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 SUMMER 2014 ISSUE

CONTENTS
Features
COVER
Focus: Ontario
14
p14
Onward and upward

Breath of life 18

Coming out 22
of the shadows

Separating fact 24
from fiction

p18
Departments
p24 From the editor 5
Touch Points 6
Industry news and events

RMT Tech Talk 30

Reading the fine print

Columns
The learning curve 10 On the Cover:
Our stories matter Andrew Lewarne, executive direc-
tor and CEO, Registered Massage
Therapists Association of Ontario
Few and far between 12
Under the sea

MASSAGE THERAPY CANADA SUMMER 2014 3

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Editor
Summer 2014 - Volume 13, ISSue 3
from the editor
Mari-Len DeGuzman mdeguzman@annexweb.com

(905) 726-5445
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No part of the editorial content of this publication may be
reprinted without the publishers written permission. 2013
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.
All advertising is subject to the publishers approval. Such
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.
I
t looks like national accreditation for massage therapy
education will be commencing as early as 2015.
The newly established Massage Therapy Council for Accreditation (MTCFA),
currently led by the founders group, has commenced the work of incorporating
the MTCFA under the Not For Profit Corporations Act. The founders group
consists of three stakeholder representatives: Randy Ellingson for the Canadian
Council of Schools, Lori Green for the Canadian Massage Therapist Alliance, and
Corinne Flitton for the Federation of Massage Therapy Regulatory Authorities of
Canada.
The founders group is also tasked with drafting the by-laws, developing the
descriptions for the roles, responsibilities and qualifications of board members,
and developing a nomination process for the appointment of the initial board of
directors of the MTCFA.
As of this writing, the founders group is consulting with the massage therapy
community about a number of proposed documents: the process for nomination
and appointments to the first MTCFA board, criteria and process for selecting board
members, and the description of the board members roles and responsibilities.
Early this year, the MTCFA launched the council website, which contains
information about the planned national accreditation for massage therapy education,
and updates on the progress of the founders group.
According to the October 2013 report released by the national accreditation
planning committee, the MTCFA is expected to begin the accreditation process
on its second year of operation in 2015 starting with four program reviews and
accreditation. The number of reviews will increase each year and by 2020, the
council will have accredited a total of 74 programs, nationally.
National accreditation is the next best thing to massage therapy regulation. It
ensures that educational institutions teaching massage therapy programs are at
par with nationally accepted standards, and elevates the level of competencies of
practitioners across Canada regardless of whether they come from a regulated or
non-regulated province.
As national accreditation elevates the level of education for would-be massage
therapists, it also compels educational institutions to raise the standards of their
curriculum and effectively weed out the uncommitted and underperformers.
This will also open up more opportunities for massage therapists as practice
mobility gets easier and recognition of their high standard of education becomes
more pronounced.
An undertaking as big as this needs the support of all stakeholders involved, and
it looks like the entire profession is rallying behind this and why not? A national
accreditation body for massage therapy education signifies that the profession is all
grown up and is poised to become a significant player in the health-care realm as it
should be.
For updates on the development of the national accreditation for massage therapy
education, visit the MTCFA website at www.mtcfa.ca.

