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 sUMMer 2011 issUe

Contents
Features
The Story of Fascia 6
p22
Keeping Our Future 10
in Our Hands

A Wake-up Call to Better 14

Sleep, Part 2

p10

Departments
p7 Editorial 5
News 28
Resource Directory 29
Continuing Education and 18
Massage Therapy RMT Tech Talk 30

Post-surgical Therapy for 21

Mastectomy and Implants,
Part 2

Massage Therapy in 24
Quebec

Massage Therapy Canada sUMMer 2011 3

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 Summer 2011 - Volume 10, ISSue 3

from the editor

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

Managing Editor

T
Maria DiDanieli mdidanieli@annexweb.com
(289) 259-1408 (888) 599-2228 ext. 247 his Summer 2011 issue of Massage Therapy Canada magazine marks
Sales Manager my farewell as editor.
Christine Livingstone clivingstone@annexweb.com
(519) 429-5173 (888) 599-2228 ext. 239
Sales Assistant I am most pleased with how the magazine has moved forward, and how
Pauline ONeill poneill@annexweb.com my dream of a published national voice is being developed further.
(519) 429-5183 (888) 599-2228 ext. 219
Production Artist
Krista Misener I am pleased to be moving forward, myself, as well, and directing my
Group Publisher focus toward other publishing projects as well growing my private practice
Martin McAnulty mmcanulty@annexweb.com to bring massage to as many clients as possible.
President
Mike Fredericks mfredericks@annexweb.com
Maria DiDanieli is taking the full reins of the position of editor. She has
Mailing Address
P.O. Box 530, 105 Donly Drive South, been working with the magazine for over a year, now, and as the editor of
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Canadian Chiropractor magazine, brings great skill, experience and knowl-
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and services we believe may be of interest to you. If you
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.
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.

www.massagetherapycanada.com
Massage Therapy Canada sUMMer 2011 5
Feature By Cathy Ryan, RMt

The Story of
Fascia
A multi-layered and multi-faceted multi-tasker

F
ascia the soft-tissue component of connective tissue weaves its way throughout the body,
enveloping, investing and supporting various musculoskeletal elements.
Fascia is highly variable in its presentation (i.e., histological components, fibre ratios and
arrangement, and innervations) and fascias presentation is determined by its role or function
in turn, the demands placed upon fascia will influence its presentation.

Recent research has identified that fascia is densely populated

with nerve receptors. Such elements provide fascia with the
ability to perceive and respond to stimuli including stimuli in
the form of pain, proprioception and manual therapy!
Traditionally, among the various tissues involved in muscu-
loskeletal dynamics, fascia has received comparatively little sci-
entific attention. Given fascias pervasiveness and multi-tasking
capabilities it is that much more disconcerting that fascial
involvement in musculoskeletal pain and dysfunction has gone
largely unnoticed by the conventional health-care community.
This lack of consideration given to fascia could explain
why some individuals do not fully resolve their soft tissue
pain and dysfunction following a whiplash or a work-related
back injury; why some individuals do not resolve a muscle
strain injury in the widely accepted time frames; or why an
individual is susceptible to subsequent re-injury.

Shape determines function and

function determines shape.
Ida P. Rolf

Many are working toward change in this arena. The

International Fascia Research Congress (FRC) is a continu-
ing series of conferences dedicated to the emerging field of
fascia studies.
One standout at the first FRC (Boston 2007) was the work
of Luigi Stecco, PT, who formulated and refined his Fascial
Manipulation approach over 30-plus years of clinical experi-
ence. Dr. Stecco and his colleagues are now recognized as

6 Massage Therapy Canada sUMMer 2011

major contributors to the world of fascia
research and fascial manipulation therapy.
Physiotherapist Julie Ann Day has
been an integral part of the Stecco col-
laborative since 1999; she has been
one of the authorized instructors of
Fascial Manipulation The Stecco Method
since 2002, and is also the translator of
Fascial Manipulation for Musculoskeletal Pain
and Fascial Manipulation The Practical
Part (English editions, 2004 and 2009).
Originally from South Australia, she com-
pleted her diploma in 1977 and has been
living and working in Italy since 1984,
mostly in the field of orthopedics and
connective tissue massage. Day is a found-
ing member of the Fascial Manipulation
Association (AMF). She has taught inter-
nationally and was part of the group that
won the best poster award at the first FRC,
One myofascial sequence in the upper limb.
held at Harvard in 2007.
In the following interview with Day, we
will explore the nature of fascia and why it should be consid-
ered when treating issues presenting with musculoskeletal pain
and dysfunction.
Massage Therapy Canada: Research findings noted by
the Stecco collaborative identified some key regional differ-
ences in fascias presentation; in particular, the trunk and
limbs. Can you describe for us the biomechanical significance
of these variations in presentation?
Julie Ann Day: First of all, we need to distinguish
between the superficial fascia and the deep fascia.
The superficial fascia is a membranous layer lying within the
hypodermis. The hypodermis is involved in the gliding of skin
on underlying structures; thermoregulation; metabolic exchange;
and the passage of nerves, blood and lymphatic vessels.
The deep fascia surrounds muscles and has a more
mechanical function of force transmission as well as a
possible proprioceptive role.
Fascial anatomy studies have shown that the deep fascial layer
in the trunk is quite different, both morphologically and func-
tionally, from that of the limbs. Generally, apart from the
thoracolumbar region, trunk fascia is thinner (approximately
300 millimetres). The large superficial muscles of the trunk
region (e.g., pectoralis major, latissimus dorsi and trapezius)
have developed within the superficial lamina of the deep
fascia, and are not separable from the same. The fascia adheres
to these muscles via numerous intramuscular fibrous septa.
Many muscular fibres are inserted into both sides of these
septa and into the fascia itself, which provides additional
insertions for these fibres. In the embryo, these muscles orig-
inate as part of the limb muscles, then they extend towards
the midline of the trunk. Migration of limb muscles into the
trunk forms an additional myofascial layer with respect to
underlying muscular planes. This ensures functional continu-
ity between limbs and trunk, including myofascial connec-
tions between the upper and lower limbs, and the two upper
limbs. This firm relationship between trunk fascia and mus-
cles allows for fine orientation of the vectorial forces created
by the activation of the muscles: different
portions of these muscles are activated
according to the degree of movement,
modulating transmission of tension
more effectively.
The deep fascia in the limbs is a relatively
autonomous structure with respect to
the underlying muscular plane. It is much
thicker (0.5 -1.8 millimetres), with multiple
layers of parallel collagen fibre bundles,
each layer oriented in a different direc-
tion, and significantly fewer elastic fibres.
It is easily separable from the underlying
muscles due to the presence of the epimy-
sium, which permits the muscles to slide
independently from the overlying deep
fascia. A thin layer of loose connective
tissue between deep fascia and epimysium
facilitates sliding between fascia and the
muscular planes. The deep fascia in limbs
perceives contractions of the muscle it
surrounds due to some myofascial expan-
sions that the muscles extend to the fascia and a few muscle
fibres that insert directly onto its inner surface. We can say
that limb fascia is less adaptable than trunk fascia but it is ideal
for the transmission of force along limbs, so it is suited to the
function required of our limbs.
MTC: It is becoming more evident that that fascia displays
essentially two distinct functions: it separates, allowing for
slide and glide; and it connects, augmenting the transfer of
forces and providing stability.
Within the conventional health-care
community, fascial/myofascial pain
and dysfunction has largely gone
undetected, untreated and unresolved,
and subsequently too many people have
continued to struggle with pain and
dysfunction unnecessarily.
With these basic functions in mind, can you summarize
the Fascial Manipulation/Biomechanical Models perspective
that identifies fascias role as a unifying, connecting and co-
ordinating element?
JD: The body is a complex system made up of interacting
subsystems. We require interpretative models that simplify
the complexity. Steccos biomechanical model is an interpre-
tation of one of the bodys subsystems, the fascial system.
It essentially shifts our focus from muscles with origins and
tendinous insertions moving bones, to motor units, activat-
ing groups of muscle fibres, united by fascia that bring about
movement. It suggests that deep muscular fascia could act as
a co-ordinating component for motor units grouped together
into functional units and that it unites these functional units
to form myofascial sequences.
Massage Therapy Canada sUMMer 2011 7
 In synthesis, Stecco divides the body into
14 segments. Six myofascial units move and co-
ordinate each body segment. A single myofascial
unit (MFU) includes motor units innervating
and activating monoarticular and biarticu-
lar muscle fibres, the deep fascia that unites
these fibres together, and the joint that they
move when the muscle fibres contract. MFUs
can be considered as the functional building
blocks of the myofascial system.
Stecco has identified key areas of the deep
fascia, called Centres of Co-ordination, where the Julie Ann Day is a physio-
tensional forces of each MFU coincide. If the therapist working with Dr.
deep fascia in these areas is densified, and not Luigi Stecco.
sliding, then the MFU will be dysfunctional.
Biarticular muscles link unidirectional MFUs to form myo-
fascial sequences. A myofascial sequence is considered to monitor
movement of several segments in one direction on one plane.
While deep fascia derivatives (endo, peri, and epimysium) unite
the muscle fibres of single MFUs, fascial anatomy studies have
also identified muscle fibres that insert directly onto the inner
surface of deep fascia and myotendinous expansions that
form bridges between adjacent body segments.
The intricate architecture of deep fascia corresponds to
precise motor directions and is intimately involved in mus-
culoskeletal function. The premise is that if manual work
can restore gliding to the deep fascia in these key areas then
it can influence poor muscle recruitment, myofascial force
transmission, faulty movement and pain avoidance patterns.
MTC: What is known thus far about the impact of
trauma/injury on fascia?
JD: Further studies will be necessary to better clarify the
possible alterations of the fasciae in pathological conditions.
Different authors claim that trauma/injury can alter proper-
ties of the extracellular matrix due to neurophysiological
influences, with water loss in the tissue influencing collagen
fibre bundle formation and orientation. Others implicate
changes in fibroblasts with their transformation into
A few significAnt resources
for fAsciA informAtion
The Stecco website: www.fascialmanipulation.com
International Fascia Research Congress: www.
fasciacongress.org
Robert Schleips website, www.somatics.de
Julie Ann Day, PT, and Antonio Stecco MD,
PM&R, will be presenting a post-conference
workshop, in conjunction with the third
International FRC, being held in Vancouver
March 2012, called The fascial manipulation
technique and its biomechanical model A guide
to the human fascial system.
For more information on the third FRC, go
to www.fasciacongress.org, or to the website
of the hosting sponsors, the Massage Therapy
Association of British Columbia, www.massag-
etherapy.bc.ca.
8 Massage Therapy Canada sUMMer 2011
myofibroblasts. Reduced gliding between layers of
collagen fibre bundles within the deep fascia could
result in an alteration of the mechanical properties
of the fascia.
MTC: Can you explain for us the impact of
injured fascia on the neural components (fibres
and receptors) and the subsequent impact on bio-
mechanical function?
JD: In superficial fascia, we can find free nerve
endings: Pacinian and Ruffini corpuscles.
Deep fascia is highly innervated with free and
encapsulated nerve endings, such as Ruffini, Golgi-
Mazzoni and Pacinian corpuscles. Density of innerva-
tion varies according to location, with higher density
found in retinacula compared to deep fascia over
muscle bellies. Muscle spindles lie within the endomysium and
perimysium, encased in a connective tissue capsule in parallel
with a group of muscle fascicles, whereas at the muscle-tendon
junction we can find more Golgi tendon organs.
A hand guided by deep scientific
know-how can solve well and quickly
a musculoskeletal problem. The more
knowledge you have, the more easily
you can find the cause of pain and
joint dysfunction.
Luigi Stecco, PT
Therefore, because these mechanoreceptors are embedded
within fascia, any impediment to gliding between endofascial
fibres and interfascial planes could cause anomalous tension
and subsequent altered proprioceptive afferents. This could
trigger faulty movement patterns at joints. Furthermore, over
a certain threshold, all receptors can potentially become algo-
ceptors (i.e., pain receptors), with consequent propagation of
nociceptive signals.
In the absence of normal physiological elasticity, receptors
embedded within the fascia may also be in an active state
even at rest. Any further stretching, even that produced by
normal muscular contraction, could cause excessive stimula-
tion with consequent propagation of nociceptive afferents.
MTC: Should fascia be given serious consideration when
treating repetitive strain injuries (RSIs) and why?
JD: If we consider that muscles and fascia are functionally
inseparable then it follows that fascia should play an impor-
tant role in these dysfunctions. Interestingly, not all people
exposed to the same continuous stress develop RSI injuries.
This implicates that a tensional malfunctioning, either in the
same region or in adjacent regions, is a probable component
in RSI syndromes. Fascia is a malleable tissue composed of
collagen fibre bundles and elastic fibres. Overuse or repeti-
tive strain causes repeated inflammation, resulting in changes
in stiffness with disorientation of the collagen fibre bundles.
Manual therapy can potentially restore elasticity/malleability to
this tissue and re-establish correct tensional interplay between
muscles and their fascia. In RSI injuries, it is often important
to look beyond the local area of strain, questioning our clients
carefully about past injuries in order to identify areas that may
have never resolved completely in terms of fascial gliding.
In gaining a better understanding of
fascias functional role we can better
comprehend the implications of its
dysfunction and thereby devise more
effective treatment interventions.
MTC: We (clinicians) can see and feel changes in our cli-
ents body in response to treatment, but what is actually
happening beneath our hands? What is fascias response to
manual manipulation what can our hands influence?
JD: This is a big question that requires further studies. The
perception of altered segmental tissue texture and its modification
during therapy is a daily experience for most manual therapists.
Fascia demonstrates viscoelasticity, a material property
whereby the deformation (strain) that results from a load
(stress) will vary with changes in the rate and amount of load-
ing. Loads within the elastic limits of the tissue will deform it
but then it gradually returns to its original resting length after
the load is removed. It is likely that a modified viscoelasticity
of the extracellular matrix with subsequent misalignment of
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the endofascial collagen fibres will affect the fascias capacity
to elongate and to adapt to stretch from muscle fibres.
By applying localized friction in an area of palpable rigid-
ity, therapists create local heat, and this may increase certain
chemical reactions within tissues such as reduced secretion
of inflammatory cytokines. The redistribution of water from
the tissue to the anatomical spaces surrounding the tissue
also appears to be involved. This change in viscosity seems
to involve an increase in the production of hyaluronic acid,
one of the components of the matrix that has interesting
intrinsic anti-inflammatory capacities. Improved drainage of
inflammatory mediators and metabolic wastes probably con-
tribute to the changes we feel under our hands by reducing
chemical irritation of the various receptors in the tissue.
Hopefully, we will gain a lot more information about this
subject at the next Fascia Research Congress!
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
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Feature By don dillon, rMT

