Decongestive
Therapist and holds a Doctorate of
Acupuncture. She was an instructor
at the Canadian College of Massage
and Hydrotherapy for seven years
and is director and co-founder of
the College of Acupuncture and
Therapeutics. Louise will present
a workshop titled Introduction to
Acupuncture designed to be a
didactic and practical introduction
to this therapy and a lecture titled
Breast Health, an introduction to the
basic general information about breast
health, how it can apply to your prac-
tice and how to approach your clients
about breast massage.
Paul lewis, RMT Well known
0211MT
massage therapist and instructor Paul
Lewis will offer two workshops, Post-
surgical treatment of Mastectomy/
Implants and Advanced Upper Body
Treatment. Lewis is a Registered
Massage Therapist (RMT), Certified
Reflexology Healthcare provider, a
graduate of Sutherland-Chan School
and Teaching Clinic in Toronto,
Canada and an approved and accred-
ited educational provider with the
NCBTMB (USA), FHT (UK), and
the CMTO (CANADA).
Stephanie Allen and Peter
Stuart Stephanie Allen and Peter
Stuart will be on-hand to pres-
ent an Introduction to Awakening
the Healer. Drawing from ancient
practices of Traditional Chinese
Medicine, Yoga and energy medicine
you will learn a step-by-step process
that will enhance your effectiveness as
a therapist and enrich your practice.
Stephanie studied massage therapy
at Mount Royal College in Calgary,
Alberta and has extensive training in
stress management and psychology
from the University of Santa Monica
having attained a Masters in Spiritual
Psychology program. Peter Stuart
graduated from the Canadian College
of Massage and Hydrotherapy in
Sutton Ontario in 1993. He began
extensive Myofascial release training
with John F. Barnes in 1998. He has
also trained with Kimberly Herkert
and Daniel Goodenough with the
Way of the Heart in psychology, spir-
ituality and life mission coaching.
These are only a few examples of
the qualified instructors and educa-
tional sessions that will be available
at this three-day event. For more
information on the conference, or
to become an exhibitor at the trade
show component of the event, please
visit http://www.mtans.com/forms/
Conference2011.pdf. You will also
find complete program details and
listings, registration forms, and
accommodation and venue infor-
mation at this web address.
Feature by don dillon, rMT

United Front
Physician-led integrated medicine

C
omplementary and integrated medicine
(CIM) is a physician-led community medi-
cal practice embracing CAM, which itself
includes massage, chiropractic (osteopathic),
homeopathy/naturopathy and acupuncture/
traditional Chinese medicine. Collaboration between
mainstream medicine and CAM poses benefits
beyond more holistic medicine. A radical shift away
from individual CAM professions fighting for funding,
supportive policy and positive public relations to an
integrated, physician-led model has particular ben-
efits for CAM practitioners, physicians, government
health-care policy makers, insurance funders, and a
wellness-focused and information-savvy populace.

Interest has grown in CAM. A study funded by Health

Canada, Complementary and Alternative Health Practices and
Therapies A Canadian Overview, states Canadians spent an
estimated $3.8 billion dollars on alternative treatments in
1998. Many Canadians have already integrated complemen-
tary and alternative health practices into their health care,
and consumption is likely to grow.1
The study shows it is time for us to move on from the
mistrust that has characterized the relationship between con-
ventional medicine and alternative practitioners in Canada,
and start examining broader questions about alternative
therapies, their place in the health-care system, and how
efficacy is determined. This work is sorely needed, said Joan
Gilmour, associate director of the Centre for Health Studies
at York University, professor of law at Osgoode Hall Law Pooling resources and maintaining a working relationship with allo-
School and a co-author of the study.2 pathic medicine is an opportunity for mutual benefit.
A more recent study by the Fraser Institute estimated 74
per cent of Canadians had used at least one CAM sometime Many physicians are increasingly dissatisfied with linear, non-
in their lives, and 35 per cent of Canadians had tried mas- holistic approaches for their patients,5 and are looking for partners
sage. Expenditures in 2006 were estimated at $5.6 billion in delivering holistic care integrated with other providers. Dr.
out-of-pocket for visits to CAM providers in Canada.3 J. W. Diamond, MD, relays, The recent focus on health-care
The public appears somewhat dissatisfied with administra- reform has unfortunately been geared almost entirely toward
tion of public health care.4 With drug interactions, skyrock- increasing access and decreasing costs. While these are laudable
eting expenditures, unnecessarily invasive and costly proce- goals, creating increased and affordable access to a failing medical
dures in lieu of lower-cost and less invasive options, long wait system does not address the actual causes of the high costs and
times, idiopathic diseases and burned out health-care provid- poor outcomes causes that include a rapidly rising epidemic
ers, there is increased interest in seeing health-care reform of chronic disease and a health-care system poorly designed to
delivered with less risk and as minimally invasive as possible. counteract or prevent it. It is the practice of medicine that should
Current medical practice neednt be replaced, but rather sup- be addressed first, with the greatest potential for effective change
ported and supplemented. coming from [combining allopathic and complementary and