www.massagetherapycanada.com Mari-Len De Guzman

Editor

@MTCanadaMag

MASSAGE THERAPY CANADA SUMMER 2014 5

Touch Points
Ontario rejoins national massage therapist alliance
T he Registered
Therapists of
(RMTAO) has rejoined the
Massage
Ontario
Canadian Massage Therapist
Alliance (CMTA), a national
alliance of massage therapist
associations, citing the necessity
for a unified national approach for
the profession.
In a letter sent to the CMTA,
Krystin Bokalo, chair of the
RMTAO, expressed the Ontario
associations commitment to sup-
porting and maintaining an open
dialogue with other provincial mas-
sage therapy associations.
The RMTAO is in full agree-
ment that there is a clear and unde-
niable need for a national massage
Alberta wants residents to talk
about wellness
A lbertans are invited to
share ideas and inspire
new ways to improve wellness
in communities across the
province.
The provinces new
program, Lets Talk about
Wellness, engages resi-
dents and aims to broaden
Albertans collective under-
standing of health and well-
ness and shift conversations
from the delivery of health
care to the factors that con-
tribute to wellness.
Lets Talk about Wellness
conversations begin this fall,
and they will be led by the
associate minister of wellness,
Dave Rodney, and chief medi-
cal officer of health, Dr. James
Talbot. Albertans can visit
talkwellness.ca to express their
interest in taking part.
Participants will have an
opportunity to join together
and share their wellness pri-
6 MASSAGE THERAPY CANADA SUMMER 2014
INDUSTRY NEWS AND EVENTS
therapy presence, Bokalo said.
The RMTAO was previously
a member of the CMTA until it
withdrew its membership in 2011.
Then RMTAO chair Amanda
Baskwill cited, in the RMTAO
annual report, the reason for the
withdrawal as due to the amount
of financial and human resources
that would have been required to
participate in this organization.
In deliberating to rejoin the
CMTA, Bokalo said some of the
concerns voiced in recent board
discussions had to do with the
CMTAs financial structure and
compliance with the Not-For-
Profit Act and the integration of
any future amendments to the
orities this fall through local
community events and online
conversations.
Alberta has become a
leader in disease prevention
and wellness, but there is
so much more that we can
do thats why were asking
Albertans to participate in
this important conversation.
I encourage all Albertans to
think about the possibilities
we have to strengthen our
collaboration and broaden
the amazing opportunities for
Albertans to enjoy a greater
degree of wellness, said
Rodney.
The Lets Talk about
Wellness engagement sup-
ports Albertas Strategic
Approach to Wellness, which
aims to improve health
outcomes for Albertans by
addressing the social, eco-
nomic and environmental fac-
tors that contribute to health
Act to the alliances by-laws.
At this time, the RMTAO
board of directors sees the necessity
for a unified national approach, and
would like to move the profession
forward by joining the discussion as
a part of the CMTA.
As well, in this capacity, the
RMTAO would like to work
towards ensuring the CMTA is fully
compliant with the implementation
of the Not-For-Profit Act as well as
any other necessary amendments
to its financial structure, Bokalo
wrote in the letter to CMTA chair,
Marilyn Sparling.
Commenting on RMTAOs
recent decision, Sparling said the
CMTA is currently in the process of
and wellness.
Wellness is more than not
being sick or hurt it is some-
thing we build together with
our families, schools, com-
munities and workplaces, in
our parks and playgrounds,
the places we live, the air
we breathe and the choices
we make. Promoting wellness
in our communities requires
all of us to work together as
individuals, families, com-
munities, business and gov-
ernments. The true wealth of
our province is our people
promoting the wellness of
integrating the Ontario association
with the national alliance and will
be proceeding as soon as possible.
The CMTA very much wel-
comes the RMTAOs decision to
enter negotiations for full par-
ticipation and membership in the
National Alliance, Sparling told
MTC in an email. The massage
therapy profession is now an impor-
tant part of the health-care sector in
Canada and there is a clear need for
national coordination to advocate
on behalf of the profession. We
very much look forward to working
together with the Ontario asso-
ciation as part of the overall positive
dialogue within the profession.
Mari-Len De Guzman
Albertans is essential to our
future, said Talbot.
The Government of
Alberta has undertaken a
number of initiatives over
the past few years to help
improve the quality of life
for Albertans, including:
Tobacco Reduction Strategy;
Get Outdoors Weekend;
International Symposium on
Wellness; U-Walk; Healthy U
initiatives; 5&1 Experiment;
Social Policy Framework;
Poverty Reduction Strategy;
and Early Childhood
Development.
New Brunswick gears up for regulation
N ew Brunswick is now in
full swing to establish
the new college of massage
therapy, after its passage of
Bill 25 last winter regulating
the provinces massage
therapy profession.
The college of massage
therapy would be formed in
order to protect the public
and govern regulated mem-
bers of the profession.
This legislation came after
a lengthy process, which
began in 1990 when the
New Brunswick Massotherapy
Association (NBMA) first decid-
ed to write the Massotherapy
Act.
The Association of New
Brunswick Massage Therapists
(ANBMT) was then officially
incorporated into the Act in
1994, and in 2004 the two
associations formed the joint
legislative committee (JLC).
However, progress was halted
because the third and final pro-
vincial association refused to
get on board.
John MacKenny, president
of the NBMA, described the
process as a slow go.
What had to happen was
the two of us really needed to
work together and we had to
go in and accommodate the
third, because the government
wanted everybody to be on
the same page. So we had
to change and ratify things in
order to make the third associa-
tion accept it, he explained.
According to Pierre Wust,
president of the ANBMT, the
Act outlines the participation
of all three associations and
acknowledges that any current
member in good standing of
an association would become
grandfathered into the new
college.
The situation in New
Brunswick is still fresh and noth-
ing has been set in stone as of
yet, but speculation is that New
Brunswick will operate along
the same lines as the other reg-
ulated provinces. These include:
requiring an entry exam to the
college, membership fees and
a minimum amount of hours
needed to reach the provincial
standard.
New Brunswick was some-
what of a surprise because
theyve been trying for as
many years as I know, but I
guess the timing was finally
right for it to go through, said
Florent Villeneuve, director of
schools for the International
Complementary Therapy (ICT)
Schools, an institution special-
izing in massage therapy
education with locations across
Canada, including in Moncton,
N.B.
Kathy Watson, government
relations advisor for the Natural
Health Practitioners of Canada
(NHPC), has weighed in on
what regulation means for
practitioners in the province.
I think its probably both
positive and negative and its
important for massage thera-
pists to understand that when a
province takes regulation of a
health profession they do that
with the idea of protecting the
public, Watson said. So their
focus isnt to provide better ben-
efits to massage therapists, their
focus is to protect the public
from being harmed.
However, Watson points
out that there are many who
may fall just outside of college
requirements, or who may not
be able to go back to school
to take the entry exam with
the new college, and their
practice will now be set at a
disadvantage.
Some practitioners are
going to choose not to be part
of the college, and thats just a
matter of economics. Some will
the final two people to be a
part of the founding committee.
Realistically, its going to
retire, some will try to practice be another 12 to 18 months
outside of the college boundar- before its fully functioning like
ies, and very likely, the people one of the other colleges in one
who are going to find the most of the other three provinces,
trouble trying to go back to he said.
school and learn how to qualify The fate of the three pro-
for college entry are most likely vincial associations is also up
to be the ones that are function- in the air following regulation.
ing and working in outlying MacKenney said hed like to
communities, Watson said. see one association for the
But Candace Gilmore, entire province, but not every-
academic director for the one shares this sentiment.
Atlantic College of Therapeutic The future of the massage
Massage in Fredericton, said therapy associations in New
the past, present and future stu- Brunswick is uncertain as there
dents at her school have noth- is no requirement to remain a
ing to worry about in regards member in any of them. The
to passing the entry exam. ANBMT has currently over 400
This shouldnt affect my active members. And while it
school because ACTM already will be actively trying to main-
meets the national competency tain membership, the ANBMT
standards, she said. Right is presently not interested in a
now our students can go to merger with the other associa-
Ontario and write exams tions, Wust said.
there. So, as far as them being Jessica Beaulieu
prepared, theyre well pre-
pared.
Villeneuve echoed that state-
ment in regards to ICT Schools.
It wont affect us because
our curriculum is established
in Ontario, so we meet the
requirements for the CMTO
(College of Massage Therapists
of Ontario).
The college is still in its early
stages. Were putting things
together right now for new stu-
dents and people entering the
province, to go in and be able
to do college exams. Thats
probably one of the biggest
highlights that were working
with the college on right now,
MacKenney said.
He said there are only four
of the required six committee
members in place now. The
New Brunswick Ministry of New Brunswick legislative assembly
Health has yet to put forward building in Fredericton
MASSAGE THERAPY CANADA SUMMER 2014 7
The learning curve
Our stories matter
Creating knowledge-sharing opportunities for massage therapists
I am fortunate that teaching continuing
education unit (CEU) courses gives me
the opportunity to travel throughout
Ontario and the rest of Canada
during the year. Meeting with massage
therapists from around the country and
talking about clinical practice has always
inspired me to read up on the various
modalities and techniques they use. I
know that without these conversations I
would not be treating clients with all the
tools I now have at my disposal.
Learning about how other therapists
practice in their clinical settings is
without a doubt one of the most potent
ways of motivating me to explore new
approaches to treatment and to seek
out new information. This helps me
evaluate, adapt and utilize the practices
and techniques that I feel will benefit
my clients. I am fortunate to have this
opportunity for collegial interaction and
ongoing learning.
When speaking with other presenters
that I meet on the road, they too express
much the same sentiment. It is one of
the perks that we get from travelling.
However, most massage therapists
do not get such a wide and diverse
sampling of what other therapists are
up to. Many therapists may interact
on occasion with those near to them
and/or get to meet others when taking
various CEU courses, attending annual
general meetings or going to conferences
when possible. Many more find that
outside of fulfilling the requisite number
of CEU hours they have little contact
with the diverse number of those in
our profession and therefore miss the
wide range of national knowledge. Even
when taking CEU courses they are often
seeing many of the same MTs, who
already share their interests. Yet, most
will tell you that this collegial exchange
is one of the benefits, often hidden or
surprising, about such interactions.
10 MASSAGE THERAPY CANADA SUMMER 2014
Unfortunately, I have had many of the
therapists tell me that those interactions
seem few and far between.
I have been wondering how we could
expand our contact with each other
with respect to what we do day-to-day
in our clinical practices. Certainly,
reading journals and professional
publications like Massage Therapy
Canada is central and helpful. This need
for learning about what it is that others
are doing in our profession is what
sustains professional journals like this
publication.
Online searches can lead us to research
articles, case studies and the like. These
provide us with valuable information
with which we can re-evaluate certain
aspects of how we choose and perform
an assessment, a technique, a treatment
plan and the like.
The formality inherent in research
studies and case reports can present
varying degrees of evidence concerning
causative certainty within very
circumscribed explorations of technique,
theory and modalities. This careful
collection of evidence brings about the
science of massage therapy. We can
add this data to the mix of our current
BY DAVID ZULAK
theories about how massage works, to
our assessments of clients and, hence,
to the treatment plans we negotiate.
But from research and its evidence we
cannot get what we need most to be
therapists.
We need to learn from the experiences
of other therapists, along with our
own clinical experience of trial and
error. We need not just data; we need
to learn to recognize the patterns that
clients present with, learn to recognize
common patterns of compensations
or adaptations that occur with various
impairments we see. Most importantly,
learn the art of modifying these
commonalities (or to know when to
abandon them, in certain circumstances)
so we can still see the unique inter-
relationships of adaptations of each
individual client.
Case studies might come to mind as
possible sources. However, case studies
are quite formal in nature, lengthy
(20 to 40+ typed pages), and require
a good deal of time to put together.
(For examples visit the Student Case
Study Award page on the website of
the Registered Massage Therapists
Association of B.C.) They do take place
in a clinical situation, but they are insulated by distance from more diverse about, stories put out there without
required to articulate a specific thesis, contact. judgement.
explore it and report the results. They Having a place online where other These stories will require no review, no
remain constructed scenarios that try to therapist can send informal reports or critique, and no comment on another
limit variables. They can be great sources field notes could possibly help provide field report. The only restriction is that
of ideas for potential research projects. a reservoir of stories, experiences, they not be of professional misconduct,
While I believe it would be good for all questions, and suggestions that either in the content or in the telling. If
massage therapy students to be required therapists across the country and a therapist wants feedback or a debate,
to do such a project as part of their abroad could contribute to and access. leave an email address. If not, thats ok.
training, it is a lot to expect from most A submission could include a few Such a site could be a place to hear
practicing therapists. Yet, it is from those sketches of the client (especially what what others are up to, that may show
with experience in the field that we is pertinent to the story), the brief trends in our profession, and suggest
would hope to hear. S.O.A.P notes of a treatment, or topics of research for those so inclined.
I believe that what we also need is summary of several all to sketch out Or, it could be a place to just find
something a little more grass roots, a the context and then a short write-up out that there are others who have
little more accessible, and something in of an experiment, a novel approach, experienced the same thing a place
which any MT could contribute to in a lesson learned, an observation that for stories that we can share with fellow
order to share the stories of what it is changes ones perspective or a persistent massage therapists.
we do, what it is that many of us are up problem or question that keeps
to, across the country. Something that popping up but for which one seeks an David Zulak is a RMT,
speaks to the art of massage therapy. answer. author and educator. The
That is, how we put it all together in the Posts in this online community majority of his teachings
moment. could also include a collection of those focus on clinical assessment,
All of us need to hear how others interesting events that happen in the treatment and advanced
make their treatment choices. What clinical setting humorous, frustrating, techniques. He is the author of the text-
theories or models do they draw on amazing, mind-boggling or inspiring book Comprehensive Assessment for
to supply the context for assessing stories about our work occurrences Massage Therapists. He works in a busy
and treating; do they use one model, that we just would like to tell someone group clinic in Brantford, Ont.
or several, and when? Do others also
use, for example, Strain Counterstrain
followed by stretching (employing
contract-relax, on occasion) to treat
trigger points? What are the innovative
and creative approaches that others
have found to work in specific
situations?
What I have in mind is a database
that contains what would technically be
called field notes.
Field notes are defined in The Case
Study of a Research Method, 1997, by
Susan Soy. Field notes record feelings
and intuitive hunches, pose questions,
and document the work in progress.
They record testimonies, stories, and
illustrations which can be used in later
reports. They may warn of impending
bias because of the detailed exposure of
the client to special attention, or give an
early signal that a pattern is emerging.
They assist in determining whether or
not the inquiry needs to be reformulated
or redefined based on what is being
observed.
So many massage therapists work
on their own and do not often have
opportunities to consult with peers.
Others may have small informal groups
they can consult with but may be