Keeping Our Future

in Our Hands
New economy requires RMTs to self-assess

I
n this piece I have purposely chosen a serious and foreboding perspective to challenge what I perceive
as our collective unease and unwillingness in this profession to discuss and deal with the hard issues.
By hard I mean the politico-cultural issues, the discomfiting flaws in our group think that
hamstring our growth and evolution.

Our discourse has perhaps been impaired by our protective

maternal nature, our default to political correctness or a lack
of confidence (maybe perspective) to debate the issues. Its
imperative our dialogue elevate here and now to ensure our
professions future remains in our hands.
I refer the reader to real opportunities for massage thera-
pists (see MTC Winter 2011 and Spring 2011 columns)
where our profession can position itself more favourably.
Subsequent articles that I will write in this column will fur-
ther explore tangible options for the viability and longevity
of massage therapy practice.

tHe rise of mAssAge tHerAPY:

HistoricAL conteXt
Since their distinct separation from the physiotherapy and
nursing professions, massage therapists have been largely
self-employed, working from a home base or contracting
work from a spa, chiropractor, physiotherapist or another
massage therapist/clinic owner.
In the period following the Second World War, massage
therapists benefited from a strong North American economy.
Industrial manufacturing led to industrial illnesses such as
workplace-related musculoskeletal disorders (most prevalent
were repetitive strain injuries) and job-related stress syn-
dromes. The athletic/fitness movement and the informa-
tion/computer technology age ushered in further musculo-
skeletal and nervous/mental conditions requiring remedy.
During this boom period, workers accessed generous
employee benefit plans, higher discretionary income, com-
prehensive health care, and workers compensation plans or
auto-insurance funding for rehabilitation.
Registered massage therapists (RMTs) are not covered by
government provincial health plans, and therefore rely heav-
ily on patients/clients with high discretionary income, gener-
ous workplace benefit plans, third-party coverage from auto
insurance / workers compensation claims and direct referrals
from gatekeeper health-care providers to build a practice.
A new economY, A new reALitY
Boom has turned to bust in North America, imposing
change in the employment landscape and affecting the viabil-
ity of practice for massage therapists. Among the changes
that influence the profession are:
Workplace benefits clawback The disappearance or
decline of manufacturing and other sector jobs in eco-
nomically recessive North America negatively impacts

10 Massage Therapy Canada sUMMer 2011

 Join us for
Canadas Largest Massage Exhibition
November 4, 5 & 6, 2011 Holiday Inn, Burlington

CONFERENCES
Bringing our Professional
Together as ONE!

The Canadian Massage Conference is Canadas largest exhibition of massage products,

continuing education and new business opportunities for therapists of all disciplines.
To find out more information and to register online go to
www.canadianmassageconference.com
This years Conference features International presenters and exhibitors that bring years of experience and innovation.
The Education component offers over 100 hours of Continuing Education Credits including two 1 day courses, over
twenty 3 hour workshops and twenty-eight FREE 1 hour presentations. There is truly something for everyone!!