Massage Therapy Canada spring 2011 11

alternative medicine].6 Gatekeeper physicians and registered nurse
practitioners could recognize substantial business benefits and cost
offsets through collaboration, not to mention better patient out-
comes and considerably less professional isolation.
Complementary and alternative medicine (CAM) providers
are typically directed into sole practice without the health-care
policy infrastructure that physicians and nurses have to support
them. With this lack of infrastructure comes insufficient business
models or management experience required to successfully oper-
ate, promote and administer a business. Unlike administration-led
hospitals or large medical facilities, CAM providers frequently
work without administrative/support staff, public and media rela-
tions experts or a board of directors (advisors). CAM is financed
primarily out-of-pocket or by employee benefit/workplace plans, a
situation that impacts access to care and treatment plan fulfilment.
By collaborating with physician-led practices, CAM practitioners
could reap the benefits of business models employed by progres-
sive allopathic practices and hospitals, extend CAM scope in pub-
lic health and disease prevention, and avoid many of the pitfalls
currently dogging them.
CAM has traditionally been considered an alternative to allo-
pathic medicine, and there has developed an unfortunate opposi-
tion between the two ideologies. Its unlikely public/government
funding will support CAM until its providers, regulators, research-
ers and educators demonstrate efficacy, cost-savings and willing-
ness to work together with allopathic medicine. CAM is typically
seen by insurers, government, media and the public as expensive
and experimental. Despite this skepticism, public expenditures
for CAM continue to rise annually.
Resource-rich baby boomers and their benefactor offspring
and grandchildren are seeking out and financing, with workplace
benefits or out-of-pocket discretionary income, more and more
complementary and alternative medicine. Government and insur-
ance companies7 will become more interested in the cost savings
CIM provides, and serving the broader interests of information-
savvy health-care users.8 Baby boomers have made it clear they are
willing to finance a broader range of health-care services for them-
selves and their families, and they expect health-care providers to
work together towards best practices.
Government agencies and insurance companies want evidence-
based practice, cost savings and public safety. Working alone, inde-
pendent CAM professional associations are woefully inadequate
in providing these assurances. CIM would yield stronger lobbying
efforts and influence on government policy, better compensation
in insurance plans, more resources towards research and evidence-
based practice (and hence greater public safety and cost-savings),
and stronger public confidence.
At the Highlighting Massage Therapy in CIM Research con-
ference in May 2010, William Meeker, DC, MPH, asked the
salient question, Why are we trying to do this by ourselves?
Moderating the panel Role of Massage Therapy in Public
Health, Meeker described that CAM professions are all pursuing
the same goals: generating research and evidence-based practice,
lobbying government for policy change and inclusion in health
care, negotiating with the insurance industry for better service
funding, and raising the standards of education and training in
their respective practitioners. Working alone, each profession is
limited by resources and is ultimately slow and ineffective. Meeker
suggested CAM professions collaborate on resources, share knowl-
12 Massage Therapy Canada spring 2011
edge and co-ordinate lobbying and education initiatives.
Detractors from this argument may complain that physicians
have the most authority in such a model and could impair CAM
administration (or salaries, or other benefits to CAM practitio-
ners) or may argue a loss of professional identity with such col-
laboration. I would counter that, for the proper administration of
health care, we need an overseer someone who can direct the
treatment plan, especially in complex cases. With the support of
physicians and other gatekeepers, I believe CAM pratitioners can
assist in co-ordinating care very well, especially if that care is pro-
vided under one roof in a collaborative effort.
Secondly, CAM providers are already losing ground. In particular,
massage therapists in many Canadian provinces pay dispropor-
tionate taxes compared to their counterparts, physiotherapists and
chiropractors; experience barriers to insurance coverage; face exclu-
sionary health-care policy and negative public and media percep-
tion (Google massage insurance fraud); deal with snubbing by
gatekeeper health professions or exploitation by profiteering in large
rehab and spa facilities. Massage therapist professional associations
dont retain the resources or political leverage to overcome these
obstacles. Massage therapists are relegated as adjunctive/assistive pro-
viders under the direction of gatekeeper health professions, or skilled
labour service providers in spas. Our professional identity, our train-
ing and education, our position with government, insurance com-
panies and other health-care providers and our image in the public
eye have all been depreciating, I would contend, for years.
However, imagine the momentum generated by a united front
of CAM professions. Individually, none of these professions have
a chance at integration into mainstream medicine . . . theres too
much opposition. However, when collaborating, pooling resources
and maintaining real working relationships with mainstream
(allopathic) medicine, an adversarial, territorial stance becomes
an opportunity for mutual benefit. Maintaining their favour-
able position as gatekeepers, physicians (and Registered Nurse
Practitioners) would realize better profit margins and cost-savings
by overseeing and working with CAM counterparts in their medi-
cal clinics and hospitals. CAM practitioners would enjoy well-
oiled business models and could concentrate on providing care
instead of marketing, billing and operations. And public citizens
could finally enjoy and benefit from the vast knowledge and expe-
rience base afforded by a truly integrated health-care system.
Now is the time. Talk to the leaders of your professional asso-
ciations, schools and regulatory bodies and press them to open a
dialogue across North America. Then approach other CAM pro-
fessions, and eventually allopathic providers, to stage a coup and
change the face and the relationships of public health care.
Please visit www.massagetherapycanada.com, for article with
references.
Don Dillon is the author of Better Business Agreements and the self-
study workbook Charting Skills for Massage Therapists. More than 60
of his articles have been published in industry publications, including
Massage Therapy Canada, Massage Therapy Today, AMTA Journal,
Massage Magazine (online), AMTWP Connections, Massage Therapist
(Australia) and various massage school and professional
association newsletters. Don has presented in seven
provinces to massage therapy schools and associations,
and his website, www.MTCoach.com, provides a
variety of resources for massage therapists.
Feature by JessiCa FosTer

RMT Tech Talk

Bill C-28 and what it could mean for you

I
n this issue, I would like to raise awareness among registered massage therapists of new legislation passed in
Canada on December 15, 2010. Bill C-28 will come into effect in September 2011 and massage therapists will
want to make sure their marketing communications methodologies are on the right side of this law. Failure to
comply could cost individuals up to $1 million in fines and corporations up to $10 million dollars per infraction.
The bill is 79 pages long, and it is complex. This article is not intended to provide legal advice nor a complete
analysis of the Act, but rather to inform readers of the potential ramifications to their day-to-day business practices.

WhAT IS BILL C-28?

Bill C-28 is called the Fighting Internet and Wireless Spam
Act (FISA). Its intended effect is to deter and prevent deceptive
and damaging forms of spam and Internet practices. After long
consultations with industry, organizations, legal experts and inter-
ested parties, Canada has now passed a bill that is intended to
increase the reliability and trustworthiness of the digital economy
for Canadians. A full copy of this bill can be viewed on Industry
Canadas website at www.ic.gc.ca.
The legislation will deal with how, when, where and why
you are authorized to send commercial electronic messages.
Commercial electronic messages that may affect RMTs includes
e-mails, text messages, instant messages, social media messages,
telephone calls, and voicemail messages that are intended to
solicit business.
You may be asking yourself the following question: As a legiti-
mate business and RMT practitioner, how can FISA affect the
day-to-day operation of my practice?
In a nutshell, under the new rules of the FISA, you are now
required to obtain permission (either implied or expressed) from
your potential clients before you can legally send them electronic
messages about your business and services. In addition, you would
be well advised to maintain records so that you are able to prove,
if needed, that you have received this permission from them.

WhAT IS A COMMERCIAL MESSAGE?

A commercial message is a message that contains content
that is intended to solicit business or commerce. FISA covers
more than just the words contained in the message. It also
includes commercial website page content, but only if a link
to that page is included in the transmitted message.
WhAT IS PERMISSION?
As mentioned, FISA requires that you receive permission from
your clients and potential clients before you communicate
with them electronically about your business and services.
Within the act, both expressed and implied permissions
are acceptable. What is the difference between the two?
Expressed permission describes a situation in which cli-
ents, or potential clients, have formally opted-in to receive
commercial messages from you. They check a box on a web-
site registration form, or mail-in a point-of-purchase postcard
requesting your communiqus. This is, by far, the strongest
form of consent, as it is very clear what your clients intent is

Massage Therapy Canada spring 2011 13


with respect to you marketing to them.
Implied permission, on the other hand, denotes consent
that is not actually stated, but is inferred by another action
taken by your clients. For example, when you already have
an existing business relationship with customer or clients, it
is implied that they expect ongoing business-related commu-
nications from you.
In addition, implied permission may include persons you
may not even know, as long as their business and duties are
relevant to your business and their contact information has
been made publicly available to you. Obviously, potential
clients (consumers) of an RMT do not fit this description,
but doctors or chiropractors in your area would. You could
contact them and strike up a conversation intended to initi-
ate referral services. You do, however, need to ensure that
persons who publish their contact information have not also
published a disclaimer along with it, stating that they do not
wish to receive commercial messages.
hOW DO I GO ABOUT
GETTING PERMISSION?
When you stop to think about this for a minute, you will
quickly recognize that, as a health-care professional, it can be
very easy for you to obtain permission from your clients without
deviating from your regular day-to-day practices. Here are just a
couple of ideas you may want to consider implementing:
As an RMT you are required to obtain signed treatment
consent from your clients before you are able to treat them.
Why not add a checkbox to this form that simply states, I
understand and agree that as part of my ongoing care, I may
receive communications from you electronically about my
treatment and related services. Once checked, this would
be an example of clients giving you expressed permission
for you to communicate with them about your business and
services.
An example of implied consent would be when a new client
visits your website and requests an online appointment with
14 Massage Therapy Canada spring 2011
you. This action is inviting a business relationship with you
and therefore is implied permission for you to communi-
cate with them.
In both cases, there will be adequate documentation for you to
provide proof of consent later, if you are ever required to do so.
BEYOND PERMISSION
There are two more very important issues that FISA compliance
requires and that may affect the way you presently communicate
with your clients. These include, but are not limited to:
All the commercial message e-mail and electronic newsletters
you send to your clients must contain the full name of the
sender along with valid contact information. You are likely
already doing this, as it is only common sense to provide
your clients with a way to get back in touch with you. That
said, with FISA, it is no longer an option, but a must-have.
All of your commercial messages must provide the recipient
with a working mechanism, manual or otherwise, for them
to opt-out of receiving any further electronic correspon-
dence from you. It is also very important that you monitor
and honour these Unsubscribe requests to ensure FISA
compliance.
ThE SKY IS NOT FALLING
FISA in no way should reduce or hinder your legitimate busi-
ness practices. So dont panic. The core requirements of FISA are
straightforward to adopt into your practice, and are not costly.
One of the results of this legislation will be the desirability
for RMTs and other commercial ventures to maintain relevant
and legitimate contact with clients and potential clients. There
are affordable practice management systems available to RMTs
that will help you build your practice by engaging your clients
and potential clients through professional, interactive website
tools and legitimate e-mail correspondence. These systems also
will help you maintain your client list and minimize the time
required to legitimately correspond with your clients through
mass e-mailing tools and automation all the while maintaining
FISA compliance.
While visiting your website, potential clients will gladly provide
you with consent if by doing so they believe it will be beneficial to
them. They will welcome the convenience of online website tools
such as online appointments, newsletter subscriptions and class
registrations, to name a few, through which they may willingly
provide you with their e-mail address and consent to receive fur-
ther communications from you, all well within the rules of FISA.
As mentioned at the outset of this article, the new FISA legisla-
tion will come into effect in September 2011. This leaves you
plenty of time to consider its implications and put appropriate
business practices in place to ensure your compliance in electronic
communications.
Until next time, be well!
Jessica Foster writes on behalf of mindZplay
Solutions a leading provider of massage therapy
websites and practice management solutions. To
learn more about mindZplay Solutions for Massage
Therapists please visit www.massagemanedger.com
or call toll free 888-373-6996.
News
Vitality and READ thEsE stoRiEs AnD moRE At