MASSAGE THERAPY CANADA SUMMER 2014 11

Few and far between BY JULES TORTI

Under the sea

Tracing the origins of ingredients in body products used in practice
Its easy to buy and use body products without considering the
source, but with all of the recent hype surrounding the benefits
of natural products, perhaps its time to take a deeper look at
their origins.
Two major products that massage therapists use coconut oil
and Dead Sea salts rely on a geographically limited bounty.
And then theres seaweed, a recent tonic that is making big
waves in different parts of the world.

BOTTOMS UP
When visiting Placencia, Belize, our daily routine involved stacks
PHOTO CREDIT: JULES TORTI

of banana pancakes and thick Irish moss shakes offered at The

Shak, a local beach caf.
After a chance encounter at a gas station off the
Hummingbird Highway where I opted for the most radical
choice in the cooler a peanut sea moss drink I was hooked.
I expected a woodsy-chalky, peanut butter concoction but was
pleasantly surprised with the pleasing soy overtones and eggnog
viscosity. The moss shakes are derived from carrageenan, a red,
edible seaweed extract used as a thickening and gelling agent in
dairy products like ice cream.
Wherever I travel, the itinerary is not just about landmarks
and scenic vistas but also a carefully researched list of things to
sip and eat. This summer, in Quebecs Magdalen Islands, Ill be
able to add to my seaweed aficionado repertoire by sampling
sea tea. The Magdalen sea tea is the leftover liquid slop from
seafood cooked in seaweed-lined pots.
For an extra hit of sea serendipity, La Fille de la Mer on
Magdalen makes handmade sea soaps and a Sea Kelp massage
oil with ylang ylang an essential oil known to stimulate
relaxing and calming sensations.
At Algaran Organic Irish Seaweed Products for Health and
Beauty in Ireland, one can find the likes of Irish seaweed
spaghetti harvested from the islands west coast. Their skin
rescue balms, for calming itch and serving as a protectant, are
made from seaweed, organic sunflower oil and pure organic
beeswax; and for kissy-cool lips, they make a seaweed lip balm
too.
THALASSOTHERAPY
Yes, there is a name and science behind seaweed. Its a shake,
its a moisturizer, its spaghetti, its trending now. Fresh brown
seaweed and warm salt water are the authentic ingredients
of thalassotherapy (therapy with seawater) elixirs. The
presence of copper, zinc and iron gang up as a task force for
anti-inflammatory battles, anti-infection and speedy healing.
The vitamin compounds stimulate cell growth and act as
Seaweed farming is a huge industry for the women of Zanzibar.
antioxidants, and the amino acids boost protein synthesis and
skin elasticity.
Seaweed products have also been linked to the longest-living
populations in Okinawa, Japan, and Nova Scotia. Sea vegetables
were among the seven to 10 servings of fruit and vegetables
eaten on a daily basis. For east coast centurions, a dulse-dense
diet could be the underwater miracle.
Gurneys Montauk Resort & Seawater Spa in Montauk,
New York, is the only authentic thalasso centre in the United
States. The spa menu is delicious: a spruce and pine-scented
soak in a 94-degree sea water hydro massage thalasso tub after
an invigorating coffee bean, frankincense, salt and almond oil
scrub. There are also algae body polishes with pine oil, warm
seaweed wraps, maple sugar scrubs and detox seaweed foot
baths, if you cant get enough dulse.
Canadas largest thalassotherapy spa, Aqua Mer
Thalassotherapie, is in Carleton-sur-Mer, Quebec. The
marine-focused spa offers niche treatments for nasal hygiene,
cellulite and anti-tobacco management. There are algae-based
cryotherapy sessions, seawater hydrotherapy baths, seawater rain
massages and an intense itinerary for a five-day rehab requiring a
commitment to 34 treatments in that time span.
SEAWEED 101
Diane Bernard, known as the seaweed lady of Sooke Harbour,
B.C., suggests a skeptical and informed approach to seaweed spa
treatments. Sometimes the seaweed is harvested in fresh water

