A couple of years ago Stephen Ryason, LMT, successful medical massage practitioner and a member of our Editorial Board, informed me that massage therapist, Paul Greear from Idaho contacted him to discuss various professional issues, especially the medical aspects of massage therapy. This conversation greatly impressed Stephen, and he recommended Paul as a candidate for the Person of the Month section of the Journal. We are trying to share with readers the interesting stories of the professional success, and we think Paul’s interview contains a lot of interesting thoughts.
Here is our interview with
MASSAGE THERAPIST IN THE PRACTICE OF REHABILITATIVE MEDICINE
JMS: How did you get into the field of massage therapy?
Paul Greear: Occasionally when I was younger I would work on my mother’s back and feet, and she would pay me! During high school I began mountain biking, and running, and was introduced to massage. In college I began a pre-physical therapy program, but switched to psychology/communications. I had worked in therapeutic fields, as a developmental therapist/ recreation therapist. A passion to see others grow and heal was in my blood. After working a long string of “jobs” to make ends meet and support my family, I enrolled in a massage therapy program locally in Boise. Four months after I graduated I found employment with Saint Luke’s Elks Rehabilitation. I have been practicing for five years now.
JMS: You are practicing massage in a medical rehabilitation facility. In your opinion what category of patients have mostly benefited from your treatments?
Paul Greear: Since the majority of patients I see are orthopedic, then that population has most benefited from my work. While the scope of my work is technically limited to the body part or area of body indicated on their prescription, I still am able to provide more structural work. I also treat patients recovering from cerebro-vascular accidents, traumatic brain injuries, autoimmune disorders, neuro-invasive pathologies, parkinsonian syndromes and muscular dystrophies. There are a steady group of geriatrics who come to this clinic, for standard “aches and pains.” The subjective (and objective ROM) feedback from treatment of cervical strains resulting from whiplash is generally very good.
JMS: You are practicing in a state which doesn’t have massage therapy licensing. How is this affecting you and your colleagues practice?
Paul Greear: I could digress here; I’ll attempt to keep it simple. In three main ways: First, and foremost, the lack of licensure requirement has limited the necessity for higher and specific knowledge base. If I am to demonstrate proficiency at a higher clinical or medical level, it is my job to seek more advanced technical instruction, and I won’t necessarily be more employable with the additional education. Without licensure the ability to bill insurance companies (our main vein in this healthcare environment) is greatly reduced. Second, the pool of therapists in a non-licensure state/area is flooded, as anyone with a city business license can set up a sign and start massage. Also this is detrimental to how other medical colleagues see our profession. Licensure would demonstrate our proficiency, but more importantly clearly define our scope: what we do and don’t do to treat people. Effective systems demand clear and efficient communication.
Third, I really feel that my lack of licensure limits the efficacy of adjacent medical disciplines. After all, this is about patient care. Limited involvement of licensed massage therapists (billing, scope issues) into the treatment program by physical therapists, doctors, etc. ultimately prohibits the therapeutic development of the patient. It is high time that we see competent triaging of patient care, especially given there are so many specialized healthcare disciplines.
JMS: You practice massage therapy in a medical establishment as a rehabilitative tool. What advice do you have to those practitioners who have just started to work in a medical clinic or are planning to do so?
Paul Greear: Think of yourself not as a tool (negative connotation, very cold, and concrete), but rather as an instrument. You have many tunings, but yes, one general function. You can be an exceptionally valuable tool, based on your features. Have you broadened beyond NCTMB standards by acquiring other treatment skills/continuing education? But be very careful about what features you bring to the treatment room, in the clinical context. Most clinicians are very closed off to hearing about Reiki, energy healing, and meridian clogging. The medical body requires research and professionalism. Statistics. Research. But more importantly, therefore so do insurance companies.
Finally, I would advise you to be prepared for the difficulty of establishing your scope amongst peers whose scope is highly defined. The better your clinical language skills, the easier this process, and the more comfortable you might feel. It can be a difficult process, and pretty dirty, at that, but the reward is great while you press into higher levels of care and receive a clinical education, while you’re getting paid!
JMS: What changes in the massage therapy profession will help you and other practitioners who practice massage as a medical remedy to be more efficient and successful?
Paul Greear: There must be a shift here in the USA where massage therapists are on a higher level of educational/skill requirement. Manual therapy is in the progressive forefront in the Physical therapy world (I work in an outpatient physical therapy clinic…). Who better to administer manual therapy than… Massage therapists. But we won’t get anywhere until our license shows that we have demonstrated clinical competency.
There must be a national standard massage therapists’ meet for this competency; probably more schooling from a nationally recognized accrediting agency. (a national Medical Massage accrediting body/board).
JMS: Do you have a favorite type of bodywork?
Paul Greear: My favorite type of bodywork is bodywork! Almost always I will utilize three or four different massage modalities in one session. I keep it simple. I do a broad visual assessment (structural visualization/bodywork). I then go about lengthening, toning, sedating according to what appears to be called for in a tensegrity sense. I have learned to work towards the main area of complaint pain, rather than work “on” or “at.”
I do find the tool of Trigger point to be valuable. However after reading an article in Massage Therapy journal Joseph Muscolino calls for an interpretation of ischemic approaches based on anatomy and physiology. I will find tender points which call for the Jones model strain-counterstrain. I like this technique because it is often effective and with correct body mechanics can really save a therapist’ energy. I am dabbling in Active Isolated Stretching; mostly for hip flexor and hamstring/gastroc treatment.
JMS: Would you like to give any advice to our readers?
Paul Greear: Let’s not get discouraged at the hurdles we face to be brought up to speed, and to be taken seriously! Rather, we must function through encouragement. There is new research. Physicians are beginning to acknowledge the value of massage. There are positions opening in clinics that just five years ago would never have been opened.
Advice best for me (apply yourself if you want): Press into the advancement of knowledge. Don’t let fears of the unknown hinder my development. Keep it simple and attenuate the learned techniques already acquired, and try to attain continuing education In the areas most effective in my practice environment.
To the academics and researchers reading this publication: THANK YOU! Your work is allowing me to work. Please continue to make more available, and visible, the research that establishes Massage as a valid treatment in our clinical blender.
Born in the high mountain desert of Southern Colorado. Moved around quite a bit growing up. Settled in Eastern Oregon. Went to University in Western Idaho, Eastern Oregon, Salt Lake City, and finally completed a BA in Communication at Boise State University. Attended Apollo College in Boise to complete Massage Therapy Certificate 650 Hours.
Have been employed in a variety of locations. Employed as a Massage Therapist for Saint Lukes Elks Rehab for 4 1/2 years in an outpatient physical therapy clinic.
Married with Three Children, a boy of 9 years, and two girls 3, and 1 year old. Love outdoor activities including bicycling, bicycle touring, hiking, fishing, camping, telemark skiing, and getting buried in the sand at the beach in Washington (ok that just happened so its fresh on my mind:-) by my kids. Enjoy reading, good movies, and gardening.
Category: Person of the Month