Doug ANDrEo TINA

ALExANDEr
rMT
Doug Alexander holds a biology degree from
Carleton University (1982) and is a graduate
of Sutherland-Chan School and Teaching Clinic
(1985). He currently teaches in the Algonquin
College Massage Therapy program. Doug has
served as a trustee for the Massage Foundation in
the United States and published over 20 papers in
the massage therapy literature. He has particular
expertise in neurological and orofacial problems as
well as therapist and client self care strategies.
Doug Alexander will be presenting two full
day classes and one three hour workshop:
Nerve Mobilization of the Neck and
Upper Extremity
Nerve Mobilization for the Low Back,
Pelvisand Lower Extremity
Teaching Homecare that Your Clients
Will Actually Do
SpINA
D.C.
Dr. Spina holds a Bachelor of Kinesiology degree
from McMaster University. He later graduated
with summa cum laude and clinic honors from
the Canadian Memorial Chiropractic College as a
Doctor of Chiropractic and subsequently completed
the two-year post-graduate fellowship in sports
sciences. In addition to being both the creator and
head instructor of Functional Anatomic Palpation
Systems (F.A.P.) and Functional Range Release
(F.R.) Techniques.
Dr. Spina will be presenting a three hour
class Saturday and Sunday on:
Functional Range Release Technique An
introduction to the new and comprehensive
fascial assessment, treatment, rehabilitation,
and conditioning system
ALLEN
LMT
With over a decade of service to children and
families, Tina Allen, founder of leading childrens
health and nurturing touch organization
Liddle Kidz Foundation (LKF), has become an
internationally respected educator, author and
expert in the field of infant and pediatric massage
therapy. Tina Allen managed the United States
first comprehensive pediatric massage program
at Childrens Hospital Los Angeles. She also
developed pediatric massage programs at Mattel
Childrens Hospital at UCLA and Cedars-Sinai
Medical Center.
Tina will be teaching Pediatric Massage:
Highlighting Massage for Children with
Cancer (three hour class)
Pediatric Massage: Highlighting Massage
forAutism & ADD/ADHD (three hour class)
Introduction to Pediatric Massage
(FREE one hour class)

ADDITIoNAL 3 Hour prESENTATIoNS The RMT Career Fair

David Kent LMT - Headaches: Types, Triggers and Back Pain: Breaking the Cycle Sun. Nov. 6, 2011 1-3pm
Angie Dubis of BIOTONE - The Fascial Matrix: Head Forward Postures Free Student Day & Smart
Chris Nentarz PT - Kinesiology Taping From the Start Seminar
Anita Shannon - MediCupping Produces Radical Results for Cellulite, Solid Bloat, and Wellness! Sun. Nov. 6, 2011 Begins at 10am SHARP
Dr. James Donovan - Bioflex Laser
Dr. Cohen D.C. - Move over Tennis Ball - Acuball Home Care for Clients Friday Night Facebook
Dr. George Roth D.C. - Matrix Repatterning Meet and Greet
Don Dillon - Insurance Claims...Why Bother? Party with LIVE Music &
Patrick Ingrassia - Introduction to BodySaver No Thumbs Massage Saturday Night Dance Party

Massage
BIOTONE

Professional Massage & Spa Therapy Products

Warehouse
& S PA E S S E N T I A L S
 employee benefit plans and worker utilization of mas-
sage therapy.
Disproportionate taxation Massage therapy is subject to
the harmonized Goods and Services Tax (HST) while
competing services, chiropractic and physiotherapy, are
not. This creates a clear competitive disadvantage.
Barriers to funding Auto insurance and workers com-
pensation claims require gatekeepers to authorize
massage therapy plans. RMTs are positioned as ancil-
lary health providers with controlled access to capped
(limited) funding.
Growing competition Health-care provision is shifting
from physicians and nurses to lower-cost and more
readily available physiotherapists, pharmacists and
nurse practitioners. These professions employ assis-
tants to deliver health care at lower cost to a larger
number of people. Physio/occupational therapy
assistants, kinesiologists and other assisting providers
may usurp RMT employment by providing massage
in house. Gatekeepers earn profits from this, keeping
care in house rather than referring down the street to
an independent RMT.
Employment upgrade Large, business-savvy, well-
financed spas and rehab facilities draw more RMTs to
employment. Self-employed small-scale RMT practices
find it tough to compete.
Insufficient credibility Insurers and governments are
skeptical of RMT results without degree-level educa-
tion and evidence-based practices, elements that are
standard requirements for other health disciplines. No
credibility translates to no funding.
Threat to primary funding Insurance fraud, association
with prostitution and illegitimate business taint public
and media perception of massage therapy.
Exploitation Problems internal to the profession (dis-
cussed in the next section) leave the profession vulner-
able to commoditization and exploitation by ignoble
profiteers hoping to cash in on massage popularity.
entroPY from witHin
The massage therapy profession is ill-prepared to respond
to the aforementioned encroachments in part because of
problems inherent in its own political culture. Some of these
problems are explored here:
Unsustainable time- and labour-intensive business
model. Given the physical labour of providing care, an RMTs
capacity is often limited to 15-20 hours per week. Massage
therapists are relegated to a part-time work schedule yet
require full-time wages. RMTs must charge exorbitant rates to
earn a basic income possible if only serving affluent patrons
but not in rehabilitative capped, fee-for-service insurance envi-
ronments. It should be pointed out that the rehabilitative ori-
gins of massage therapy in physiotherapy and nursing limited
massage application and turned it into only one of many inter-
ventions provided in a days work. Nurses and physiotherapists
did not intend to provide massage therapy all day its curious
the massage therapy profession adopted such an idea.
Practitioners may elect to: i) apply spa or rehab modalities
to reduce hands-on care, thus increasing physical capacity
12 Massage Therapy Canada sUMMer 2011
and providing more service per day (and hence increasing
income); or ii) relegate providing massage to part-time hours
and seek secondary sources of income from other employ-
ment. Innovative practitioners design, field-test and imple-
ment better, viable models of providing care.
Strained, dysfunctional business relationships. Clinic
owners often give 60 to 70 per cent of the service fees to the
contracting associate. What sustainable business can assume
business risk, pay the operating expenses, make a profit and
still give the lions share to the worker? These ill-conceived
terms are financially foolish and potentially ruinous to the
clinic owner. In addition, the contact list is rightfully an asset
of the business, but aggressive associates may attempt to
leave with as many clients/patients as possible.
The associate mistakenly believes the grass is greener else-
where. With the lopsided terms favouring the associate, her/
his expenses are in many cases supplemented by the clinic
owner. Ironically, the associate is financially better off staying
put. Understandably, many associating RMTs are not trained
in business and dont understand the true costs of operation.
The associate may feel cheated if they pay what amounts to be
the true costs borne by the clinic owner. And, of course, there
are situations where the associate really isnt treated fairly.
In most cases, I suspect the problem stems from the mis-
calculation you can work part-time hours and generate a full-
time income. Its not that the clinic owners rent is too high,
but that the associating RMT needs a more lucrative business
model that provides a full-time income.
Many clinic owners realize their contract terms are unsus-
tainable, but feel trapped in a culture that distrusts clinic
owners and disapproves of profit motives. A business must
earn a profit for contingency, expansion and as a reward to
the business owner for bearing the risk and costs of creating
a business. Sadly, many clinic owners only experience strife
and financial ruin.
Divisive viewpoints. Massage therapists lag behind other
health disciplines in evidence-based practices, public relations
strategy, school accreditation, regulation and credibility. A
particular point of tension is the polarity between spa and
rehab-focused massage therapists. Were trying to squeeze
two entirely different identities into one, and mitigate the dif-
ferences. The product (service), pricing, distribution, promo-
tion, funding and marketplace needs are vastly different for
these two identities, yet our professional culture maintains an
umbrella-like inclusion. Is massage therapy a health-care pro-
fession or a personal service?
Government policy makers, insurance adjudicators, other
health professions, the public and media are trying to grasp
our identity and are confused. An overly broad and unfocused
identity attempting an unmanageable scope of practice leads
to marketplace confusion and impaired credibility. Reluctance
to refer and withheld funding dollars are the result.
Another inherent divisive argument involves education
and training. Some RMTs oppose degree-level programs
and research as onerous and expensive. Many RMTs vie for
status and recognition as health-care professionals; they feel
entitled to the same privileges bestowed on other health-care
providers, despite avoiding research literacy and refusing
to support evidence-based practice and higher educational
requirements as other health professionals have. Many RMTs
concur that laypeople should be formally restricted from
applying massage therapy yet they themselves wont support
the mechanisms that lay groundwork for restricted application
(controlled acts) to laypersons. Further to the problem, teach-
ing institutions display a wide variance in quality of education
and training. Most are non-accredited. A certain standard of
quality for entry-level massage therapists cannot be guaran-
teed this raises the credibility issue again.
Perhaps a third point of divisiveness is the self-employed
mentality and distrust of organizations including regu-
latory colleges and professional associations. Some RMTs
oppose regulation they view regulation by government as
a cash grab and intrusive and are unsure of the benefits
of self-regulation. Massage therapy professional associations
wrestle with insufficient membership, working with limited
resources while attempting to provide value and gain a
majority of practising RMTs as members.
Massive and clearly targeted resources are required to advo-
cate RMT interests and position the profession favourably
with government, the insurance industry, gatekeeper health
disciplines, the public and media. If you consider your work
a profession, you should be supporting the efforts of your
professional association.
We have met the enemy, and he is us.1 The massage
therapy profession faces many threats to its integrity and lon-
gevity perhaps the most pervasive are those we are unwilling
to engage. Heres what I (and you) can do. Take this dialogue
to social media, challenge your associations, schools and regula-
tory bodies to have town-hall meetings to identify the prob-
lems and explore solutions. Capture this chance to attack the
problems and perceptions (rather than each other), redefine
the profession and pool resources to get past chronic sticking
points. For certain, if we are unwilling to entertain uncomfort-
able intra-professional conversations to refine our identity and
focus, influential and powerful bodies outside the profession
will do it for us.
If you would like to contribute your ideas on some of these
issues, please visit www.massagetherapycanada.com and see
my blog question, How do you think RMTs should respond
individually, locally and nationally to the threats and inherent
politico-cultural issues in the profession? I look forward to
reading what you have to say.

reference
1. Walt Kelly, Pogo comic strip, The first earth day.

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.