12 MASSAGE THERAPY CANADA SUMMER 2014

tanks or lakes, making it void of the inherent benefits found in
naturally sourced seaweed. It should smell like the ocean but not
fishy (since this indicates that it may have been harvested from
the shore in a washed-up composting clump), and should not be
perfumed.
As president of Outer Coast Seaweeds, Bernard is picky for
good reason: she supplies high-end restaurant kitchens across
Canada and her product is served within 24 hours. Her seaweed
body products are hand-harvested and free of dyes, animal
by-products, animal testing and artificial fragrances. As massage
therapists, we have an underlying commitment to provide safe,
hypoallergenic products and services to our clients. In terms
of our own health and well-being, we must also consider the
products that we are exposing ourselves to on a daily basis.
ROAD TRIP TO ZANZIBAR
Reading about the entrepreneurial spirit of the seaweed ladies
of Zanzibar was definitely part of the lure of visiting the
archipelago off the coast of Tanzania, Africa. My partner and
I were staying on the east coast of the island, in the Michamvi
peninsula of the Indian Ocean. There, we had front-row seats to
the tide tables.
Like clockwork, we would see the seaweed ladies pass by,
striding with buckets on their heads, around 1:30 in the
afternoon. Most of them were barefoot, which was remarkable
because the coral rock underfoot was sharp, uneven rubble.
Seaweed farming in Zanzibar is a huge industry for women
over 12,000 residents find steady employment harvesting
seaweed. The Seaweed Centre is the hotbed for drying and
processing collected seaweed for juice, soap and moisturizing
creams. Two years after initial training and recipe development
began in 2006, a seaweed grinder was acquired to enable the
women to produce and sell their first soaps.
Local women from Paje have found a lucrative enterprise
that allows for learning transferable skills, negotiation, English
exchange and cost-planning. Zanzibar produces 5,000 metric
tonnes of seaweed a year all picked by hand.
Seaweed can grow rapidly, much like bamboo, in ideal
conditions. Viable pieces are tied to rope strung across the low-
tide fields. Work hours are dictated by the tide: when the tide
is low, work is full force; and high tide signals the days end.
On the east coast, the tide levels can change rapidly by nine
meters.
Many women carry buckets or sacks weighing in at 10
kilograms not an easy feat especially if you add a broiling
48-degrees Celsius to that weight, uneven footing and a four-
kilometre picking route. Some of these women are single and
struggling to support a family, many have only elementary
school education. They know hardship all too well, but seaweed
harvesting has unexpectedly offered them hope, an income and
a social network.
The seaweed women are engaged in the grassroots movement
of their industry. They interact with travellers, farmers,
producers, buyers and packers and visualize their soaps and spa
products on a larger scale. They understand supply and demand
and how networking can attribute to distribution.
In 1973, plans to introduce seaweed to Tanzania to create
a diversion from fragile fish stocks flopped. Low world prices
made for an unsustainable market, and heavy monsoon rains
destroyed the sensitive seaweed environment (salinity is critical
for survival and fresh water is a fast and efficient destroyer).
Two new species of seaweed were introduced, which were more
resilient and gained better market prices for world consumption
in toothpaste, agar, antibiotics, furniture polish, medicinal
capsules and a bevy of spa indulgences.
Seeing the women pass by daily as the tide came in and
engaging in conversation with them made the tangible final
product a true work of art, worthy of appreciation. It certainly
made me think about the origins of our body products at home
and work.
Next time you warm that oil in your hands and suds up
post-treatment with soap, consider these products path and
origin, prior to ending up in your treatment room. Whether
its a clove bar from Zanzibar, Irish seaweed lip balm or the
ambitions of the seaweed lady of B.C. that entice you, each has
an admirable story of perseverance.
Maybe you are already tuned in to the local scene and have
found a responsible product source. If anything, find yourself
an Irish moss shake and contemplate how you can elevate your
clients massage experience to a new and educated level, locally
and globally.
Jules Torti has been a RMT since 1999 and a free-
lance writer since age six. In between massage
engagements, she travels to Africa to be with chim-
panzees and writes about her zany travels for
Matador Network.
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MASSAGE THERAPY CANADA SUMMER 2014 13
Focus: Ontario
Onward
and upward
Massage professionals push to take their place in health care
W
hen the Ontario Board of Regents first regulated the practice of massage in the province of
Ontario in 1919, it was in recognition of massage therapy as a form of health care. Today,
nearly a century later, Ontario continues to play a leadership role in propelling the profession
further up in the health-care chain.
Although massage therapy has evolved significantly through
the decades, debate over professional identity still remains:
relaxation versus therapeutic massage, spa setting versus health
care setting. Disagreements notwithstanding, and as far as
the Ontario regulatory college is concerned, massage therapy
remains within the health-care realm.
I think there are still some conversations going on within
the profession as to how they identify themselves, says
Corinne Flitton, registrar and CEO at the College of Massage
Therapists of Ontario (CMTO). The college sees them as
regulated health professionals, so we expect our vision is that
they should enter the current health-care system.
Despite being one of the most highly utilized forms of com-
plementary and alternative health services, massage therapys
recognition as a necessary component of the overall health-
care system remains wanting, and those in the leadership roles
within the profession are continuously trying to change that
for the better.
PROACTIVE APPROACH
The Registered Massage Therapists Association of Ontario
(RMTAO), an organization of about 5,000 registered massage
therapists, is among those working to elevate the profession. To
accomplish this, RMTAO believes massage therapy needs to
be part of a larger conversation on improving Ontarios overall
health-care system one that focuses on proactive prevention
and wellness promotion.
What needs to be talked about in Ontario is that we need
to look at a new health-care model, says Andrew Lewarne,
executive director and CEO of the RMTAO. At the moment
were reactive. Every provincial health plan seems reactive.
Ontario Ministry of Health says 25 per cent of health-care
costs are due to preventable illnesses. In 2010-2011, more
than 271,000 hospital emergency room visits could have been
treated in alternative primary care settings at lower costs.
14 MASSAGE THERAPY CANADA SUMMER 2014
BY MARI-LEN DE GUZMAN
The Ontario government estimates that if no changes are
made to improve the health-care system today, health-care
costs will increase by $24 billion by the year 2030.
Lewarne believes prevention is key to sustaining the countrys
health-care model. Massage therapists and other alternative
and complementary health practitioners will be the ideal part-
ners for pursuing this goal of wellness and prevention.
That means we need to be partnering up, we need to be
able to turn around to the gatekeeper physicians, the family
doctor, and say, heres what we can do, heres how we can do
it and if you want to get some really good responses to whats
walking into your office, refer them to me.
However, for this to succeed, Lewarne says alternative and
complementary health services need to be partially supported
by government.
RMTAO is engaging the legislative leadership to propose a
tax credit for Ontarians who use the services of complemen-
tary and alternative health practitioners covered under the
Health Professions Act for preventative health care.
Under the current system, only health expense receipts in
excess of $2,171 (for 2014) or three per cent of net income,
whichever is lesser, can be claimed for federal tax credit
The RMTAO believes this current system is reactionary as
opposed to proactive. A tax credit for preventative health care,
such as what the RMTAO proposes, is more proactive and less
costly, effectively easing the financial pressure on an already
cash-strapped health-care system in the long run.
Lewarne sees this as a win-win for both massage therapy
professionals in Ontario and the provincial health-care sys-
tem as preventative health care will become more accessible
for Ontarians, putting less strain on hospitals and acute care
services.
Massage therapy, which is one of the most widely used
among the complementary therapies, if you make it more
available then you know that people are going to use it and
Massage therapists have a role to play in overall efforts toward disease prevention.
when they use it the credibility of the profession is going to
go up, Lewarne says.
CREDIBILITY
A constant challenge that is certainly not unique to Ontarios
more than 11,000 RMTs, as it is faced by practitioners in
other provinces, is a bruised credibility with the insurance
industry. Its the consequence of malicious and fraudulent acts
of a few unscrupulous practitioners that have effectively man-
aged to stain the profession in the eyes of insurers. The situa-
tion has been improving significantly in recent years, however,
as practitioners across the country, through their respective
professional associations, have taken an active role in engaging
the insurance industry and educating them on professional
practices in hopes of aiding the reduction of insurance fraud.
Most recently, the RMTAO has engaged the Canadian
Health Care Anti-fraud Association to ensure the insurance
industry is aware of the steps and systems in place to help
prevent fraud.
These kinds of clarifications are really important and they
need to happen, says Lewarne. And as that happens, you will
find that the responsiveness both to the insurance industry and
from the insurance industry is going to go up.
Ontario is also pursuing means of enabling regulated health-
care practitioners, including massage therapists, to help prevent
fraud. The Financial Services Commission of Ontario is get-
ting ready to implement a professional credential tracker tool
that allows health-care practitioners to do an online check to
see which clinics or health facilities are using their information
to submit auto insurance claims.
This new system, when implemented, will allow practitio-
ners to have better control of their professional information
and an easier way to determine potential fraud.
I suggested to the insurance industry that (the professional
credential tracker) might not be a bad idea to put in place for
the extended health-care industry, Lewarne points out.
EDUCATION
Massage therapy training in 1935 was only offered in private
schools and was completed in less than a year. In response to
advances in medical trends, the curriculum was expanded to
a two-year program in 1987, and then further expanded to a
three-year program in the mid-90s.
Many in the profession would like to see education evolve
even further into a degree program. Torontos Centennial
College is one of them. Centennial offers a three-year
advanced diploma program in massage therapy.
(A degree program) is certainly a direction for our future,
says Lori Copeland, coordinator at Centennials faculty of mas-
sage therapy program. Were a regulated profession but we
dont need a degree. I think (having a degree) puts us on the
map in health care.
Although there has been no concrete advancement in insti-
tuting a degree program as of yet, the profession is currently
working on the next big thing: national accreditation for
massage therapy education.
The recently formed Massage Therapy Council for
Accreditation seeks to establish national accreditation for mas-
sage therapy programs, in an effort to bring Canadian massage
therapy schools up to national standards.
Ontario is working as one stakeholder from the Federation
of Massage Therapy Regulatory Authorities of Canada, the
MASSAGE THERAPY CANADA SUMMER 2014 15