Core Alliance
www.mAssAgEthERApycAnADA.com

NEWS HIGHLIGHT

C
ore Products is pleased to Myofascial Release 2011 Seminar Dates
announce the appoint- The Myofascial Release Treatment Centres and Seminars announces dates for 2011
ment of The Vitality
sessions for health professionals.
Depot as its exclusive
importer and master dis- READ Full stoRy onlinE
tributor in the Canadian market.
This partnership strategically enhances
the availability to the health care market WEB EXCLUSIVE
for our entire product line, says Phil
Mattison, CEO of Core Products. This Regulatory Issues Surrounding Natural
new alliance will also increase our nation- Health Products
al brand recognition and greatly expand By Victoria Coleman, DC
our patient education platforms.
Scott Spencer, CEO of The Vitality
Depot notes "It is with great pleasure we A Q-and-A article with Dr. Gerry Derganc, ND, regulatory
and quality assurance advisor with Douglas Laborato-
ries/Pure Encapsulations Canada, intended to dispel myths
announce the addition of the entire Core
Products line to our family of products. and hopefully offer some clarity to any questions regarding
This new opportunity fits into our busi- the use of natural health products in daily practice.
ness model perfectly and allows us to
maintain our goal of bringing our valued
clients the best in class products, value
and technology.
Core Products International, Inc., was
founded in 1988. Core has continued to
expand their family of products and have
introduced new concepts and technolo-
gies in the hopes of assisting health care
professionals with tools to increase patient
wellness. Some of Cores products include
extremity supports, orthopaedic pillows,
backpacks and therapeutic belts. The
understanding that Core Products is a
North American-based manufacture adds
great value and interest at all levels.
The Core Product line will be available
directly through Vitality Depot, or any
authorized Vitality dealers from coast to
coast. For more information about Core
Products and/or The Vitality Depot,
please visit www.vitalitydepot.ca.

Massage Therapy Canada spring 2011 15

Feature by paul lewis, rMT

Post-surgical Therapy
for Mastectomy and
Implants, Part 1
Scope of practice, assessment and consent

S
hould massage therapy be an integral
component of the rehabilitation process
for post-surgical cancer patients? Yes,
absolutely.

I must ask why, then, the massage therapy profession is not

considered, during roundtable discussions, as a recommended
adjunct for post-surgical clients. When we have a cold, we
generally think about visiting our family physician, and an
increasing number of us may see a naturopathic doctor or even
our pharmacist. But, when we require help to restore range of
motion, reduce pain and address issues related to scarring and
mobility, where do we think of going? Is it advertising and pub-
lic perception that keep massage therapy in the background of
treatment options, or are there just not enough of us engaged in
the rehabilitative work to make a large enough impact?
I would like to share with you my experiences with post-
surgical clients, outline treatment techniques I used during their
rehabilitative process and offer the rationale for the modalities
chosen. It is my hope that more of us will become engaged in
helping post-surgical patients and raise awareness of the possible
benefits that massage therapy has for the
challenges these patients face.

REGULATED SCOPE OF PRACTICE

Whenever a client requests treatment from a Registered Massage
Therapist (RMT), consent for treatment is always required. The
College of Massage Therapists of Ontario (CMTO) standards
of practice require consent for treatment from each and every
client. Therapists are reminded that full body treatment may
mean different things to different clients. Therefore, it is recom-
mended that all body areas be discussed for inclusion or exclu-
sion to a given session, but as well, special consent is required for
sensitive areas such as the inner chest wall, inner thighs, buttocks
and breast areas. It should also be noted that consent can be
modified or revoked at any time by the client for any reason.
The CMTO defines the practice of massage therapy as the
assessment of the soft tissue and joints of the body, the treat-
A robe can be worn by the patient while the RMT conducts the
assessment.
ment and prevention of physical dysfunction and pain of the
soft tissue and joints by manipulation to develop, maintain,
rehabilitate or augment physical function, or relieve pain. In
order to gain licensure with the CMTO, one must complete a
training program from an approved Ontario school or equiva-
lent (generally averaging 2000 hours of academic and clinical
training), followed by successful completion of both written
(multiple choice question) and Objectively Structured Clinical
Examinations set by the CMTO. Once registered with the

16 Massage Therapy Canada spring 2011

I wanted to grow my
massage practice, help
more people, and do it
without burning out.

- Christine

After only 4 years as a massage therapist, I was beginning to

physically burn out. I loved my profession, but my body
couldn't keep up with the demands of my practice.
That's when I heard about Bowen. I added Bowen First to
TM

my modality to help me preserve my body, be a more effective

therapist and, oh yeah... triple my income.

Bowen reboots the body by stimulating the autonomic

nervous system. Add it to your practice with as little as
4 days training. Register at Bowen College today
and reboot your world!

For CEUs and Special Offers for

Massage Therapists go to:
bowencollege.com/massagetherapists
or call:
1-866-DoBowen (362-6936)