Massage Therapy Canada sUMMer 2011 13

Feature By deBra CUrTies, rMT

A Wake-up Call
to Better Sleep, Part 2
Sleep and massage therapy

I
f, as sleep experts suggest, health professionals should be monitoring sleep with the same vigilance as
blood pressure, diet and exercise, this has significance for massage therapy practice. Part 1 of this
article looked at the health risks associated with sleep deprivation; this second instalment will consider
the compenents of good quality sleep and a sampling of the volume of current research to discover
what it tells us about massage therapys role in helping our clients achieve it.

wHAt is HeALtHY sLeeP?

There are three main aspects of healthy sleep, which, when
they occur together, constitute a high-quality sleep pattern.
They are: sufficient sleep, restorative sleep and efficient sleep.

sufficient sLeeP
While it is an overlysimplistic marker of sleep quality, sleep
duration is an important bottom line. In the first half of
this article, we saw the guidelines for average hours of
sleep needed per age group and heard that our emerg-
ing cultural trend is to denigrate the value of sleep for
work-age adults, by equating sleeping less with being more
productive or having a stronger character. Experts are
also expressing concern about the declining average sleep
durations of toddlers, teenagers and seniors because of
the negative impact on their particular physical and mental hospital in-patients who were receiving intensive
health requirements. radiation or chemotherapy protocols. The intervention
Just being able to get enough sleep is a big challenge for group (MT) received a minimum of three massages
many who are ill or in pain. Insufficient sleep is a well- during their one-week stay as compared to a group who
established component of conditions ranging from fibro- spent similar time in conversation with a supportive nurse
myalgia to emphysema to multiple sclerosis. In individuals (NI). Sleep was essentially maintained in the MT group
with cancer it is estimated that co-morbid insomnia but worsened significantly for the NI group. This is a sub-
incidence is 30 to 50 per cent (Theopold, 2004; reported in stantial result for massage therapy, as anyone who has been
Berger et al., 2006). Poor sleep duration is also associated in hospital can attest. Another study (Mok & Woo, 2004),
with life-change situations such as pregnancy, menopause, which evaluated massage for anxiety and shoulder pain in
major surgery and terminal illness. elderly stroke patients, found that when questioned about
One aspect of massage therapy efficacy appears to be their reactions to the massage treatments, many focused on
helping people get to sleep and sleep longer. An interesting how it benefitted their sleep, saying variations of, I finally
study in the cancer literature (Smith et al., 2002) involved slept. In a sleep assessment (Richards, 1994) involving a

14 Massage Therapy Canada sUMMer 2011

comparison of back massage versus standard nursing care
only in patients in private rooms in a critical care unit, the
massaged subjects slept more than an hour longer than the
control group.
Generally speaking, these types of studies involve
short, simple massage therapy protocols such as a gentle
back treatment with a soothing, nurturing intention.
Individuals in an acute or persistent sympathetic state are
neurochemically impaired from falling asleep or sustaining
sleep. Such massage-related findings point out the
usefulness of massage in stimulating the elemental
sense of relaxation, normalcy and safety that has
soothed infants and those under duress over the course
of human evolution.
Not everyone who sleeps as much (or more) as the
averages suggest is getting a good nights sleep, however.
Individuals with sleep apnea often complain of waking up
exhausted despite having slept as much as 10-11 hours.
This can also happen in certain types of depressive illness.
Some circadian sleep disturbances also involve normal
sleep duration. This is where the other aspects of sleep
quality must be considered.
restorAtive sLeeP
Healthy sleep patterns must meet the criteria encompassed
in the word restorative. In order to be restorative, a
major sleep must:
include the correct NREM/REM cycling;
complete several full sets of sleep cycles;
include sufficient time in each phase to match the
individuals current requirements, including
homeostatic catch-up as needed, or additional
time in the correct specific sleep segments if the
person has particular needs such as healing tissues,
learning a new skill or restoring emotional balance;
occur at the right circadian time, in that maximum
melatonin concentration and minimum body
temperature must both occur after the mid-point
of sleep but before waking.
Massage therapy appears to be
effective in helping people get to sleep
and sleep longer.
With respect to the last point, current thinking is that the
human body cannot evolve a response to sleep deprivation
nor to altered light/dark signals. Individuals who work at
night and sleep during the day tend to have lighter, shorter
and less restorative sleeps, and people who live nearer the
poles have higher incidences of sleep-related physical and
mental health problems.
In the massage client population, there are numerous
factors such as stress, pain and physical impairments that
Massage Therapy Canada sUMMer 2011 15
reduce the restorative qualities of their sleep. When there
are bodily issues such as apnea/dyspnea, pain, mobility
challenges, digestive or urinary hyperactivity, heart rate
irregularities, and so on, the brain will not allow itself to
sink into deeper sleep modes, maintaining a more vigilant
and less restorative light sleep pattern. Stress and worry
tend to have similar effects. Deep sleep and REM sleep
are the most easily lost or impaired, and as we discussed in
Part 1 these are the sleep stages where restorative needs are
mostly fulfilled.
Sleep will not be restorative without deep sleep processes
that ensure function and balancing of neurochemicals,
hormones, enzymes, metabolic rates and the like, and REM
procedures that include thought, learning and emotion pro-
cessing. All of these are essential to the physiological and
psychological elements of restoration during sleep.
We need to be monitoring our clients
sleep information and considering its
relevance in each symptom picture.
In a nursing article (Davis, 2003) about sleep and pain
from arthritis and fibromyalgia, the author considers that
the traditional concept of sleep loss as secondary to fac-
tors like pain is being replaced by a much more chicken-
and-egg view of interlaced causation. As an example,
she reports on a study where it was observed that simply
improving sleep reduces pain levels and pain distress in
arthritis sufferers. This can be accomplished in the first
instance via sleep medication, but with limited efficacy
because, although sleeping pills can get the person to
sleep and sustain sleep duration, none have yet been
created that can impel normal sleep stage cycling. Any
strategy beyond an initial one of re-establishing sleep
duration must involve more viable longer-term methods,
and massage therapy is on the short list of those found to
be most effective. She also points out that people become
accustomed to the idea that good sleep is not possible,
and that long-term strategies must be effective in demon-
strating that consistent sleep improvement is possible
they must restore sleep confidence, if you will.
Massage therapy seems to be remarkably effective in
promoting restorative sleep even in difficult circumstances.
There are numerous in-hospital studies that show mas-
sage therapy has major measurable effects, usually on
pain and anxiety, following the promotion of a restorative
sleep. In a Mayo Clinic instructional article (Anderson &
Cutshall, 2007) that talks about the benefits of massage
therapy in cardiac intensive care, a specific patient anecdote
is recounted in which a surgical patient was so physically
uncomfortable on Day 2 post-op that he could not co-
operate with normal recovery protocols. After a 20-minute
session with the staff massage therapist, he reported [the
next day] that he no longer had pain in his neck and shoul-
ders and was finally able to have a good nights sleep. In
16 Massage Therapy Canada sUMMer 2011
addition he was able to walk round the unit several times
and was able to use his incentive spirometer without diffi-
culty. The numbness in his left arm and fingers went away.
This patient had no prior experience with massage and
had been initially skeptical.
Another aspect of massage effectiveness in such cases
(Mitchinson et al., 2007) is a reduced need for strong anal-
gesics, which has many health and recovery benefits. These
types of results speak to the capacity of massage to help
restore neurochemical availability and re-establish more
normal neuromodulation. In addition to pain and anxiety,
factors such as nausea, blood pressure and dyspnea often
show improvement with massage, especially if there is sub-
stantial symptom distress. While most of these studies con-
sider acute symptoms, others have found beneficial effects
for chronic conditions such as fibromyalgia, migraine and
low back pain. In some studies, the sleep effect is well docu-
mented and in others the reader is left to infer the degree to
which sleep promotion played a role in the massage therapy
results. A well-known meta-analysis (Moyer et al., 2003) sug-
gests that promoting restorative sleep, especially deep sleep,
is a likely mechanism for massages effects on chronic pain
conditions.
Several studies have also considered the effects of
massage on stress, appetite and growth in infants. One
(Kelmanson & Adulas, 2006) observed sleep as a major
focus, showing that their massaged low birth weight infants
had significantly better quality sleep and gained more
weight compared to the control group infants.
There is also an interesting small study (Ferber et al.,
2002) that examines massage and circadian rhythm adjust-
ment in newborns. Mothers in the intervention group
massaged their infants at a set evening time for 14 days in
a row during the first month of life. The control group
mothers followed an alternate consistent bedtime routine.
By eight weeks of age the massaged infants were showing
better light/dark cycle adaptation than the control group
babies, and at 12 weeks were producing more melatonin.
This is a single study, but raises some interesting questions
about whether future research might support the use of
massage therapy for people with circadian sleep disorders.
efficient sLeeP
Sleep quality is also measured in terms of the Sleep
Efficiency Index (SEI), which is a simple calculation of the
amount of time spent asleep versus the amount of time
in bed aspiring to be asleep. Normal sleep efficiency for a
child or teenager is around 95 per cent, for a healthy adult,
about 85 per cent, and for an 80-year-old, 75-80 per cent.
In contrast to the myth that seniors need less sleep, since
they have less efficiency they actually need to spend more
time in bed in order to achieve restorative sleep. People
who are ill, injured, in pain, stressed, depressed or anxious
have substantial declines in sleep efficiency.
Sleep efficiency is notoriously bad in intensive care units,
often falling under 50 per cent at a time when the need for
restorative sleep is especially high. In the Richards study
mentioned earlier, the massaged patients had a 20-point
jump in SEI as well as substantial improvements in sleep
staging. Another interesting study (Field et al., 1992),
involving adolescent in-patients in a psychiatric facility,
focused on massages capacity to reduce anxiety and
negative behaviours. The study involved back massages on
five consecutive afternoons. The researchers included an
observation of the subjects night-time sleep the average
SEI was 79.7 on the first day and 91.3 on the fifth.
fooD for tHougHt
One of the issues sleep specialists have begun to tackle is
that most doctors, having themselves been educated within
a sleep deprivation value system, tend to have blind spots
when it comes to sleep and health. A thought-provoking
study (reported in Cole & Richards, 2007) created a situa-
tion where seniors who went to their doctors for a check-
up were debriefed by social workers following the medical
appointment. It was found that while 70 per cent reported
having at least one sleep quality complaint and 45 per cent
reported substantial difficulty, few received any advice or
treatment and only 17 per cent of the doctors recorded
the information in the patients file. It is incumbent on us
as massage therapists to consider whether we are doing
much better.
While we assume that there is more interesting research
and analysis yet to come, the volume and range of the
current literature suggest massage therapy is very effective
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in all aspects of sleep quality promotion. We need to be
monitoring our clients sleep information and considering its
relevance in each symptom picture in many instances sleep
restoration will be the cornerstone to achieving the other
treatment goals. As well, the evidence to date, suggests that
powerful results often come from shorter, lighter treatment
approaches that focus on soothing and nurturance. There are
times when this is the most suitable and effective treatment
plan, especially until restorative sleep is re-established and
more tissue-challenging work becomes appropriate. Massage
therapys effectiveness in this realm points to our need to
re-think assumptions about how much of our work actually
is accomplished via direct manipulation of tissue and how
much through influencing factors such as metabolism,
hormone production and brain chemistry.
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.
Canada 2011
Pediatric Myofascial Release
Vancouver, BC
September 17 & 18
Myofascial Release I
St. Johns, Newfoundland
October 21-23
Massage Therapy Canada sUMMer 2011 17
Feature By Maria didanieli