As the new president and CEO of the RMTAO, Andrew Lewarne
engages stakeholders in an effort to propel the profession forward.
Canadian Massage Therapist Alliance and Canadian Council
of Massage Therapy Schools to establish the accreditation
agency and process, explains CMTOs Flitton, one of the
council founders tasked with incorporating the accreditation
council, among other things.
The standards to be instituted by the national accredita-
tion council will be based on the Inter-jurisdictional Practice
Competencies and Performance Indicators, developed and
approved in 2012 by the three regulatory bodies for massage
therapy: Ontario, B.C. and Newfoundland and Labrador
The accreditation council expects to commence the accredi-
tation process by 2015, but many schools in Ontario have
already began mapping their curriculum to the new entry-
to-practice competencies document as early as 2013. This is
largely due to the fact CMTO has announced it will begin
testing for registration based on the new competency docu-
ment in 2015.
When the competency document was released in 2012, mas-
sage therapy schools in Ontario begun mapping their curricu-
lum to the new competency standards.
Centennial has been adjusting its massage therapy curricu-
lum to meet the new standards. Copeland says it has not been
a huge adjustment on the part of the school and she is con-
fident the graduates will be able to write the new registration
exam with success.
The students and graduates who come from a program that
has really taught to the inter-jurisdictional competencies will
be accepted and recognized across the country once the word
gets out there, Copeland says.
Enabling professional mobility for massage therapists in
the regulated provinces of Ontario, B.C. and Newfoundland
and Labrador has already been in place since 2009, under
16 MASSAGE THERAPY CANADA SUMMER 2014
the labour mobility provisions in Ontarios Regulated Health
Professions Act, according to Flitton.
CMTO facilitates the registration of RMTs coming to
practice in Ontario from other regulated Canadian provinces,
without any need for further assessment of their program of
study in massage therapy.
The only thing that will be required of massage therapists
from another province seeking registration in Ontario is evi-
dence of good character from the Canadian jurisdiction where
they practiced and successful completion of the CMTOs juris-
prudence examination.
Practice mobility is expected to further expand to other juris-
dictions as national accreditation becomes fully operational.
RESEARCH
Research is another front that Ontario is actively pursuing.
The CMTO provides funding for the Massage Therapy
Research Fund, an annual national level research competi-
tion administered through the Canadian Interdisciplinary
Network for Complementary and Alternative Medicine
Research.
CMTO wishes to encourage high quality research in mas-
sage therapy, particularly in relation to professionalization of
massage therapy, for example, evidence based practice, col-
laboration with other health-care professionals, evaluation of
MT practices, and massage therapy effectiveness, efficacy and
safety, says Flitton.
It is not just being able conduct research that is in vital
need for the profession, however; its the ability to under-
stand and evaluate the quality of scientific studies.
Research literacy, according to RMTAOs Lewarne, is as
vital as the research itself. We need to actually have the
research literacy thats what needs to happen. And thats an
educational component, he says.
Expanding and developing massage therapy research will
directly influence the professions credibility in the health-care
arena. However, research should not be done at the expense of
tradition, notes Lewarne, who is also a RMT.
We have a huge tradition in massage therapy and its a tra-
dition based on trust, he explains. At the end of the day its
about touch, but the research needs to support the touch.
Copeland and Lewarne agree that research will drive the pro-
fession forward, and so would making massage therapy educa-
tion a degree program.
Its just becoming clear that we need to make that step, and
part of the reason that I would like that step to be in place is
because I want to have practitioners that are mature right out
of the gate, says Lewarne.
A degreed program would also propel more research in the
field of massage therapy, says Copeland, and provide the foun-
dation for advancing the professions role in disease prevention.
As we get stronger in research and recognized as a degreed
profession, then we start moving where we need to go, and
thats higher up in the health-care field, Copeland says.
Mari-Len De Guzman is the editor of Massage
Therapy Canada and Canadian Chiropractor
magazines. Contact her at
mdeguzman@annexweb.com.
Technique
Breath
of life
Treating the respiratory musculature
R
espiration is arguably the most vital human function. Struggling for breath is surely the most inca-
pacitating and soul-destroying aspect of any illness. It is gratifying to know that as massage thera-
pists, we can make a difference for patients suffering from a respiratory condition.
This article does not pretend to teach a cure for asthma or
chronic obstructive pulmonary disease (COPD). However, the
important role of muscle tissue in respiration is without dispute.
Hence, by treating the muscles of respiration, we can improve a
patients quality of life.
COPD indicates disease that blocks airflow (e.g. chronic bron-
chitis, emphysema). Lung damage cannot be reversed, but medi-
cal treatment is aimed at treating symptoms and minimizing
further damage. As with asthma, symptoms include shortness
of breath, wheezing, chest tightness and chronic cough, which
exacerbates respiratory muscle tightness.
As with any extreme and prolonged physical effort, muscles
develop holding patterns. This can be described as a low to
moderate involuntary sustained contraction of parts or all of the
muscle. This is also true for the respiratory muscles. Chronic,
laboured breathing compounded with coughing will put inordi-
nate stress on muscles such as the scalenes, intercostals and the
diaphragm. Consequent muscle pain referral can result in low
back pain (diaphragm) and chest pain (intercostals and scalenes),
compounding the patients misery. Respiratory illness can cause
a myriad of conditions and result in extreme and often unfore-
seen symptoms.
TREATING THE DIAPHRAGM
The diaphragm is an umbrella-shaped muscle spanning the
thoraco-lumbar junction. With contraction, as with any muscle,
it shortens. The dome flattens and air is drawn into the lungs.
The aorta and oesophagus penetrate the diaphragm. Chronic
diaphragm holding will pressure these structures, especially the
oesophagus which can affect digestion.
NEUROLOGICAL APPROACH
An effective method of reducing diaphragm holding can be
performed by the massage therapist as well as the patient on
their own. This is done supine or seated, the latter with a pillow
between the therapists torso and the patients back. If supine,
18 MASSAGE THERAPY CANADA SUMMER 2014
BY JONATHAN MAISTER
the patient should keep the knees and hips flexed, shortening
the hip flexors. This reduces abdominal tension and enables the
therapist to access the diaphragm via the abdomen. Seated or
supine, the therapist inserts curled fingers along the inferior rib
margin and takes up the slack of the soft tissue. The posterior
edge of the lower ribs may be accessed, at the very least, the
inferior edge of the ribs. Regardless, work with the patients
respiration to allow further penetration. As the diaphragm
slowly relaxes, the therapists curled fingers will creep superior
on the inside edge of the thorax. The seated patient may lean
marginally forward to facilitate this process. The best location to
commence is the lowest anterior edge of the ribcage. Once that
site responds and further penetration has plateaued, repeat the
process laterally along the ribcage, as well as medially toward the
xiphoid process. With the patient seated, treatment is bilateral.
Experience suggests that unresponsive areas be left for later.
By moving to areas that do respond, the therapists efficiency of
time and treatment are enhanced. Obstinate areas respond better
when the rest of the muscle has released. Because the liver sits
in the upper right abdominal quadrant, that diaphragm region
does tend to hold, and more patience may be required. Periodic
breaks for the therapist may be needed as this technique can
cause lactic acid in the hands. However, the gratitude of your
patients will cause you to persevere and continue to produce
results.
Done supine, the therapist is positioned beside the patients
thorax facing the patients feet. This will enable the curled finger
positioning along the ribcage. In this instance, treatment is uni-
lateral after which the therapist switches sides.
Self-treatment by the patient is best accomplished seated. By
curling their fingers and slowly leaning forward allowing their
ribcage to slip slowly over their fingertips, they will achieve
results. In all instances, be gentle and patient. The body does
respond, but each release may take upwards of two minutes.
Ten minutes in one location with no response is an indication
to move on. I would assure patients and therapists alike that
a release in one area alone provides some relief and should be
deemed a success on which to build.
In all instances, the patient need not disrobe. He or she can be
treated through the fabric of a loose-fitting shirt.

FASCIAL APPROACH
Fascial release in the same region will augment treatment and
should be done after the diaphragm has been released. This
order of treatment is less bothersome to the patient and makes
the physicality of the fascial release easier for you as a therapist.
The therapists fingertips or thumb engage tissue along the
inferior thorax. This should be done engaging laterally or medi-
ally depending where resistance is greater, so do diagnostic pal-
pation to determine this. Your own body should be positioned
to allow you to engage the tissue pushing away from you, usu-
ally beside the patients abdomen or thorax. Challenge the tissue
a level deeper than the skin, feel the holding of the tissue on
the ribs inferior edge. Pressure should be firm and movement
slow to avoid bruising. The plastic quality of the fascia is what
you are stretching, and this should determine how slowly you
proceed. In essence, its the resistance you feel once the elastic
quality is at its end-feel. Keep your fingers and wrist straight.
Generate the force, as gentle as it can be, from your elbow or
body. This will save your fingers. Repositioning yourself around
your patient, you will address all the restricted areas along the
inferior ribcage.
Fascial work can be challenging because it is associated with Diaphragm release with the patient supine
pressure that may be uncomfortable for the patient. The tissue
will allow you to stretch it, but dont force it. If it resists, change
the angle of attack by a few degrees, or change position a few
fingertips further and retry. Forewarn the patient that feeling
tender is likely the day after treatment. So long as the therapist
works slowly, bruising should not occur. Bear in mind, in this
instance we are dealing with tissue that is sensitive and with
patients that may be seriously ill. Treatment has to be modulated
in accordance with the patients and tissues status. I see this not
as an impediment, but rather as an indication of our versatility
as massage therapists to adapt and make a difference.
Fascial work does require access to the tissue. Disrobing is
not essential, but the patient will need to elevate his or her shirt
above the inferior ribs in order to allow contact.