Massage Therapy Canada spring 2011 17

CMTO, you are able to practice as a massage therapist.
Even though treatment of the breast tissue is within our regu-
lated scope of practice, many RMTs avoid treating this area. This
is often due to lack of confidence, lack of knowledge or concern
about public opinion.
KNOWLEDGE IS CONFIDENCE
I was first introduced to breast massage, its pathology and
clinical theory by Debra Curties, instructor and director
at Sutherland-Chan school and teaching clinic. She is an
advocate of breast massage and womens health, focusing
specifically on indicators and health concerns for cancer
patients. I am grateful to the instructors I had for the train-
ing and knowledge they provided. I am also interested in
passing this knowledge and training on to others by offering
presentations at workshops and conferences. Perhaps, if we
maintain this cycle of knowledge, then breast massage, and
the issues surrounding it, will become less intimidating for
therapists and they will become more confident about treat-
ing clients who require their expertise and knowledge.
APPROACh TO TREATMENT
For my post-surgical rehabilitative treatments, I use a variety of
skills and treatment modalities in addition to a technique called
Dynamic Angular Petrissage (DAP). I find this engagement tech-
nique helps to augment the rehabilitative treatment and is not
stressful either for the client or the therapist.
Assessment is vital to confirming your hypothesis, and to
providing a rationale for the choice of modalities and treatment
techniques employed. When a client presents with an issue or an
injury, it is necessary to look not only at the area of referred pain,
but also at related structures that may indirectly contribute to
their symptoms or underlying cause of injury. The cause could be
skeletal, muscular or neurological, or a combination of the three.
Therefore best practice is to go beyond the standard health history
and ask to perform a clinical/orthopedic assessment.
When clients are referred to me after having undergone radia-
tion or chemotherapy for breast cancer, those clients are typically
feeling vulnerable or uncomfortable with their bodies, and fearful
about the extent of their injuries. There are a few simple steps that
can be taken to help clients feel informed and comfortable about
the process of receiving a therapeutic treatment. For example, at
the beginning of the palpation and physical assessment, I suggest
providing a robe that allows for some coverage of sensitive areas
while allowing you to perform your assessment. (Personally, I use a
Japanese, half kimono style of robe.) This helps reduce feelings of
vulnerability, reinforces the feeling of security and reduces embar-
rassment regarding their changed appearance. As well, the client
does not get cold during this assessment phase. These steps may
seem unnecessary, but I see this small gesture as an essential part
of building trust in the relationship.
INITIAL CLIENT PRESENTATION
The physical and emotional state of these women, before they
start their massage treatments, can often be described as emotion-
ally fragile and physically exhausted. Many feel their lives have
been interrupted, that some of their sexuality been compromised,
and may feel as though they have had minimal control over their
bodies. I have witnessed the transformation of these courageous
women, in just a few months, as they transition from feeling
depressed and withdrawn to outgoing and confident. This trans-
formation can be facilitated by some simple gestures. I find it
helpful to create an environment that is comfortable and secure,
and gives control (that is, decision making) back to the client.
It is important to take your time in explaining the various steps
and procedures that are involved and the techniques you plan
on using in their treatment. During the treatment of scar tissue
or adjacent structures of the body, the massage may trigger emo-
tions that overwhelm clients, bringing them to tears. When this
happens, I do not attempt to verbally engage them. I stop all
movement and maintain a firm, but gentle, contact. When clients
regain their composure, I reassure them that this is a natural reac-
tion. I then ask if they would like to break for a moment, or con-
tinue the treatment another day. Most clients are able to resume

LETTER FROM A WIFE, MOThER AND CANCER SURVIVOR

Ms. K sums up her experience with massage therapy and the His recommendations for self-treatment were easy to remember
synergy that resulted: and fit into my lifestyle with ease. During each session, he took
I just wanted to inform other survivors who are feeling extra measures with draping and positioning my body this
depressed and self-conscious, as I did, that massage therapy allowed me to relax completely throughout the duration of treat-
improved my life! Having undergone mastectomy, chemo- ment. After only two months, once per week for 1.5 hours, my
therapy and radiation therapy, my body was feeling foreign, scar tissue has improved, and range of motion on my left side has
weak and wounded. Surgery had left me with limited mobility been restored to nearly 90 per cent. Ive gone from someone who
on my left side; even combing the little hair I had left was a could barely comb her own hair to someone who can once again
painful challenge. When I was referred to Registered Massage swim with my kids while on our recent family vacation.
Therapist, Paul Lewis, for post-cancer rehabilitation, I was Ive begun to reclaim the things I enjoyed in life before my
apprehensive about how my body would cope with yet anoth- cancer diagnosis.
er form of treatment. But with very limited rotation in my I know it is difficult to think of going for further treat-
shoulder, along with restricted movement in my neck and a ments after we have been through so much to battle the
constant numbness and tingling in my hands, I felt I had little cancer, but you need to know that massage therapy is worth
to lose from trying something new. As soon as he started his it to get your active life back. I would recommend it to other
assessment of my condition, however, any worries I previously survivors, as well as to doctors, surgeons and therapists look-
held went out the window. Paul explained every movement, ing to refer their patients to someone who is both knowl-
stretch and therapeutic touch to ensure my comfort and ease. edgeable and sensitive to cancer-related trauma.

18 Massage Therapy Canada spring 2011

These patients may feel vulnerable and compromised -- it
is important to provide an environment that is secure and
comfortable, and gives control for decision making back to them.

treatment. In my experience, for many of the women this

emotional release is part of the healing process.

INDIVIDUALIZED ASSESSMENT
AND TREATMENT
In my experience of having worked with individuals who
have undergone a biopsy, single or double mastectomy,
augmentation, reduction or transverse rectus abdominis
myocutaneous (TRAM), I have discovered how critical it
is that each clients treatment plan is unique to her set of
circumstances. This requires personalizing the assessment
information, as well as any self-care exercises prescribed
to the client, so that they are effective and realistic for the
client to use in her particular lifestyle. I accomplish this by
using various modalities this combination contributes to
the overall result.
In Part 2 of the article, the author will discuss in detail self-
care exercises for post-operative patients who have undergone
breast procedures, as well as treatment approaches he uses
and the rationale for techniques and modalities utilized. It
will appear in the Summer 2011 issue of Massage Therapy
Canada.

Paul Lewis, practises out of his clinic in Mississauga, Ontario, and

will be presenting at various conferences and
teaching engagements in Canada, Europe and
the United States (CEUS). For more details visit
www.paullewis.ca.

Massage Therapy Canada spring 2011 19

News
International, Interdisciplinary Conference
on Medical Acupuncture
T
he Canadian Contemporary
Acupuncture Association
(CCAA) has announced its first
international, interdisciplinary
meeting to be held in Niagara
Falls from May 3-6, 2012.
Two years ago, graduates of the original
McMaster Medical Acupuncture Program
since 1998 (known as Contemporary
Medical Acupuncture for Health
Professionals), formed the Canadian
Contemporary Acupuncture Association
(CCAA), which already has several hun-
dred members. This unique professional
interdisciplinary association is devoted to
the dissemination of the very successful
contemporary neurofunctional model
20 Massage Therapy Canada spring 2011
taught at the McMaster Contemporary
Medical Acupuncture Program.
As part of these efforts, the CCAA is
organizing an international meeting titled
Contemporary Acupuncture Integration
into Todays Health Care.
Participation of prominent educators
and proponents of the neurofunctional
acupuncture model has already been
secured, among them Dr. Thomas
Lundeberg from Sweden, Dr. Mike
Cummings from England, and Dr.
Claudio Couto from Brazil.
Canadian experts will include Dr.
Elorriaga, Dr. Ohson, Dr. Fargas-Babjak,
a list of chiropractors including Dr. Mike
Prebeg and Dr. David Salanki, and RMT
Chris OConnor.
This exciting event will see the cul-
mination of almost a decade and a
half of hard work by the McMaster
Contemporary Medical Acupuncture
Program devoted to the expansion and
integration of a 100 per cent neuro-
functional acupuncture model.
For more information, or to register
for this event, please visit
www.contemporaryacupuncture.ca.
News
System Transformation by Canada's Future Health Leaders

C
anadian students from every health-care dis-
cipline gathered in Toronto the weekend of
March 12-13 to strategize and share ideas on
how improved collaboration and teamwork in
health care could improve health outcomes for
all Canadians. The event was a meeting of the National Health
Sciences Students Association or NaHSSA.
NaHSSA was built on the belief that collaboration can
improve the patient and health-care provider experience, said
Luciano Di Loreto, president of the National Health Sciences
Students Association and recent graduate of the Canadian
Memorial Chiropractic College (CMCC).
As Canadas future health-care providers, we are passionate
about shifting the health-care system from one that focuses on
uniprofessional patient care to one that focuses on interprofes-
sional patient-centred care.
Each year NaHSSA holds an annual conference, bringing
together students from occupational therapy, nursing, respira-
tory therapy, medicine, chiropractic, rehabilitation sciences,
dietetics, and many more health-care disciplines. The theme
of the 7th annual conference was Crossing the Bridges of
Socioeconomic and Cultural Diversity in Healthcare, and rep-
resented the participants growing awareness that cross-cultural
diversity management in health care is extremely relevant to
todays professionals.
This years conference, a joint venture hosted by the
Canadian Memorial Chiropractic College, the University of
Toronto, Canadian Naturopathic College of Medicine, and
Ryerson University, included a workshop for student-run clin-
ics, an interprofessional problem-based learning session, and
the National Health Care Team Challenge where teams com-
pete to provide an interprofessional plan of care based on an
assigned case study.
Established in 2005, NaHSSA was the first interprofessional
student association in the world. Students who are driven
to improve education and health care continue to network
through NaHSSA each year. To learn more about NaHSSA,
please visit http://www.nahssa.ca.