Continuing Education
and Massage Therapy
Lifelong learning for the profession in Canada

Attendees at the Massage Therapists Association of Nova Scotia conference enjoyed smaller sessions and workshops, with breaks that allowed
for informal roundtable discussions.

P
rofessionals in an increasing number of fields are required to pursue continuing education in order
to maintain licensure. This is particularly true of those in health-care disciplines where knowledge
evolves at an astounding rate and keeping abreast of new developments is an integral component of
offering safe and high-quality care. But aside from simply keeping one legal, evidence shows that
lifelong learning also keeps ones work fresh and alive, thus maintaining ones interest and attention and,
concomitantly, a higher calibre of performance while boosting the credibility of a profession as a whole.

In most professions, lifelong learning is offered in a vari-
ety of formats including seminars and workshops that may
be presented in-person or over the Internet. Reading cer-
tain accredited articles or publications may also qualify for
credit (often dubbed continuing education units, or CEUs/
CEs). Congresses actual or virtual held by well-known
bodies within the profession are excellent vehicles for access-
ing high volumes of relevant information and often include
trade shows that feature products and services to enhance
ones practice or business.
Arguably, for those in health care, the best form of learn-
ing is in-person and hands-on. The opportunity to interface
with peers makes this format most rewarding, especially
for those who do not work in circumstances where they
have ready access to colleagues to consult with. However,
attending a workshop or conference can also be the most
expensive bordering on cost-prohibitive form of con-
tinuing education. Tuitions can be high, travel and hotel
expenses need to be considered, and so forth. This is where
emerging opportunities for on-line continuing education
might be able to provide an alternative for many health care
professionals.

18 Massage Therapy Canada sUMMer 2011

 Realistically, professionals need to examine their personal
goals as well as their clinic or company visions and man-
dates in order to choose which events will be most worth
their time and money. They also need to survey budgets and
schedules prior to deciding whether the best bet is an online
course, a reading series, or to attend a conference in person.
LifeLong LeArning in tHe mAssAge
tHerAPY Profession
As stated above, although requirements for continuing educa-
tion may seem arduous and are often expensive maintaining
them boosts the credibility of a profession and its members.
Massage therapy is one of the professions with continuing
education requirements in most jurisdictions. Many bodies
within the profession support their members in meeting these
requirements in a variety of ways including partnering with
organizations that offer training, keeping members abreast of
available courses, and so forth. Also, representative groups,
including provincial associations and specialty colleges may
themselves curate educational events for their members to
attend at reduced rates. Again, the event(s) a therapist chooses
will depend on a number of factors, but the profession is rife
with lifelong learning offerings in a number of topic areas.
This article will present a brief overview of three types of
massage therapy continuing education events from the past year.
The intent is to begin to provide a cross-section of continuing
education choices available to RMTs and also to highlight some
of the differences between each genre that might make a partic-
ular event more relevant, or desirable to, an individual therapist.
Relaxus massage summer11.indd 1
tHe ALL-encomPAssing,
nAtionAL conference
From Nov. 5-7, 2010, the Canadian Massage Conference
held in Burlington, Ont., brought together hundreds of
RMTs from across the country as well as a large gathering of
product and service providers for the profession in a large
trade show that was open throughout the weekend.
The conference comprised one-hour lectures and three-
hour hands-on workshops, all given by prominent specialists in
the profession of massage therapy in Canada. Instructors were
given ample time to develop their ideas and demonstrate their
techniques and innovations to therapists. Topics ranged from
orthopedic assessment to post-mastectomy breast massage to
womens health to mind-body-spirit areas that benefit patients
while enriching the therapist as a healer and as a person. The
conference, an annual event, offered over 120 hours of con-
tinuing education for RMTs as well as social gatherings to
enhance the already ample opportunities for networking.
The trade show featured product suppliers for every type
of massage therapy practice as well as an array of services
including coaching, digitally-based practice management
tools, insurance and investing, therapeutic music, professional
publications and more.
For the therapist searching for a broad array of information in
order to remain abreast of developments within the profession
as a whole or ideas for expanding ones practice, either in scope
or volume this type of event offers an excellent overview and
showcases several directions for patient-centred practice, thera-
pist longevity and business opportunities.
Massage Therapy Canada sUMMer 2011 19
18/07/11 10:10 AM
tHe ProvinciAL
AssociAtion event
wHY botHer going?
In many fields, including massage
therapy, provincial bodies often assist
members in their continuing educa-
tion by holding an annual conference
in conjunction with the, usually man-
dated, annual general meeting (AGM).
The value of these events is three-fold:
although sessions based on a wide
variety of specializations reflecting the
activities of the membership may be
offered, featured topics are usually quite
pertinent to practitioners within that
jurisdiction; issues open to discussion
are often directly relevant to the del-
egates practices or businesses; members
have an opportunity to support their
representative body while exercising
their voices within their profession.
Massage Therapists Association of Nova
Scotia. On May 6-8 of this year, the
Massage Therapists Association of
Nova Scotia (MTANS) held its annual
conference and AGM in Halifax.
Now in its fourth year, the event drew
approximately 70 massage therapists
20 Massage Therapy Canada sUMMer 2011
from across the province.
Massage therapists can be so iso-
lated from each other, in their prac-
tices, notes Peg McMartin, chair of
the MTANS conference and trade
show committee. A conference like
this gives them an opportunity to
come together as a community. Topics
were chosen through feedback that
participants provided at previous con-
ferences as well as by the association
connecting with individual therapists.
The topics offered at the conference
presented a surprising variation and
scope. Sessions included the massage
therapist as a birth support practi-
tioner, use of social media for the
massage therapy practice, awakening
the healer, yoga for the massage thera-
pist and more. Hands-on workshops
in a variety of techniques were also
offered. A trade show was available
for delegates to explore local options
for inclusion within their practices. As
is often the case, social events were
held in order to enhance the building
of community in this case, a pub
night inadvertently showcasing attend-
ees talents in the performing arts was
the events smash hit. This sense of
community was added to throughout
the breaks between or within sessions.
These provided perfect opportunities
for therapists to roundtable on a
variety of elements and issues directly
impacting their practices.
The AGM, comprised of association
business and discussions of the profes-
sion in the province, was productive
and informative, and will be helpful as
the association moves into one more
year of representing its members.
sPeciALtY grouPs AnD
tArgeteD eDucAtion
For the professional who is seeking
very targeted advanced training,
courses offered by a number of
educational groups or specialty
colleges might be the most efficient
use of time and money.
Meetings offering instruction in spe-
cific techniques, practice management
or business training, and other topics
might themselves be business ventures
initiated by RMTs with special quali-
fications or extensive experience in a
particular area, or might be hosted by
research societies, schools or other pro-
fessional interest groups. These courses
are fine, but RMTs are cautioned to
ensure that the group is credible and
accredited for continuing education
units. (If an RMT is interested in a
course, and is aware that no CEUs are
offered for it, thats still fine, but the
RMT should not hesitate, nonetheless,
to research the courses credibility and
the instructors qualifications.)
Specialty colleges and associations
often offer targeted instruction,
usually aimed at its members who
already hold advanced certification
or licensure in their area of practice.
Courses held by these groups are
always accredited for CEUs. Like
provincial associations, specialty
groups (for example, sport massage
therapists) may offer targeted minor
events throughout the year, and one
major, often two-or-three-day, annual
event. These events can be similar to
a provincial association conference in
that attendees have the opportunity to
receive education and boost CEU
counts while exercising ones voice
Continued on page 27
Feature By paUl lewis, rMT

Post-surgical Therapy
for Mastectomy and
Implants, Part 2
Rationale for treatment modalities and self-care exercise

P
art 1 of this article provided an overview of scope of practice, assessment and consent, and
general treatment considerations regarding massage therapy for post-operative patients who
have underdone breast procedures. Part 2 of the article will provide an in-depth discussion of
self-care exercises for these patients, as well as treatment approaches the author uses and the
rationale for techniques and modalities utilized.