TREATING THE INTERCOSTALS

These muscles had best be treated fascially. Their anatomical
position, wedged between the ribs, precludes other techniques.
Disrobing and appropriate draping will be necessary.
The ribcage spans almost the entire thorax. In order to address
as much of the intercostal muscles as possible, you will have
to treat supine and prone. Bear in mind that respiratory chal-
lenges of the patient may preclude prone lying. In this instance
treat supine only. Hopefully, as relief is achieved, this will
allow a prone position. Another possibility for treating poste-
riorly is having the patient seated, preferably leaning forward.
Ergonomically, this is not ideal for the therapist since you may
have to torque your wrist and body to achieve the correct angle.
But persevere if you can. Once again, use your body leverage to Fascial work to the intercostal muscles, supine

MASSAGE THERAPY CANADA SUMMER 2014 19

exert pressure, not your fingers.
This technique is performed specifically with the fingertips.
Engage your thumb or finger in the intercostal space, and take
up the slack in the tissue. Usually, this will be laterally. Once
again, you will palpate deep to the skin level, you will feel the
resistance of the fascia between the ribs. You might be able
to distribute two or three fingers among the inter-rib spaces
and address more than one intercostal space simultaneously.
Regardless, engage the tissue and slide with it, gently stretching
the tissue as slow and as far as it allows.
You can probably achieve results with one to three thorough
passes over one area of tissue. Addressing the entire intercostal
region, anterior, posterior and laterally, does require time. The
pectorals and breast tissue lie superficial to the superior anterior
intercostals. Treatment in this region is not possible.

TREATING THE SCALENES

The three scalene muscles (anterior, medius and posterior) con-
nect the transverse processes of the cervical spine (C2 C7), to
ribs 1 and 2. Especially with laboured breathing, they activate.
Many athletes breathing heavily have felt compelled to clasp a
fence to assist breathing. Unknowingly, they are stabilizing their
upper body to facilitate scalene contraction and its action in
elevating the ribs.
These are treated supine with gentle direct fascial release.
Should the therapist so choose, standard trigger point techniques
may precede fascial work to address areas of particular tender-
ness first. Fascial work to the scalene muscles
Bypassing the sternocleidomastoid (SCM), slide your finger-
tips along the transverse processes. Challenge the soft tissue infe-
riorly, slowly and gently as with the intercostals or even more
so. The neck is very sensitive and is a hotbed of pain referral, so
consistent patient feedback is essential as you stretch the fascia.
Treatment order should follow as presented. The diaphragm is
by far the major respiratory muscle. I would hope that once the
diaphragm has released, the intercostals and then the scalenes
will respond more willingly. One treatment may suffice for a
patient recovering from a cold or cough. Patients with chronic
severe respiratory distress will need more sessions. Conceivably,
severe chronic cases may need regular attention to ease their
ongoing symptoms.
Restoration of a patients respiratory comfort is invaluable.
Massage therapists can offer extraordinary abilities, combining
manual techniques for the muscular system, and, if necessary,
mucosal drainage, and correcting elevated ribs. Fine-tuning
these techniques makes for a set of skills that both patients and
therapists consider to be priceless. (Special thanks to Dr. Marco
Caravaggio, DC, and Melanie Tinianov, RMT, CHA, for their
kind assistance with the accompanying photographs.)

Jonathan Maister is a massage therapist, sport mas-

sage therapist and athletic therapist, with a private
practice in Markham, Ont. He has taught across
Canada and written extensively on a variety of ortho-
pedic, sport medicine and related topics. He assists at
the committee level for the Canadian Athletic Therapists Association
and the Canadian Sport Massage Therapists Association. He can be
contacted at jmtherapy@JonathanMaister.com. Fascial work to the intercostal muscles, seated

20 MASSAGE THERAPY CANADA SUMMER 2014

Health care
Coming out
of the shadows
Giving hope for patients living with lymphedema
L
ymphedema is a condition of chronic and progressive swelling
that can be inherited or acquired. If it is left untreated it can
become disfiguring, potentially disabling and, possibly, even
life-threatening.
Historically as recently as the 1980s the general con-
sensus in the North American medical community was
that there was nothing that could be done for patients with
lymphedema.
The first lymphedema clinic in North America opened in
1987. This clinic primarily used compression pumps to treat
patients. In 1989, the first Complex Decongestive Therapy
(CDT) clinic opened in the U.S. under the auspices of Dr.
Robert Lerner. In 1993, the Vodder School North America
was established in Victoria, B.C.
There are two kinds of lymphedema: primary lymphedema
and secondary lymphedema.
Primary lymphedema is inherited. It may be present at
birth or it may show up later in infancy, childhood, at
puberty or even later, in adulthood. It can be very serious if
left untreated for a number of years. With early intervention
it can be successfully managed over a lifetime.
Secondary lymphedema is acquired. Some trauma has
affected the lymph system, resulting in lymphedema. Often,
in North America, the cause will be the surgical removal of
lymph nodes for staging the spread of cancer. If the cancer
in question is breast cancer, then the lymphedema is referred
to as breast cancer-related lymphedema (BCRL). BCRL can
range from mild to severe, as many variables affect the devel-
opment of the swelling.
Lymphedema has four stages:
Stage 0 (latent). This initial stage of lymphedema has no
visible signs. Symptoms are a feeling of heaviness or achiness
in the affected limb. There is no measurable swelling. This
stage may continue for months or years before the edema
becomes evident.
Stage 1 (spontaneously reversible). In Stage 1 lymph-
edema there is evident swelling. It is called spontaneously
reversible because the swelling is mild and will reduce during
overnight sleep or on elevation.
22 MASSAGE THERAPY CANADA SUMMER 2014
BY JOHN MULLIGAN
Stage 2 (spontaneously irreversible). In Stage 2, eleva-
tion no longer has any effect on the swelling. The swelling
increases and there is evident and palpable tissue thickening.
It no longer reduces with overnight rest.
Stage 3 (elephantiasis). Signs of elephantiasis are gross
swelling leading to limb deformation, as well as tissue fibrosis
that is classified as non-pitting due to the density of the tis-
sue. In this stage we also see skin changes occurring; the skin
can develop papillomas (tissue blisters), changes in pigmenta-
tion and increased skin folds, to name a few.
While lymphedema progresses through these stages it is
important for patients to know that Stage 3 is rare. Many
cases of lymphedema will plateau in Stage 2, and not prog-
ress to Stage 3. This is partly due to time. Lymphedema is
characterized by a slow onset and it takes a very long time to
develop into Stage 3. The incidence of Stage 3 lymphedema
seems higher in cases where lymphedema onset was early in
life and went untreated well into adulthood.
Lymphedema is a chronic condition. There is no cure at
this time. However, the condition does respond very well to
treatment and management if the therapist is diligent and
the patient compliant.
The tools for treating lymphedema were developed by
Danish massage therapists (Emil and Astrid Vodder) in the
1930s and by German physicians and researchers in the
1960s. These physicians and researchers worked with highly
trained European massage therapists and physiotherapists
who administered the therapy. This interest in lymphology
and applied lymphatic treatments, however, did not occur to
the same degree in North America, and still has not had suf-
ficient impact on medical training in North America.
THE GOLD STANDARD
In Europe, lymphedema treatment was becoming standard-
ized. The Complex Decongestive Physiotherapy system was
developed. This combination of therapies, all of which were
aimed at decongesting the tissues and promoting lymphatic
function, proved to be a very effective treatment with no
side-effects. Eventually, researchers and leaders in the field of
lymphology recognized and supported CDT as the gold stan-
dard of treatment for lymphedema and related conditions.
CDT consists of:
manual lymph drainage
compression therapy (bandaging and compression gar-
ments)
decongestive exercise
skin care (lymphedema patients are prone to cellulitis)
patient education
This multi-faceted approach yields tremendous results; even
patients with advanced longstanding lymphedema respond
well. The treatment approach is to have an intensive phase
of treatment, where the therapist is seen as frequently as pos-
sible. The patient is treated with manual lymph drainage and
compression bandaging. The bandaging must be worn 23
hours a day, with time off for showering and treatment.
Once the swelling is reduced, the patient may transition
into daytime compression garments and nighttime bandaging
or nighttime therapeutic garments. This brings the patient
into the maintenance phase. In this phase the patient is self-
managing the lymphedema through compliance with com-
pression and exercise protocols.
If properly applied, CDT can reduce the swelling of even
the largest lymphedema. There are instances when the results
seem almost miraculous.
These wonderful results are gained through hard work and
compliance with the established standards of treatment and
self-management. If the therapist and the patient do every-
thing that is needed, then lymphedema can be reduced and
managed. Over time, management of lymphedema becomes
easier, simpler and more routine.
at risk of developing lymphedema.
Patients who have had lymph nodes removed and have
received radiation therapy as part of their treatment are at a
somewhat elevated risk of developing lymphedema.
Patients who have had lymph nodes removed, received
radiation, and then experienced significant weight gain after
their surgery and subsequent treatments have an even higher
risk of developing lymphedema.
RESOURCES
Find a provincial lymphedema organization by visiting the
Lymphedema Depot website where lymphedema organizations
and other support networks are listed: www.lymphedemadepot.
com. This is a commercial website that maintains these listings
as a service to the lymphedema community.
A document called Best Practices in Lymphoedema
Management is freely available for download at this site:
www.lympho.org/resources.php. The document supports
CDT as the standard of treatment for lymphedema and
offers established international guidelines for that treatment.
John Mulligan is a RMT and certified lymphedema
therapist and educator. He sits on the Education
Working Group of the Canadian Lymphedema
Framework and is also co-owner of Lymphedema
Depot, a company that offers advanced options in
the management of lymphedema.