Dr. John E.
Upledger,
Massage Therapists Select
Developer CRANIOSACRAL THERAPY
#1 Technique to Learn
CranioSacral Therapy 1
Anchorage, AK May 14-17
Vancouver, BC May 26-29
Toronto, ON May 26-29
Ottawa, ON Sep 8-11
Edmonton, AB Sep 22-25
CranioSacral Therapy 2
Now for just $100* per month! Anchorage, AK May 19-22
Isnt it time you discover the benefits Edmonton, AB Sep 22-25
of Upledger CranioSacral Therapy? SomatoEmotional Release 1
Effective new skills to enable you to Toronto, ON May 26-29
address a wide variety of health issues Edmonton, AB Sep 22-25
Enhanced credentials to help you Advanced CranioSacral Therapy 1
broaden your practice Vancouver, BC Jun 6-10
Light-touch techniques that are easy on Upledger Celebrates 25 Years!
your body Win a FREE CranioSacral Therapy 1 workshop!
Register online www.upledger.com /win
An international network of professionals
to help you grow professionally and Proud Member
personally of International
Alliance of
Full range of educational materials to Healthcare
Educators
support your classroom experience
1-800-233-5880 www.upledger.com
*New! Upledgers CST Core-Pak. Ask about it today! Priority code: MTC

Massage Therapy Canada spring 2011 21

Feature by CaTherine ryan, rMT

Understanding
Stress Part 2
An interview with Dr. Leon Chaitow

T
he name Chaitow is pretty much a
household word amongst manual
therapists! Dr. Leon Chaitow, editor of
The Journal of Body Work and Movement
Therapies, is an internationally renowned lecturer
and prolific author of health-care-related books,
articles and journal publications. Youd be hard
pressed to find a manual therapist who hasnt
read a book, an article, an editorial, a blog or a
tweet written by Dr. Chaitow.

Part 2 of this article features an interview with Dr. Chaitow,

an ardent advocate of massage therapy, who will explain, for
Massage Therapy Canada magazine, the interaction between pH,
breathing, stress and pain to support his view that massage ther-
apy can, indeed, play a beneficial role in the treatment of stress.
MTc: One of the cornerstones of naturopathic medicine is
nutrition. Balancing the bodys pH (by addressing nutritional
practices as well as other factors) is one of the first issues most
naturopathic doctors will address. According to Li and Fidler
2000, an acidic environment or acidic pH, which is often
found in solid neoplasms, not only has been linked to cancer
but to other issues as well. Dr. Chaitow, can you share with us
Given the interaction between pH, breathing, stress and pain, massage
any insights into the potential impact of acidic pH on the soft- therapy can, indeed, play a beneficial role in the treatment of stress.
tissues/fascia of the body?
lc: This is a very complex area of human physiology that has (1996), who showed a positive correlation between pain
not been fully studied. What we do know is that the modern levels and local acidity. An acidic milieu alone (without
Western diet is thought to produce a low-grade systemic acidosis. muscle damage) seems to be sufficient to cause profound
And this (acidosis) influences what is known as NMDA receptor changes in the threshold sensitivity of pain receptors, so
function, which alters sodium, calcium and potassium balance. that a stimulus say manual pressure that, under normal
This low-grade metabolic acidosis, induced by diet and amplified conditions, would not be painful is perceived to be painful
by age, is thought to result in, among other things, clinical osteo- when acidity increases.
porosis, loss of muscle bulk, diminished growth hormone secre- An acidic pH also stimulates the production of inflamma-
tion and an increased tendency to epileptic episodes (Yuan 2006). tory precursors such as bradykinin and helps to explain the
Acidosis also increases during pregnancy. One effect of acido- pain associated with active myofascial trigger points.
sis is an increased breathing rate, which if already dysfunction- Gerwin et al. (2004) have suggested that an acidic pH
al, can result in what is known as respiratory alkalosis, which is directly involved in sarcomere contraction that leads to
has effects Ill try to explain briefly later (Levitsky 1995). formation of the taut band phenomenon, which is a charac-
Its against that general background that we should teristic of myofascial trigger points.
consider evidence such as that offered by Issberner et al. The role of pH in local soft tissue dysfunction and pain