A review of imPortAnt concePts

To review and emphasize a point I made in part 1 of this
article, client assessment is vital to confirming your hypoth-
esis, helps to give you a base-line for measuring progress,
and provides support for rationale regarding the choice of
modalities and treatment techniques employed.
As an RMT, I have worked with individuals who have
undergone a biopsy, single and double mastectomy, augmen-
tation, reductions and transverse rectus abdominis myocu-
taneous (TRAM). Just as the medical procedures differ, so
should each clients treatment plan. It should be unique to
their set of circumstances. This requires personalizing the
assessment, as well as any self-care exercises suggested to the
client, so that the exercises are effective and realistic for the
client to use in her particular lifestyle.
Paul Lewis performs massage on a post-mastectomy patient.
tHe goALs infLuence tHe treAtment
When is it appropriate to apply cold or warm hydrotherapy, ties (tools) that may apply. In some cases engaging the tissue
to optimize circulation and drainage, to maintain or increase may be contraindicated, gentle joint play to one area and
range of motion (ROM), to reduce myofascial restrictions, to not to another may be indicated. Take, for example, a client
apply joint mobilizations or to not engage the tissue at all? undergoing radiation therapy. He or she may be experiencing
There are many stages in the clients post surgical cycle at pain, entry and exit burns, skin sensitivity or fragility, nausea,
which massage therapy treatment could be applied one fatigue, nerve irritation andmany associated effects. The goal
week post surgery, before radiation protocols, before chemo for this specific client during their cycle may be to reduce
treatments begin, during radiation, during chemo protocols, pain and distress and optimize available range of motion
post radiation, or post chemo protocols. At each of these whereas prior to the radiation treatments, this clients goals
stages in the clients possible cycle, the goals of the mas- may be to increase range of motion, ease any myofascial
sage treatment will differ and so will the modalities (tools) restrictions, eliminate guarding and enhance drainage. At
and techniques used to achieve the goals. The clients health each of these stages, the goals and available tools used to
status and goals dictate the indicated techniques and modali- achieve the desired results will differ.

Massage Therapy Canada sUMMer 2011 21


A face cradle is used to support the arm, allowing the client to
maintain a gentle stretch.
Having reviewed these important concepts from part one
of the article, I will now focus on post surgical, post radiation
or post chemo therapy and addressing the client starting from
four to six weeks post surgery. At this stage the client should be
recovering and addressing any effects due to the surgery.
reAcHing into tHe tooLboX
To help achieve the desired outcome of post-surgical
rehabilitative treatments, I use a variety of learned skills
and treatment techniques (modalities), such as clinical/
orthopedic assessment, Swedish massage, joint
mobilizations, myofascial release, remedial exercises, Post
Isometric Relaxation, hydro therapy, Dynamic Angular
Petrissage (DAP) and breast massage, to name a few. I
find DAP, an engagement technique, helps to augment the
rehabilitative treatment, allowing me to engage the tissue
at varying depths and enhancing neuromuscular release.
Furthermore, I find DAP is not stressful either for the
client or the therapist.
cLient PresentAtion
Using the following client presentation, I will describe my
approach to treatment. A client comes to see you three
months following a surgical procedure. She had a mastec-
tomy on the right that left her with a scar across the chest
from the sternum to the axilla. About four or five nodes
were removed from the right axillary area. She has restricted
lateral rotation of her right shoulder (GH); feels pain when
moving or lifting her right arm into flexion beyond 20
degrees; feels pain and restrictions at the scar when mov-
ing beyond 20 degrees and therefore avoids this movement;
has rounded shoulders; restricted cervical movement due to
tight (high resting tension) neck muscles; she is experienc-
ing altered sensations in her thumb and forefinger in the left
hand; and has shallow, apical breathing due to pain and dis-
comfort when expanding the chest to breathe. When the cli-
ent is in a supine (face up) position, she cannot let her right
elbow rest on the table due to restrictions in slight extension
of the shoulder.
22 Massage Therapy Canada sUMMer 2011
treAtment PLAn
The treatment plan is, of course, based on the client request
and the findings from the assessment.
After completing the assessment, I would start the client in a
supine position with the goals of normalizing range of motion,
reducing any restrictive adhesions or pain due to the scar, help-
ing to normalize body mechanics, and helping with circulation
and drainage. In the supine position, to allow the client to leave
her arm in a comfortable, flexed position I would support the
arm and forearm using the face cradle or pillow.
In short, following the principles of massage, my objec-
tive would be to release muscles holding the client in the
anteriorly rotated positions, addressing the right side of the
body followed by the left, the neck area, abdominals includ-
ing the diaphragm, breast massage to the left side to help
with drainage and circulation. If the client was unable to
lay in a prone (face down) position I would work in a side
lying position which would also allow you to treat the back
and shoulders. In the supine position, the face cradle can
be used to support the arm and help the client to maintain
a gentle stretch without having to engage their own muscles
to hold the arm in a laterally rotated position. As the range
of motion increases I would continue to support the arm
by moving the cradle closer towards the head. The client
can use the same techniques at home to help with monitor-
ing their own range of motion.
It is my hope that more RMTs 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.
seLf-cAre
Lewis Circle exercise is an exercise that engages muscles in
the upper thoracic, neck and shoulder area. The exercises
require the client to perform movements with a shortened
lever. The client is leading with their elbows and creating
circles in one direction then the other. The benefits are to
help with mobility and to warm up the tissue in the shoul-
der and upper thoracic area. Self-monitoring of range of
motion, soft tissue restrictions and joint restrictions is easily
achieved. The circular movements also help to contribute
to joint mobility at the following areas: sternoclavicular,
acromioclavicular, and glenohumeral joints. This exercise is
simple and can be performed before or after any activity.
Lewis circLes How to
As you are moving, certain muscles are contracting and oth-
ers are elongating, helping with circulation and joint health.
You would start by placing your fingertips gently onto the
tops of the shoulder. Leading with the elbows, bring the
arms together in front of the chest, contracting the pecto-

Lewis Circles are simple exercises that engage muscles in the upper
thoracic, neck and shoulder area. To view the exercises in full, visit
www.paullewis.ca/irndex.php/continuinrg-ed/videos.
ralis muscles and lengthening the interscapular and lateral
rotator muscles of the shoulders. At the same time, lower
the chin to the chest. You should feel a gentle lengthening
of the posterior neck muscles. From here, you are using your
elbows to create large circles (circumduction), bringing the
elbows as close as possible to your ears.
You should feel lengthening of the pectoral muscles and an
opening up of the chest area. The lengthening of latissimus
dorsi, and the muscles attached to the shoulder blade will
be felt as you lift the elbows close to the ears. First perform
three slow controlled movements in one direction and then
in the other direction.
Remember slow and controlled movement is best.
The feedback I have received concerning Lewis Circles
from physiotherapists, RMTs, chiropodists, and personal
trainers, to name a few, is positive. These professionals use
the exercise for themselves and recommend it to their cli-
ents. Catherine S., a physiotherapist with the Hand Therapy
program at Trillium hospital in Mississauga, writes, I use
the Lewis Circles for my own self care and for the client
after or prior to hand surgery as a preventative measure to
minimize the chance of developing shoulder issues due to
lack of mobility.
People have a tendency to protect the part of the body
that gets injured. Take the arm or hand as an example. After
injury people tend to hold their arm in a flexed position
close to the chest. If this position is held for extended peri-
ods of time without movement, various joint and soft tissue
complications could develop.
My experiences include treating clients at their homes,
hospital and at my clinic. In describing some treatment tech-
niques that I have applied with some success during the reha-
bilitative process and offering the rationale for the modalities
chosen, it is my hope that more RMTs 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.
sources useD for tHis ArticLe:
Curtis, Debra. Breast Massage. Toronto, ON: Curties-
Overzet Publications, 1998.
Curtis, Debra. Massage Therapy and Cancer. Toronto,
ON: Curties- Overzet Publications, 1998.
Lewis, Paul. Dynamic Integrative Massage Techniques
for the Upper Body Vol 2. Toronto, ON: Paul Lewis
Services Inc., 2010.
Rattray, Fiona and Linda Ludwig. Clinical Massage
Therapy. Elora, ON: Talus Inc., 2000
Snyder, Goodman. Differential Diagnosis for
Physical Therapies. St. Louis, Missouri: Saunders
Elsevier, 2007.
Travell, Janet G. and Simons, David G Myofascial
Pain and Dysfunction vol.1. Baltimore, Maryland:
Williams & Wilkins, 1999.
For additional information visit www.paullewis.ca.
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 sUMMer 2011 23
Feature By MarTine Frigon

Massage Therapy
in Quebec
Training, recognition and involvement in health care

I
n Quebec, there is no official recognition from the provincial government for massage therapy,
so, technically, anybody can use the title of massage therapist, whatever their experience and
training. However, this has not seemed to dull the enthusiasm the people of Quebec have for
massage therapy, and certainly, those who are serious about training to become one will still seek
out the best programs. There are a few problems, though. One is that there are various private orga-
nizations in Quebec that offer training for someone who would like to become a massage therapist,
but, at this time, someone who enrols in one of these programs will unfortunately, not finish with a
provincial diploma. This stands in bizarre opposition to other programs in the field of personal and
health care, such as those for hairdressers or beauticians, which grant them provincial credentials
upon completing their training.