BREAST CANCER-RELATED LYMPHEDEMA

Patients who have had lymph nodes removed to determine
if the cancer is spreading or still contained are at risk of
developing lymphedema. The lymph nodes are required to
process and purify the lymph fluid that enters into them
from the lymph vessels. Removing them, while necessary in
fighting cancer, leaves some of the lymph vessels with dead
ends, and the fluid they would have carried to the nodes
becomes excess fluid that is left in the tissues of the limb.
When patients have had lymph nodes surgically removed
for any reason, the transport capacity of the lymph system
has been reduced and they are at risk of developing lymph-
edema for the rest of their lives. Post-surgical swelling should
resolve in six to eight weeks, but may take longer in some
cases. Do not mistake post-surgical swelling with lymph-
edema. If patients have concerns about their condition, they
should talk to their physicians about it.
The risk of developing lymphedema is not the same for
everyone. While there are exceptions to every rule, risk can
be related to these factors.
Patients who have had lymph nodes surgically removed are

MASSAGE THERAPY CANADA SUMMER 2014 23

Education BY JENNIFER BLOCH

Separating fact
from fiction
How research literacy can benefit you,
your business and your profession

M
any massage therapists push research literacy to the bottom of their list of selected continuing
education units (CEUs) due to its complexity or a preference to pursue courses that enhance
practical techniques or skills to drive in more business, such as marketing. Research literacy, at
the very least, is an important part of upholding therapists commitment to ethics and profes-
sionalism. Great strides have been made in the last few years with respect to evidence-based practice in
massage therapy and, more recently, research literacy has become a mandatory part of curricula for RMTs.

No one is expecting massage therapists to wear lab coats and
evaluate the statistical significance of the results of their practice.
The expectation for the research literacy of massage therapists is
simply to: know where to find it, how to read it, who to engage,
and how to ask the right questions to determine the studys cred-
ibility. Another important expectation of massage therapists is to
responsibly educate clients about the results the research identifies.
Susan Salvos book, Massage Therapy Principles and Practice,
cited Dr. JoEllen Sefton, author of Research Literacy and Massage
Therapy, defining research literacy as the ability to locate, read,
understand, and evaluate research literature. For massage thera-
pists, this means being able to incorporate the information found
from reliable studies into your massage practice and to communi-
cate research findings to others. It gives you the skills necessary to
become good consumers, trustworthy sources of massage informa-
tion, and independent lifelong learners.
By learning how to find, interpret and criticize research articles,
you are enhancing your knowledge on that particular topic, indi-
rectly impacting your skills in a positive way.
GROW YOUR BUSINESS
By becoming research literate, you will be able to speak the lan-
guage of other health-care practitioners. Being able to explain
research findings related to massage therapy to physicians, for
example, in a way that they understand can increase your credibil-
ity and the likelihood that they will send you referrals.
Our profession is always justifying our role in health care to
insurance companies who are often hesitant to cover massage
therapy. Research literate massage therapists can help change the
way our profession is viewed by the insurance companies, thereby
creating less resistance to coverage for your clients.
Having an ability to understand and to explain how a particular
modality works can open the door to many new markets. Clients
coming for massage simply for relaxation may decide to increase
the frequency of their visits to help treat symptoms they previously
believed were off-limits to massage.
Through word of mouth, people will recognize you as a well-
informed practitioner. Clients are increasingly becoming better
consumers these days as they are becoming more familiar with the
evidence-based practice movement. People may be more willing
to tell their friends and family about their massage therapists if
they think their therapists are familiar with the latest information
about massage therapy.
By educating the client on the difference between what seems
to work based on experience versus what has been shown to work
based on scientific evidence, massage therapists are empower-
ing their clients to become better consumers of their health care.
Clients will appreciate this and may even respect their practitio-
ners opinions that much more because of it.
MAKING A DIFFERENCE IN THE PROFESSION
I spent the last few months reviewing articles and obtaining the
opinions of colleagues (including students), clients (including
potential clients) and other health-care professionals (including
physicians) on research in this profession. It is becoming increas-
ingly clear that we need to do more to improve our credibility
within the health-care community.
The results of my informal investigation revealed a divide
amongst the profession. On the one side are massage therapists
who believe the proof of effective practice lies in the results
they have witnessed in their own experiences. On the other side
are those who exclusively support evidence-based practice and
believe there is no room for anecdotal data.
These two extremes make it difficult to unite as a profession in