22 Massage Therapy Canada spring 2011

has been further confirmed by a recent histological study
(Shah et al. 2005), that revealed significant differences in
the levels of pH (as well as substance P, bradykinin, norepi-
nephrine and other substances) in people with active myo-
fascial trigger points, compared with normal individuals.
MTc: Stressed out seems to have become an all too
familiar mantra in our modern culture. Eighty per cent of
workers polled reported that they feel stressed on the job.
(Gallup poll 2000) The World Health Organization has
now identified job-related stress to be at epidemic propor-
tions. Dr. Chaitow, can you share with us any insights on
the impact of stress on pH (and, subsequently, the soft-
tissues/fascia)?
lc: A book would be necessary to answer this ques-
tion appropriately. Suffice it to say that stress commonly
results in, or aggravates, feelings of anxiety and apprehen-
sion. Think of the fight/flight response to any alarm situa-
tion, and the automatic adaptive responses of the body that
follow, including faster heart rate, increased blood pres-
sure, more rapid breathing and increased muscle tone. The
shorthand for all this is sympathetic arousal. This involves
a chronic state of affairs developing, with more or less
permanently heightened muscle tone, where areas of local
ischaemia are likely to evolve, and with the repercussions on
local tissue pH Ive already touched on.
Equally, there is likely to be a chronic state of over-
breathing, and this can result in widespread (respiratory)
alkalosis. The formula is in place for a range of general and
local changes that include one of the main effects of respira-
tory alkalosis, smooth muscle constriction. Smooth muscles
surround the gut and blood vessels, and when these are
constricted this causes a narrowing of these tubes with a
range of effects, including reduced delivery of oxygenated
blood, leading to muscle fatigue, ischaemia, and the pain
and other modifications I mentioned earlier.
Its important to remember that the self-regulating fea-
tures of the body kick in, as part of these processes. For
example, as mentioned, in a state of relative increased
systemic acidosis, there will be an increase in breathing rate,
which helps eliminate carbonic acid (via carbon dioxide in
the breath), and, as alkalosis emerges, if over-breathing is
chronic, the kidneys start to excrete bicarbonate to balance
this. The result of that is a disturbed calcium level, with
effects that include tendencies to cramping, as well as
neurological disturbances such as altered motor control.
The bottom line is that stress can lead to a variety of
changes that involve pH, and that certainly involve dis-
turbed breathing patterns, and as already indicated, this
has direct effects on the soft tissues of the body (Chaitow
2004).
An additional note here; more recent research, brought
forth at the International Fascia Research Congress, has
identified that smooth muscle cells (in the form of myofi-
broblasts) are also present in fascia providing fascia with
hEALTh ISSUES ASSOCIATED WITh ACIDIC Ph
Heightened pain sensitivity
Increased production of inflammatory precursors
Increased sarcomere contraction associated with
myofascial trigger points
Increased incidence of active myofascial trigger
points
Increased incidence of chronic muscle and
myofascial tension
Increased tendency of hyperventilation and
respiratory alkalosis (resulting in increased incidence
of muscle cramping and altered motor control)
Increased risk of osteoporosis
Loss of muscle bulk
Altered sodium, calcium and potassium levels
Diminished growth hormone production
Increased tendency to epileptic episodes
Increased risk of certain forms of cancer
Increased risk of atherosclerosis and arterial wall
degeneration
Massage Therapy Canada spring 2011 23
the ability to actively contract or regulate intrafascial
tension (Staubesand & Li 1996). Current fascia research
implies that myofibroblasts (like other smooth muscle cells)
are regulated by the SNS, vasoconstricting substances and
neurotransmitters (Schleip 2003).
MTc: At the First International Fascia Research Congress
(FRC), one of the questions you put forth to the panel of scientists
pertained to breathing pattern disorders in relation to ligament lax-
ity. Would you expand on any of your insights (already noted) with
regard to the impact of altered pH on the soft tissues/fascia.
lc: My question to research scientists at the Fascia Congress
related to the observation that smooth muscle cells also constrict
in an alkaline setting, such as that produced by over-breathing.
The background to the question I posed, involved the fact that
people who have lax ligaments, that is, who are hypermobile, are
more prone to hyperventilation (the extreme of over-breathing
Martin-Santos et al. 1998, Bulbena et al 1993).
A further aspect of the background to the question relates
to the increasing knowledge we have that smooth-muscle-like
cells are seeded throughout the fascial structures of the body
(Ahluwalia 2001, Hastreite et al. 2001), apparently to provide
architectural support, during remodelling following trauma.
What I wanted to know from researchers was whether there
was evidence that the increased tendency for these cells to con-
ThE FIRST INTERNATIONAL FASCIA
RESEARCh CONGRESS
The First International Fascia Research Congress in
Boston (2007) inaugurated a continuing series of inter-
national conferences dedicated to the newly emerging
field of Fascia Studies. Although there is an extensive
body of research on connective tissue, the study of fascia
and its function as an organ of support has been largely
neglected and overlooked for many years. Among the
different kinds of tissues that are involved in musculosk-
eletal dynamics, fascia has received comparatively little
scientific attention. It is because the importance of fas-
cia has been underrated over the last 30 years, that the
Boston 2007 conference was a necessary step in address-
ing that neglect Serge Graceovetsky, PhD.
The Third International Fascia Research Congress is
scheduled for March 28-30, 2012, in Vancouver, British
Columbia. The selection of the MTABC by the direc-
tors of the Fascia Research Congress, a project of the
Ida P. Rolf Research Foundation, is in recognition of the
excellence, quality and commitment of BCs registered
massage therapists (RMTs).
The 2012 Fascia Research Congress will centre on the
latest in fascia research and relating the research findings
to clinical issues and practical applications. Workshops
before and after the main proceedings are also planned!
For more information, visit www.fasciacongress.org or
www.massagetherapy.bc.ca.
Manual therapists can free the structures that do the breathing as
well as teach simple, effective retraining methods for over-breathing.
strict in an alkaline environment might suggest that the over-
breathing exhibited by hypermobile individuals, was in fact a
functional, possibly physiologically useful, strategy, to assist in
tightening lax ligaments?
The answer that emerged was that as yet there is no such evi-
dence. My hope is that researchers will explore this further.
MTc: What are a few key aspects of breathing pattern disor-
ders that can be addressed by manual therapists?
lc: Manual therapists are uniquely placed to recognize the
signs of over-breathing and to teach simple, yet effective, retrain-
ing methods, as well as to assist in freeing the structures that
do the breathing: the diaphragm, intercostal muscles, accessory
breathing muscles (scalenes, etc.), the rib-cage and the thoracic
region in general.
The issues have been amply covered in a book I coauthored
with physiotherapist Diana Bradley and psychologist Chris
Gilbert: Multidisciplinary Approaches to Breathing Pattern
Disorders (Churchill Livingstone 2002). My website, www.leon-
chaitow.com, has more information on this vast topic, as well as
some free downloadable articles, plus details of the book and a
direct link to Amazon if anyone wishes to purchase it.
For the authors references, as well as references used by Dr.
Chaitow to support his reponses to the interview questions, please
visit www.massagetherapycanada.com.
Cathy Ryan has maintained a diverse, treatment-oriented massage
therapy practice, and an extensive postgraduate training roster, since
1990. She is a long-standing member of the OMTA and has served
as a subject matter expert, examiner and examiner trainer at the
CMTOs provincial licensing examinations. Ryan is the managing and
commissioning editor for TouchU.ca, which pro-
vides education for touch professionals, students
and the public. She is available to teach work-
shops and can be reached at: cryanrmt@gmail.
com or www.touchu.ca.

24 Massage Therapy Canada spring 2011

 News
Student massage therapy clinic goes green

T
he Ontario College of
Health and Technology stu-
dent massage therapy clinic
announces its shift to green
practices.
When we started the Ontario
College of Health and Technology
student Massage Therapy Clinic five
years ago, says Mary Ellen Logan,
director of academics at the college,
we had no idea how quickly patient
charts would accumulate. One small
filing cabinet quickly became two
huge credenzas taking up a large
amount of space. Although annually
we would shred any files of patients
who had not returned, we seemed to
be overwhelmed with folders. Access
to the patient files was another chal-
lenge because we have between 10
and 18 student therapists needing
Students of the Ontario College of Health and Technology massage therapy program are
the patient information at the same pleased with the results of "going green."
time for every appointment.
The college wanted to find a more
practical, as well as environmentally SOAP Vault offers two portals, an tion into her computer immediately
friendly, solution to this mounting administrative one and a therapist so that the students have access to it
problem. To this end, it had previ- area. The administrative level gives before the appointment begins. That
ously sought out software for chart- full access to all patient informa- single page is then shredded and the
ing but every option seemed to be tion to only a select few, while the signed consent form is filed alphabeti-
the wrong solution. Some programs therapists can see all of the previous cally into a binder. Our eight-drawer
were American, and didnt con- notes relating to treatments and the credenzas have now been reduced to
form to provincial governing body patients medical history, but not that single binder!
guidelines; others were to be loaded personal contact information. Logan states that feedback from
onto computers by disks that clinic After trying SOAP Vault on a the students has been wonderful.
organizers worried would become cohort of patients, and meeting with Thats the best part of our story,
corrupt and crash. As well, with great success, we decided to go com- she says. Its hard to please all the
up to 50 therapists, and a supervi- pletely green and eliminate all of people all the time, but we have
sor needing access to the files for the paper charts. notes Logan. We done just that. The students love
evaluation, the clinic foresaw many purchased 12 inexpensive tablet note- the clarity of the program, and the
challenges during the shift to going books that all had wireless capability. supervisors are thrilled that every-
green that most clinics would not One half hour before clinic begins, thing documented is legible and
have to worry about and wondered, the students are given a schedule for professional. It makes the review
for a while, if, in fact, it was the the evening and a notebook computer, of the student files faster and more
wisest route to pursue. so they can log on to the website and efficient.
Then we found SOAP Vault, the review the patients they have coming My advice to clinics wanting to
secure web-based charting program, in. When new patients arrive, we have make a green change like we did is
says Logan. The students and the them fill out a single-page patient go for it! The web-based option
clinic supervisor can all just log onto information sheet, printed off the works in our very complicated envi-
the SOAP Vault website and have initial patient intake form on SOAP ronment, so it will certainly work
access to the patient files in order to Vault, and sign a consent form. The for a smaller practice situation with
add their treatment notes. clinic receptionist enters the informa- fewer therapists involved!