Another problem is that, in the province of Quebec, there
are almost a dozen private organizations and associations
that offer guidance for someone who wants to study in the
field, and the guidelines set by these groups are not necessar-
ily standardized depending on whom one speaks with, the
requirements for training in massage therapy will vary.
For instance, launched in 1979, the Quebec Federation of
Massage Therapists is made up of 5,500 massage therapists
from across the province and, according to the federations
executive director, Sylvie Bdard, Our organization recog-
nizes 18 schools that offer standardized training in accordance
with our federations agreement related to the accreditation of
training schools in massage therapy. Our agreement leads the
schools accredited to our federation through an accreditation
process whereby the quality of training is recognized on the
basis of five criteria: relevancy, coherence, value of teaching
methods, adequacy of resources, and efficiency.
Another group, the Association des massothrapeutes du
Qubec (Quebec Massage Therapist Association) is made
up of 2,273 members and was founded in 1981. We accept
members who have 400 hours and up of training, and we are
linked to around 20 private schools, said Charlotte Blanger,
Secretary-Treasurer for this group.
The Alliance des massothrapeutes (Massage Therapists
Alliance), launched in 1999, is made up of 310 members who
are located for the most part on the south shore of Montreal.
We propose a basic 400-hour training plus a continuing edu-
cation program that offers training in additional techniques,
said Marie-Jose Poisson, who is president of this group.
Meanwhile, in 2008, the board of directors of the
Massologists and Technicians in Massage Association of
Canada Professional Massage Therapists Association of
Quebec decided to standardize their requirements in order
to meet the criteria requested in all the Canadian provinces.
We wanted to allow any person who would like to work
across Canada to be eligible according to the requirements in
each province. Therefore, we require training of 2,200 hours
for a massage therapist and 1,100 hours for someone who
will only practise in Qubec, said Jean-Claude Bleau, presi-
dent of this association,which is made up of 2,200 members.
The result of this fragmentation is that, overall, the
structure of training for the profession in the province of
Quebec is unclear, making attaining provincial recognition a
next-to-impossible task.
is ProvinciAL AccreDitAtion A must?
And what do massage therapists in the province think of this?
Are they bothered by not having government accreditation or
recognition? Do they feel their training is adequate? Are they
happy with the many and varied groups that represent them?
Once again, viewpoints vary throughout the profession in
Quebec.
In November 2010, a group of 11 massage therapists
launched Massothrapie Qubec in order to initiate a

24 Massage Therapy Canada sUMMer 2011


Sylvie Bdard leads the Quebec Federation
of Massage Therapists. The federation has
certified 18 schools according to its agree-
ment, which requires an accreditation
process recognizing the quality of training
under five criteria: relevancy, coherence,
value of teaching methods, adequacy of
resources, and efficiency.
certification process that will lead to
provincial recognition. According to
Martin Valle, the president of this
group, 150 candidates are actually cur-
rently in the process of passing their
certification requirements, established
according to a training program of
1,000 hours, and developed by an orga-
nization called Centre de Recherche
sur les applications thrapeutiques
du toucher (Research Centre on
Therapeutic Application of Touch.)
Massothrapie Qubec is created
to raise the standards of the profes-
sion throughout the large number of
schools and professional associations
that represent massage therapists
across the province, said Valle, who
is also director of Mon Rseau Plus,
an organization representing a number
of manual therapy groups and made
up of 5,700 members.
Valle points out that part of the
barrier to provincial recognition and
accreditation in Quebec is a lack of
a clear identity for the profession.
Massage therapy is perceived only as
a relaxation technique requiring little
tolerance on the part of clients, and,
hence, minimal training in order to
perform correctly and safely.
However, what a lot of people
dont know, says Valle, is that mas-
sage therapy can be much more than a
way to get pleasant relaxation.
Valle hopes that more intense and
standardized training and certifica-
tion will bring the profession closer to
Marie-Jose Poisson, president of the
Alliance des Massothrapeutes (Massage
Therapists Alliance), considers that a
400-hour basic training is sufficient to
become a professional, but strongly
recommends massage therapists engage
in continuous education and learn other
therapeutic techniques.
government recognition and accredita-
tion and thus help raise awareness that
massage therapy can offer a host of
benefits for clients in many situations.
According to a survey conducted
in April 2010 by the Committee of
Personal Care Workers in Quebec an
organization subsidized through the
Government of Quebec, specifically
by the Minister of Employment and
Social Solidarity, that groups rep-
resentatives from the personal care
sector and the government half of
the respondents wish to be certified
by a single professional order (not
necessarily government run), the mis-
sion of which would be to put the
emphasis on increased standards and
better inspection trends. However, the
majority of the respondents (92 per
cent) noted that they were satisfied
with the training they received and
consider themselves well prepared for
the world of work in massage therapy.
For Sylvie Bdard, executive director
of the Quebec Federation of Massage
Therapists, government recognition and
accreditation of training programs is not
a requirement and the current standards
of basic training are acceptable.
A similar commentary has come
from Marie-Jose Poisson: To me, it
is not essential to require 1,000 hours
of basic training and to be listed in a
provincial register. As an association,
we require our members to meet our
criteria. We will accept members only
from schools that meet our strict
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Massage Therapy Canada sUMMer 2011 25
 Martin Valle is president of Massothrapie
Qubec, an organization launched in November
2010 in order to initiate a certification process that
will lead to a provincial register.
standards, and they must pass more exams with us in order
to be recognized as one of our massage therapists.
However, it is worth noting that Poisson states: basic
training of 400 hours is sufficient to meet the needs of cus-
tomers who require a relaxation massage or a muscular mas-
sage only. And this, again, raises the question of the exact
identity of massage therapy.
How are massage therapists in Quebec tackling this iden-
tity question? It does seem that, along with some noticeable
movement toward government accreditation and an increase
in training requirements, the profession, in Quebec, is in fact
bringing massage therapy into new avenues there, and per-
haps enriching its profile to go well beyond relaxation.
A new feDerAtion to
HeLP cAncer PAtients
On May 18, 2011, the Fdration qubcoise des masso-
thrapeutes officially launched a new foundation called the
Fondation qubcoise de la massothrapie.
With the slogan Lending health a strong hand, this foun-
dation aims at contributing to the health and quality of life
of people living with cancer, and particularly senior and fam-
After only 4 years as a massage
therapist, I was beginning to
physically burn out. I added
Bowen First to help me
preserve my body, be a more
effective therapist and, oh
yeah... triple my income.
- Christine, Massage Therapist
The Top 3 Pitfalls Keeping Massage Therapists
Burnt out and Working Way Too Hard for Way too Little!
Read Our Latest Report To Discover:
How to use your present day skills while adding a new and
powerful toolset that will help you avoid burn out and be kind
to your body.
How to deliver lasting results to your clients while offering
proven techniques toward optimizing your OWN health.
Work WITH the body NOT against it.
Earn MORE money WITHOUT increasing your fees.
Simply call this number to leave your email
address and well send you the FREE REPORT.
1.866.362.6936
26 Massage Therapy Canada sUMMer 2011
ily caregivers. To do so, specialized training will be offered to
any massage therapist interested in this area of expertise.
Richard Bliveau, PhD, biochemistry, well-known author of
books on cancer-risk-reducing foods, researcher in oncology, and
professor of biochemistry at Universit du Qubec Montral
(where he also holds the chair for the prevention and treatment
of cancer), is the spokesperson of this new foundation.
We need to do everything we can to ease the pain and
shock associated with the diagnosis and the stress associated
with cancer treatment. In this regard, massage therapy is a
well-established technique capable of significantly improv-
ing the quality of life of persons with cancer, he said. By
exerting effects on both the physiological and psychologi-
cal levels, massage therapy helps to mitigate the symptoms
associated with the disease, which may include pain, fatigue,
nausea, anxiety and depression.
Thats why I decided to personally support this cause
which I hold dear, added Bliveau.
Members of the profession in Quebec acknolwedge that
having the support of a well-known research figure is a defi-
nite positive step to raising awareness regarding the many
benefits of massage therapy but also may increase the num-
ber of people who have access to massage care.
worKing for sicK PeoPLe
Thanks to the massage therapist I met she helped me to
decrease my anxiety during my treatment, and I am sure that
this contributed to my remission, said Gertrude Buteau, a can-
cer survivor who offered her testimony during the ceremonial.
The foundation wishes to train more therapists, and
we are preparing a curriculum in order to offer training all
across the province, said Jean-Franois Bouchard, director
of research and development at the Fdration qubcoise
des massothrapeutes.
We are actually offering a 200-hour training program that
includes instruction in physiology, various types of cancers,
treatments such as chemotherapy, radiation therapy, side-
effects, medications and massages adapted to cancer patients,
and other courses will be added on such as pathology, aid
relationships and tutorials. The curriculum is expected to be
available at the end of this year.
In 2011-2012, we hope to offer more than 2,000 mas-
sages to cancer patients, said Sylvie Bdard, executive direc-
tor of the Fdration qubcoise des massothrapeutes and
president and CEO of the new foundation. These massages
will be offered in the five regional centres that belong to the
federation, and are located in Montreal, Quebec, Gatineau,
Trois-Rivires and Sherbrooke.
Martin Merrette and lodie Desprez, both massage thera-
pists who practise in the hospital environment, are also on
the team for this foundation, and are dedicated to planning
this specialized training.
I remember massaging a man who required morphine to
relieve his pain, said Merrette. Subsequently, he was able to
fall asleep without morphine.
It will be interesting to watch massage therapy develop within
the province of Quebec and to observe the path its members
take in the years to come to solve the issues they are facing on a
number of planes : identity, training, provincial accreditation and
recognition, and integration into the health-care system.
Two trends that do seem to be emerging are the move to
boost the identity of massage therapy from a relaxation disci-
pline and raise awareness for its many health benefits; and rec-
ognition that, in order to do this, massage therapists need to
be better trained within longer and more intensive programs.
As Dr. Bliveau notes, Massage therapy has had a var-
ied and misunderstood reputation, which is unfortunate
because massage has been around for millennia. Increasing
our involvement within health care is vital to re-establishing
awareness of its benefits and making it available to as many
clients as possible.
Martine Frigon has been a freelance
photojournalist for 25 years and owner of
Reditexte, a small company specialized in writing
and translation in French and in English. She has
published articles in various magazines. She lives
in the Quebec City area and can be reached at
reditexte@yahoo.com.