24 MASSAGE THERAPY CANADA SUMMER 2014

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our goal to adhere to our commitment to responsible health-care
practices.
Author Susan Salvo says, Some MTs do not understand the
role of research. It should inform our practice enrich what
we already do. Good research improves our understanding and
helps us be more effective. On the flip side, we should use our
knowledge and skills to best serve client goals without inserting
our own agendas.
Anecdotal information is, by its very nature, unreliable.
However, that is not to say it is not extremely important. After
all, it can form the basis for a research question that can change
the face of how we practice. Without anecdotal information, we
wouldnt have research.
There is room for both schools of thought: the therapists who
are dedicated to their personal experiences, and those who are
dedicated to research. The trick is how we are conveying the
information to our clients.
My discussions with clients and other health-care practitio-
ners revealed a gap in the perception of what massage therapists
are capable of. Most clients are not aware of the extent of our
knowledge and skills. Sure, we can expect our professional
association to do this advertising for us or wait until someone
provides us with more funding. At the end of the day, it is the
individual interactions that massage therapists have day-after-day
that will make or break our credibility.
PROFESSIONAL ETHICS IN RESEARCH
The problem with relying solely on anecdotal information is
26 MASSAGE THERAPY CANADA SUMMER 2014
that there are many other factors that can disprove a direct
cause-effect relationship of a particular modality or technique.
For example, you may have experience treating a hundred clients
with trigger points using ischemic compressions, and in every
case, the pain decreased. It is easy to believe the ischemic com-
pressions caused the decreased pain given that all of the clients
responded in the same way. There is, however, no way to be
certain the clients breathing habits, the warm up of effleurage,
or the flushing of petrissage werent what actually contributed to
the decrease of pain. There are other possibilities too, the lotion
used, the positioning of the client, the mood and lighting in the
room, the music used. Any one of these factors leaves room for
the possibility that the ischemic compression alone was not the
main contributor to pain reduction among clients, yet many of
us feel confident enough to make a statement to our clients say-
ing, Ischemic compressions will reduce your pain.
Bodhi Haraldsson, research director with the Massage
Therapists Association of British Columbia (MTABC) said,
As a profession, we have the duty to conduct the research that
tests the many hypotheses we have developed over more than a
century of our existence. We cannot just say, weve been doing
this, lets keep doing it. We cant just say, I see it work in my
office every day. The lack of control makes it impossible to
determine if the positive outcome we all see with our patients is
actually due to what we do, rather than the other non-specific
effects of placebo, context and faith in us. This is a moral duty
of our profession to ensure that those things we profess (to
profess expertise is where the word profession comes from) have
validity. Haraldsson previously sat on the board of the College
of Massage Therapists of British Columbia and served as vice-
president at the MTABC.
Our peers, clients and other health-care professionals
expect massage therapists to have a basic understanding of
what to look for in determining the credibility of evidence-
based therapy. So many clinical trials exist today, but that
doesnt mean they were conducted properly, yet more and
more massage therapists are using these studies to support
their claims that a particular technique will yield a particular
result. Factual statements should not be made on the basis
of studies that are invalid or unreliable. Massage therapists,
at the very least, need to have a basic understanding of how
to seek out research to stay current with the latest informa-
tion and identify red flags and know what questions to ask to
critically evaluate an article, or any information suggesting a
cause-effect relationship.
Let us reflect on our Code of Ethics principles put forth by
the College of Massage Therapists of Ontario and how being
research literate is a basic requirement to adhere to our Ethical
principles.
The Respect for Persons principle includes ensuring that
clients are as fully involved as possible in the planning and
implementation of their own health care. If we inform our
clients that a modality or technique will decrease their pain
when we are basing it on anecdotal data, not factoring in the
other potential contributors, then our clients are planning
their health-care based on misleading information.
Responsible Caring includes promoting the clients best
interest and well-being, through the highest possible standard
of professional practice. Do we define the highest possible
 standards by providing the client with information that
leaves room for error?
The definition of Integrity in Relationships is to practice
with integrity, honesty and diligence in our professional
relationships, with ourselves, our clients, our professional col-
leagues and society. We are not acting with integrity when,
for example, we know that there may be other factors contrib-
uting to someones pain reduction yet we say it is definitely
due to the ischemic compression.
And finally, Responsibility to Society not only dictates our
commitment to continuous improvement, it also expects us
to participate in the promotion of the profession of massage
therapy through advocacy, research and maintenance of the
highest possible standards of practice. Unless we are using sci-
entific evidence to support our claims of cause-effect relation-
ships, we are not fulfilling our responsibility to society using
the highest possible standards of practice.

RESPONSIBLE COMMUNICATION
When communicating with our clients, there are ways to edu-
cate them about the difference between anecdotal information
and evidence-based practice. Once you are familiar with what
is out there in terms of trustworthy research, you can say for
example, In my experience, whenever I perform ischemic com-
pressions, my clients seem to experience a reduction in pain, but
there is no evidence that I am aware of to support that this is
what causes the reduction of pain. If you are willing to try it, we
can get started. Or, Some small studies have shown that isch-
emic compressions may result in the reduction of pain, however
more research still needs to be conducted. We can always try
this technique and see if it works for you.
These types of responses allow the therapist to continue
practicing a modality or technique that they believe works,
while providing responsible, informed information to the cli-
ent who now fully understands that ischemic compressions
may not actually cause a reduction in pain before they provide
consent to treatment.
Research in massage therapy is still in its infancy. We can-
not stop our careers while advances in science are still being
hypothesized. We can, however, change our thinking about
the effects of our work by becoming curious and skeptical
continuing to ask ourselves why the result is the way it is,
encouraging those practitioners who are interested in pursuing
their careers in research to answer these questions for us.
In the meantime, we can continue to practice modalities
and techniques that are safe and seemingly effective provided
that we educate our clients responsibly about the differences M
between anecdotal information and evidence-based practice,
so they can make an informed decision about their own
health-care treatment plan.

Jennifer Bloch, RMT, is dedicated to research and

supporting the integrity of the massage therapy
profession. She was a recipient of the 2013 Award
for Excellence in Research and Interpretive Studies
by the Canadian Council of Massage Therapy
Schools. Jennifer is the owner of BusyBodies Health, a mobile
massage company that provides other health-care services in the
interest of saving people time to focus on their healthy lifestyle.

28 MASSAGE THERAPY CANADA SUMMER 2014

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RMT Tech Talk
Reading the fine print
In todays digital world where many of us have a personal social
media presence, we have become accustomed to simply clicking
on the I agree to the terms of service button when signing up
for our favorite social media sites. Often, we do not even read
them. The thinking is that there is very little to worry about since
we are simply sharing photos and personal experiences with family
and friends. After all, everyone is doing it so it must be ok.
While this approach may be fine for personal web services
it becomes concerning if this thought process is brought into
your business practices. Clearly, this is unacceptable when the
ownership and treatment of your clients health-care data is at
stake.
Using web-based appointment booking and practice-
management services has now become mainstream for massage
therapists in Canada. However, when you subscribe to an online
service, you are accepting to be bound by that service providers
terms of service.
It is extremely important that you fully read and understand
what you are agreeing to, as it will directly affect how your clients
health-care data will be cared for. While this article is not intended
to offer you legal advice, it will give you some helpful insight into
the importance of understanding what you agree to online.
Below are examples of some of the terms of service that
Canadian massage therapists could be agreeing to with some
online service providers (note that they have been summarized in
plain English for clarity).
Your clients stored personal health-care data is the legal property
of the software service provider not your client nor you.
Your clients health-care records may be subject to sale, by the
online service provider. They may also rent or sell your clients
contact information.
You have given your legal power-of-attorney over the health-care
data to your service provider, or even another unnamed third-
party company that provides aspects of your service providers data
management services.
The health-care records may be stored or transferred to any
third-party company, at anytime and without notice to or
agreement by you.
Without notice, you can be denied access to the health-care files
permanently.
You agree that any employee of the service provider that
you communicate with is not authorized to advise you in any
manner with respect to your terms of service, account details, the
disposition, condition, storage or possible sale of the client data
contained in the records.
Your agreement is subject to the privacy laws of foreign
countries, often the U.S.A. or European countries.
Why would a health-care professional agree to these types
30 MASSAGE THERAPY CANADA SUMMER 2014
BY JESSICA FOSTER
of terms? One can only assume that they were never read or
understood by the practitioner.
These sorts of terms of service clauses are often found in one-
size-fits-all online data services. These generic online appointment
booking and data service providers offer their same services to
businesses ranging from hair stylists to lawn care companies
often their data management policies do not account for the
special needs of health-care professionals.
Below are some terms of service that are more appropriate for
health-care providers (again, these have been summarized in plain
English for clarity).
All data created or stored on the service providers system
shall at all times be owned by the registered user.
All created and stored data will be treated as confidential and
only authorized service provider personnel will access the data
upon the request of the registered user.
Upon termination of services the service provider shall return
all data to the registered user when requested and all data is
then removed from the system.
The service provider will not, under any circumstances, use,
disseminate or transfer any user data, unless required by law
to do so.
The terms of service are subject to the laws of the (XYZ)
province in Canada.
As a regulated health-care professional you are obligated to
securely manage your clients health-care data, including their
contact information and appointment records. Finding the
right service provider to partner with is key. Often, provincial
associations have already researched solutions and can advise you
on recommended practice management systems. This can save
you a lot of time and potential problems.
There are other very important data privacy considerations
with respect to your clients data. This column has detailed these
concerns and remedies in past issues so there is no need to restate
them here.
The bottom line is to read and understand what you are
committing to. There are service providers out there that specialize
in the health-care industry with solutions that will meet your
needs. Run, dont walk, to review the terms of service on the
online systems you are presently using.
Until next time, be well.
Jessica Foster writes on behalf of mindZplay
Solutions Inc., a provider of massage therapy
websites and practice management solutions.
To learn more about mindZplay solutions
and for massage therapists visit
www.massagemanedger.com or call toll free 888-373-6996.
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