Massage Therapy Canada spring 2011 25

Feature by shari auTh, lMT, laC

Forearm
Massage for the Feet
Spare the thumb and still spoil the client

I
n massage school, I received 15 hours of
reflexology training within my program. It was
during this training that I first witnessed maps
that linked various body parts and organs to
specific areas of the foot. In class, I traced across
the sole of my partners foot while looking at
reflexology maps. Id heard stories, from people
who had travelled in Asia, that reflexologists could
diagnose headaches, digestive problems, and other
physical ailments. Although my program did not
offer enough training to diagnose such things
nor qualify me to include reflexologist on my
business card I did come to know that I could give
a great foot massage. I could work out crystals
on the sole of the foot, stimulate nerve endings
and all the organs I could remember from the
reflexology map, and turn tired and achy feet into
light and happy ones.

The only problem was that all this work was done with my
thumbs. If a client came in with really tight feet or worse,
plantar fasciitis I would diligently use my thumbs to break
up the tension on the sole of the foot. Although this was
effective and felt good for the client, it was exhausting for my
thumbs. I knew from massage school that one of the more
common injuries among massage therapists is a thumb or
thenar injury. There had to be an easier way to do this work.
Massage is a labour-intensive profession. The key to lon-
gevity is learning how to work smarter meaning clients
get the relief they are looking for while the practitioner uses
as little energy as possible to fulfil this goal.

RESPONDING TO TREATMENT AND

PRACTITIONER ChALLENGES
There were a few factors holding me back from giving effec-
tive, yet effortless, foot treatment to my clients. First was the
clients positioning. The supine position allowed me no leverage
to work the sole of a clients foot. Second, in the long term, the
thumbs are not adequate tools for performing massage; they are
too fragile. Finally, I wasnt complementing the foot work with
enough massage on the muscles of the calf that are attached to
the bottom of the foot.
TOP: Glide forearm down the calf to the Achilles tendon.
ABOVE: Sink your body weight down between the heads of
gastrocnemius.
In response to these factors, I made a few adaptations to my
protocol for foot treatments.
I decided to have the client lie in the prone position so
I could use my body weight to drop down onto the sole
of the foot. I couldnt use body weight to engage the sole

26 Massage Therapy Canada spring 2011

LEFT: Glide your forearm from the top of the heel to the ball of the foot, contacting the entire surface area of the sole of the foot. MIDDLE: Glide
your forearm down the tibialis anterior all the way to the front of the ankle. RIGHT: Glide down the tibialis anterior with your forearm.

of the foot with my client in the supine position; instead, leg farthest from the table, is in front of you and the leg
I had to push my thumbs horizontally into the sole of closest to the table is behind you. This allows the front
the foot. Using body weight to sink into tight tissue and of your torso to be open toward the area youre working
wait for a release takes little effort; using muscular force to on in this case, the calf muscle.
engage the tissue takes a lot more energy. Bend your front knee slightly. Your front foot and your
I also began using my forearms instead of my thumbs to clients ankle should be in line with each other.
work the plantar surface of the foot. Because the forearms
are more durable than the hands, fingers, or thumbs and, Continued on page 30
with practice, are just as sensitive they are a bodyworkers
most prized tool. By using my body weight and forearms,
I could work out the bulk of the tension in the sole of the
foot and polish off the toes with my hands while the client
was in the supine position. This took the work out of the
job and was much easier on my thumbs.
These concepts of efficacy and efficiency led me to design
the Auth Method of Forearm Massage with the health of
the practitioners body in mind. The Auth method allows
the therapist to use the forearms to work the clients entire
body, including the feet. It also addresses how to hold the
rest of your body while using your forearms. By using the
forearms and practising good body mechanics, the practi-
tioner can work longer with less wear and tear on his/her
body. The Auth Method is also designed to blend in with
existing massage routines.

AUTh METhOD FOOT PROTOCOL

A treatment protocol designed for the sole of the foot must
include the muscles of the calf with tendons that attach to
the sole namely the tibialis anterior, the gastrocnemius and
the soleus. Tightness in these muscles can often contribute to
tightness on the sole of the foot.
To begin, start by working the gastrocnemius, then the sole
of the foot, followed by the tibialis anterior, and then fin-
ish by polishing the foot with your hands and integrating in
your existing foot massage routine.

calf glide technique

Stand alongside your clients calf in a lunge stance fac-
ing down his/her leg. Be sure that your outside leg, the

Massage Therapy Canada spring 2011 27

 With SchoolS, inStituteS and ProfeSSional enrichment centreS
The natural choice for a natural approach

Part-time options & two full-time entrance dates per year
Class sizes are small & maintain excellent teacher/student ratios
An affliation with the Misericordia Health Center provides students
with cafeteria facilities, a pool, library & computer lab
A transfer credit affliation allows MTCM students to pursue aditional
degrees after graduation
Student massage therapy clinic available afternoons & evenings
Body Structure
Body Movements
Body Functioning
Discover clinical massage therapy education at MacEwan.
MacEwans Massage Therapy program is offered on a
full-time and part-time basis. With a unique blend of
theory and clinical practice, you will become a
well-rounded therapist prepared to practice in a range
of medical and therapeutic environments or even start
your own practice!

Visit our website or join us for a personal tour

Contact 780-497-4129, massage@macewan.ca or
www.massagetherapycollege.com
204.772.8999 www.MacEwan.ca/massage

College of Acupuncture
& Therapeutics
COURSES IN ACUPUNCTURE
An intensive
Introduction to Acupuncture 1 day 4 CEUs
educational
experience, in Foundations in Acupuncture 250 hrs Certification 125 CEUs
acupuncture Facial Rejuvenation & Beyond 2 days
and related Advanced Courses in Acupuncture 2 and 8 days 4 CEUs
therapies, for
professionals. THERAPEUTIC COURSES
Cupping Massage 1 day 4 CEUs
TMJ Dysfunction 2 days 7 CEUs
Breast Massage 1 day 3 CEUs
Joint Mobilizations 2 days 7 CEUs
Cranial Mobilizations 2 days 7 CEUs
Call for more info 1-866-615-2787
www.collegeofacupuncture.com

the cranial therapy centre

focused on the treatment of pain, stress and neurological disorders since 1987

Craniosacral Therapy Training

~ with Robert F. Harris
Beginner / Intermediate / Advanced
Focused Training / Preceptorships
Please visit our website for course details.
www.cranialtherapy.ca info@cranialtherapy.ca

28 Massage Therapy Canada spring 2011

 MLD CLASSES ACROSS CANADA
Train in the original Dr. Vodder method of MLD
and CDT for edema management.
Strong focus on hand skills
Certified Instructors
CE credit

THE QUALITY IS IN OUR HANDS

Training excellence
in researched techniques.
www.vodderschool.com
info@vodderschool.com
(800) 522-9862