Continued from page 20 care professional, in person might be worth considering, and,
(if a member) within the organization. The difference with despite the initial accounting, could work out to be highly cost-
events held by specialty groups is that delegates will receive very effective in the long run. Furthermore, if you are an employer,
specific instruction in a specialized field, often at an advanced this plan should accommodate each employee as well. Not only
level, that may or may not be relevant to a general practice. will this boost employees performance a result that will, in
turn, benefit your business it will also send your employees
cAnADiAn sPort mAssAge tHerAPists the message that you esteem and value them enough to support
AssociAtion them in their careers. This too, may serve your business and,
On Oct. 22-24, 2010, the Canadian Sport Massage more importantly, your clients well, in the long term.
Therapists Association (CSMTA) held its annual conference For more information on the events mentioned in this article please see the
and AGM in Edmonton. The CSMTA is the certifying body following websites:
for sport massage therapists in Canada. Certification allows Canadian Massage Conference www.canadianmassageconference.ca
members to be selected and work within Canadian Health MTANS Annual Conference and AGM www.MTANS.com
Care Teams at major games, such as the Olympics. The asso- CSMTA Annual Conference www.CSMTA.ca
ciation requires its members to maintain their certification For more information regarding continuing education requirements in
through continuing education and supports them in doing your area, please check with your local jurisdiction.
so, by offering educational conferences as well as a series of
distance education courses.
Their main annual event is geared to providing up-to-date
and pertinent topics for certified members and CSMTA
members who are working towards certification but also
welcomes attendees who might be interested in sport mas-
sage therapy or simply wish to broaden their knowledge of
massage therapy in general. This year, the event was most
interesting in that organizers formulated a multi-disciplinary
program in order to give sport RMTs an in-depth perspective
of working within a health team structure. The featured topic
was working as a massage therapist with post-joint replace-
ment patients, especially athletes, and included presentations
by an orthopaedic surgeon, a physiotherapist and a massage
therapist, all geared to an interdisciplinary approach to pre-
operative preparation for surgery and post-operative recovery
and care. Hands-on sessions on specific techniques were pre-
sented by experienced Canadian RMTs throughout the week-
end. This gave attendees advanced level training in their area
of expertise (sport massage) from a Canadian perspective and
according to Canadian standards.
A banquet was held during this event. Athletes from vari-
ous sports and levels of competition were invited to describe
how massage therapy had supported them in their sport.
This was instrumental in rounding out therapists perspec-
tives of how their work benefits and enhances the clients
they service a feature that boosts professional morale by
inspiring professionals to continue to offer their expertise.
These are a few examples of continuing education available to
RMTs in Canada. A plan including participation in at least one
continuing education event a year preferably, for the health

Massage Therapy Canada sUMMer 2011 27

News
Research and Interpretive Studies,
2011-2012 Student Competition
A
s part of its dedication to excellence in massage
therapy education, and to further the development
of high calibre research study by students, the
Canadian Council of Massage Therapy Schools
(CCMTS) is pleased to announce the Second
Annual Research/Interpretive Studies Paper Competition.
In establishing this award, the CCMTS encourages its member
schools and students to engage in the practice of research and
interpretive studies and to experience the benefits of critical
evaluation, as it relates to the profession of massage therapy.
The winning paper will be recognized and published on the
CCMTS website. In addition, the student will receive a $200
honorarium and a commemorative plaque.
How to enter
Students must submit a five to 25-page paper that has a
28 Massage Therapy Canada sUMMer 2011
direct relationship to the practice of massage therapy, either
human or animal, and meets the criteria set out on the
CCMTS website and submission form. The paper does not
have to be the applicants original research, but can be a
review and analysis based on examination of a particular area
of research that the applicant has identified.
The paper must be written between June 15, 2011 and
May 31, 2012 and is due no later than June 15, 2012.
Students who graduate prior to May 2012 are eligible to
enter, as long as the paper is submitted by the due date.
Papers can be written by a group, and submitted as a team
project the honorarium will be shared and the plaque
issued to the groups school for display.
All massage therapy students are eligible to submit a paper.
For further details, students should speak with their massage
program director and/or visit www.ccmts.ca.
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Massage Therapy Canada sUMMer 2011 29

RMT Tech Talk
Data security and your massage
therapy practice
R eaders have requested a discussion about the issues
surrounding data security as they relate to a massage
therapy practice. In this article, then, we will touch
on higher-level security matters. While this synopsis is not
meant to be definitive, provide legal advice nor deal with all
aspects of data security, there are fundamental data security
precautions that should be employed by massage therapists
to safeguard sensitive information.
Data security in your massage therapy practice should
be a very high priority for you. Client records, your clinics
financial data and other confidential information need to
be shielded from unauthorized access, theft, corruption and
loss. This instalment of RMT Tech Talk aims to inform the
reader of a number of common security concerns and the
related protective measures.
wHAt is DAtA securitY?
Data security is the generic term that is used to describe the
protection of personal, client and company information. A mas-
sage therapist must employ data security measures that comply
with relevant government regulations and recognized good
business practices. These measures apply to both paper files
and paperless, or electronic, record-keeping solutions.
wHAt Are some common DAtA
securitY tHreAts?
Both paper and electronic files are subject to physical theft or
destruction by fire, flood and other natural forces. Unauthorized
access to the data is another threat that needs to be protected
against. Unauthorized individuals can include your clients, facil-
ity cleaners, family members / roommates (if files are stored in
a home-office environment) and Internet hackers.
wHAt cAn i Do to minimiZe tHe risKs?
There are some security issues that a practitioner needs
to take into account for both paper and electronic record-
keeping solutions:
Paper records require secure facilities, fireproofing mea-
sures, anti-theft precautions, access protection as well as file
duplication and storage. Alarming systems, locked-down fil-
ing cabinets and duplicate offsite secure storage are among
the must-haves.
Electronic record keeping is the most common form of
information storage. While some people believe that paper
records are safer than electronic record keeping, electronic
records can be much more secure and far easier to manage.
In addition to physically protecting your office software and
30 Massage Therapy Canada sUMMer 2011
By JessiCa FosTer
hardware, you must perform daily backups of your data and
store a copy off site at another secure location. If your PC is
connected to the Internet, be sure to install a firewall to pro-
tect it against Internet predators. Be sure to utilize username
and password best practices at all times.
Increasingly, therapists rely on affordable professional, third-
party services to provide secure Internet-based practice manage-
ment solutions. These services can include the input, storage
and management of your data practice-wide, such as appoint-
ment scheduling, client record keeping, SOAP notes and finan-
cial record keeping. The data is stored in secure, specialized data
centres utilizing state-of-the-art firewalls and server technology.
They should include daily data backup and offsite storage dupli-
cation, thus removing these burdens from the practice owner.
These service providers should incorporate the following
security precautions to protect your data:
Utilize state-of-the-art firewall, intrusion detection and
prevention technology in front of the servers that house
your data. Maintain strict physical protection and minimized
access precautions. Utilize SSL data encryption (the encryp-
tion technology used by your financial institution for online
banking transactions). Data encryption protects the data
that is sent between your local computer and the data cen-
tres server during transmission. Sign-in protection: Prior to
allowing access to your practices data the valid username
and password must be authenticated. Sign-in best practices:
Always use best practices when choosing your system pass-
word. Use a minimum of eight characters made up of a
combination of upper- and lowercase characters, a symbol
and at least one numerical digit. Change your password
frequently. Inactivity logout: When you are inactive for a
specified period of time, the system should log you out and
require re-entry of your correct username and password.
This will protect your data if you walk away from your PC
and forget to sign out.
Reliable practice management solutions that provide these
important security essentials are available. Your massage ther-
apy association may be able to direct you to service providers
that specialize in the matters discussed in this article.
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.
6 Canadian Campuses

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