Ready to go back to school? Advertisers Index

Massage therapy regulations are Bowen College ............................................................ 17
evolvingdont be left behind. Canadian College of Osteopathy .........................31 (IBC)
MH Vicars School offers the Canadian Massage Conference...................................... 9
Centennial College RMT Program ................................ 29
best way to upgrade your
College of Acupuncture & Therapeutics ....................... 28
massage training without Contemporary Medical Acupuncture ..................... 2 (IFC)
putting your career on hold. The Cranial Therapy Centre ......................................... 28
Grant MacEwan College .............................................. 28
Our innovative program combines Know Your Body Best ........................................32 (OBC)
in-class practical training in Alberta Kosim Group Co. Inc ................................................... 17
with custom print and online materials Lackner & McLennan Insurance ................................... 27
that you work on from home. Complete your education without Lethbridge Community College ................................... 28
having to relocate or give up your practice! Massage Essentials ....................................................... 15
Massage Therapy College of Manitoba ........................ 28
Join our advanced placement program and graduate with a Massage Therapy Supply Outlet ................................... 23
Myofascial Release Treatment Center ........................... 17
2200-hour diploma in only a year! Classes start fall 2011.
Parker Seminars ............................................................. 4
ProMassagers LLC ........................................................ 29
Call us today! 1-866-491-0574 Relaxus Products .......................................................... 20
Talus Inc ....................................................................... 19
www.mhvicarsschool.com Upledger Institute ........................................................ 21
MH Vicars School of Massage Therapy ........................ 29
mh vicars school Dr. Vodder School ........................................................ 29
of massage therapy
f or ind e pe nd e n t l e a r ne r s

Massage Therapy Canada spring 2011 29

Continued from page 27
Place the upper forearm closest to your client at the top
of the gastrocnemius, just below the popliteal fossa.
Take your other hand and place it under the ankle.
Glide your forearm down the calf to the Achilles tendon,
sinking your body weight down between the heads of
the gastrocnemius (Images 1 and 2).
As you glide down the leg, bend the knee of your front
leg; it is the bending of the knee that takes you forward
in the stroke.
At the end of the stroke, lighten your pressure and glide up
the inner calf back up to the top of the calf, and repeat.
Work layer by layer, patiently dropping your body weight
onto the first layer of tight tissue. As that layer releases, you
will sink into the next layer of tight tissue. Work patiently and
methodically, waiting for releases in the tissue. By doing this,
not only will the massage work you do be thorough and effec-
tive, but also your clients experience will be less painful and
more enjoyable. Remember, massage isnt something we do to
our clients, but something we do with them. Listen to your cli-
ents body it will tell you how fast and how deep to go.
Repeat this stroke as necessary, or reposition your forearm
medially and laterally to glide down the belly of each head of
the gastrocnemius all the way to the Achilles. This stroke can
be done with or without a bolster.
Forearm technique for the sole of the foot
After working the muscles and fascia of the back of the calf,
it is time to work the sole of the foot.
Reposition yourself so you are standing down by your
clients feet, facing his/her head. Depending on the
height of your client, stand either alongside the table by
his/her feet, or at the bottom corner of the table.
If theres room, I like to put one hip on the table. If the
client is taller than the table, there will not be room for
you to sit. This allows me to give my own feet a rest
while working. Again, massage is labour-intensive, so
conserve your own energy when possible. If youre sitting
on the table, keep one foot on the ground, connected to
the Earth.
Take the hand farthest from your client and position it
under your clients ankle for support.
Position your upper forearm (this includes your elbow
not the point of the elbow, but the continuation of
the forearm) at the top of your clients heel.
Glide your forearm from the top of the heel to the ball of
the foot, contacting the entire surface area of the sole of
the foot (Image 3). Angle your forearm with the contours
of the arch of the foot. To increase the intensity, drop
more of your body weight down onto the foot, stabilizing
with your other hand. Remember, the foot supports your
clients entire weight; it can take a lot of pressure.
At the end of the stroke, lift your forearm off the foot
and begin the stroke again, slowing down as necessary
to wait for releases in tight areas of the foot.
Patiently work layer by layer, waiting for releases in the
plantar fascia. Reposition your forearm medially and later-
ally to get different angles on the sole of the foot, focusing
on the inner and outer arches of the foot, as well as on
30 Massage Therapy Canada spring 2011
any areas that need special attention.
After youve thoroughly massaged the sole of the foot, have
your client turn over to the supine position and begin
working the tibialis anterior. The tibialis anteriors tendon
spreads along the arch of the foot, so tension in the tibialis
can contribute to tension in the arch of the foot.
Forearm technique for the tibialis anterior
Forearm work on the tibialis anterior can be done with
either forearm, depending on your position.
Stand by your clients feet with your left hand under
your clients left ankle and your right upper forearm at
the top of your clients tibialis anterior.
Glide your forearm down the tibialis anterior all the
way to the front of the ankle (Image 4).
Repeat this stroke on both sides and as many times as
needed.
For more leverage and a deeper stroke, stand alongside
the table at the level of your clients knee. Spread your
stance so that one foot is at the level of your clients
ankle and the other is at the level of your clients hips.
Keep your back straight. Position your upper forearm
closest to your clients feet at the top of the tibialis ante-
rior and rest your other forearm on your clients thigh.
Glide down the tibialis anterior with your forearm
(Image 5). Position your torso so that you are hovering
over the leg and can effectively use your body weight to
drop into your clients tissue.
As you glide down the tibialis, bend the knee that is
closest to your clients feet; this will move you down the
tibialis anterior. Co-ordinating the bending of the knee
with the stroke integrates the movement within your
own body, resulting in better body mechanics.
CONSERVING YOUR hANDS
FOR ThE FINER ThINGS
Now that the bulk of the tension from the plantar surface has
been released, you can integrate your usual foot routine, know-
ing the deep work is done and you have reserved your hands for
doing your fine-tuning work on the feet. Use your hands to pol-
ish off the toes and work the top and sides of the foot, stimulate
points or do soothing strokes.
Foot massage is a favourite among clients, but the sole of the
foot is used to withstanding a lot of pressure, and tension in
the foot can be deep and difficult to release. Big jobs require big
tools. Using your forearms instead of your thumbs and practising
good body mechanics will contribute to your career longevity and
a happier you.
Shari Auth is a licensed massage therapist and acupuncturist, and
is certified in the Rolf method of structural integration. She is the
creator of the Auth Method and has a full-time practice in New York
City. Auth teaches continuing education workshops and offers a
DVD titled Auth Method of Therapeutic Massage:
A Guide to Using the Forearms. For DVD and
workshop information, visit www.authmethod.
com. To contact Shari or learn more about her
practice, visit www.shariauth.com.
6 Canadian Campuses

Toronto (english)
Winnipeg (english)
30 years of experience in the Traditional Manual Practice of Osteopathy
877-893-0367
416-597-0367 This 5 year part time program is designed for health-care professionals to gain
experience and evolve their practices while studying.

The Canadian College of Osteopathy offers:

Halifax (english) A program tailored to professionals already in clinical practice
Vancouver (english) A professional student clinic experience
A low instructor to student ratio
Quebec City (francais) Experienced faculty with many years of clinical practice
Montreal (francais) The practice of traditional manual osteopathy requires a fine touch, a gentle heart,
800-263-2816 and a desire to learn. The emphasis at the College is to ensure that the hand-to-hand
transmission of traditional osteopathy is preserved. Our lead instructors hold
514-342-2816 specialization in certain aspects of the program to ensure that the knowledge passed
on is of the highest quality.

www.osteopathy-canada.com Successful graduates of the Canadian College of Osteopathy receive a Diploma in

www.osteopathie-canada.ca Osteopathic Manual Practice (DOMP) and are automatically eligible to become a
member of the Ontario Association of Osteopaths and the Canadian Federation of
Osteopaths.
Join our
Any practitioner, who is licensed, certified, or registered, in the province of Ontario, is
Osteopathic eligible to enrol today. Having this uniform high admission standard allows the
Family Canadian College of Osteopathy to tailor its program to those therapists already in
clinical practice, so that they can evolve their practice from one that is satisfactory, to
one that offers daily gratification to both the patient and the Osteopath.