In this issue we are introducing a new section of JMS we call “Opinion Page.” We think that the article below is an excellent way to start an important conversation, which is one of the main goals of the Opinion Page.
Some readers may disagree with the author’s opinion, some will greatly support it, but we think that Boris Prilutsky, the author of this article, deserves your attention. He is an exceptional practitioner, educator, and a tireless defender and proponent of massage therapy, especially medical massage. Hundreds of his students successfully work and help thousands of patients in many European countries, Israel and the United States of America. I think we all may learn from Boris’ long, professional career and incredible expertise.
MANUAL THERAPY VS MASSAGE THERAPY
The context in which a word is used could change its meaning. In the dictionary we may find a long list of meanings of the same word that can be used a different context. For example, depending on the context, the phrase “What a jerk!” can be extremely offensive or emphasize a strong, pulling motion. So the application of a word outside its common understanding may generate considerable confusion.
Various technical terms are also associated with a particular social context in which they are commonly used. If one uses a technical term in the wrong social context, he or she could generate confusion, which leads to misunderstandings and unnecessary and counterproductive arguments.
In my view, a major example of this unfortunate phenomenon is the use of the term “Manual Therapy” in the context of Massage Therapy. The Latin, the wordmanus means hand, and therefore therapy conducted by the hands is manual therapy. Technically speaking, massage therapists can call themselves manual therapists because the scope of their practice is soft tissue manipulation done by the hands.
In the Western School of massage therapy, practitioners primarily use their hands while in the Eastern School of massage therapy, feet or knees are used. However, we do not call massage therapists who practice Eastern massage techniques ‘pedisual’ therapists.
At the same time, massage therapy does not employ the entire arsenal of manual therapy. For example a massage therapist cannot administer spinal manipulations, joint mobilization, or perform carotid sinus massage. Thus the term “Manual Therapy” includes the term “Massage Therapy” as an integrative part. These two terms are not exactly interchangeable.
If a massage therapist introduces him/herself as a “manual therapist” to a D.O., D.C. or P.T., they are more likely to interpret this term in the context of their own profession and, in many cases, think the massage therapist is using these credentials inappropriately.
There are specific billing CPT codes pertaining to manual therapy that can only be used by physical therapists, osteopaths and medical doctors. In these cases, a massage therapist declaring him/herself as “manual therapist” can be seen by other medical practitioners as an “imposter,” thus creating a lot of confusion.
If the validity of the substitution of “massage therapist” for “manual therapist” is questionable, why would so many massage therapists today choose this road? In my opinion, the answer to this question is two sided. From one point of view, it is a matter of marketing and from another it is public perception, which the massage therapy profession is still trying to change.
In several previous articles, I have expressed a concern about the recent tendencies developed in the American massage therapy industry. I think that massage therapists who attempt to separate from massage therapy and present themselves in the “new” light unwillingly contribute to the fragmentation of the profession and encroachment on neighboring professional fields with possible legal consequences. Knowing that consumers are often sold on new trends, and buzz words, presenting yourself as a member of some trendy “new wave” seems to some as a good idea. In this manner, “Manual Therapy” became a new buzz word that practitioners have been quick to embrace. However, this term, or more correctly concept, is hardly new. In my professional life, I have already witnessed, at least once, this and similar unfortunate situations in which massage therapists tried to become manual therapists. Observing the current trends in American massage therapy reminds me of similar unfortunate trends that occurred in my native country where I was as a young and passionate massage therapist. Considering the importance of the topic, I think it worth sharing my thoughts and experiences on this issue.
After I graduated Vinnitza Institute of Physical Education , I was greatly excited about my professional career and was tremendously lucky in having Professor Kish from the Uzgorod Medical School, Ukraine, as one of my first mentors. He was an old man by this time since he graduated from Budapest Medical University in Hungary before World War I. However, Professor Kish had contributed a great deal to the field of medical massage and to the entire manual therapy science. For example, he proposed spinal manipulative techniques for medical massage practitioners. At the time these techniques-spinal segment /facet joint maneuver-were considered an important clinical tool for medical massage practitioners. Since the nature of the treatment was very gentle and very specific, Kish called it a “maneuver” to differentiate from chiropractic adjustments.
Professor Kish was an expert in all medical massage methods and techniques and practiced it daily on his patients. Readers will be surprised to know that the majority of “new” techniques and approaches offered now on the continued-education market are simply recycled, renamed and repackaged methods, which were widely used at that time. Professor Kish taught that there is no substitute to massage therapy, and if chiropractic adjustments are being administered without the correct application of medical massage therapy first, the treatment will be long and its clinical results will be limited. Thus, only a comprehensive approach to somatic rehabilitation is the key to quick and stable clinical results. Despite the pleas of Professor Kish and other scientists, more physicians and massage practitioners began to limit the massage therapy component in favor of various types of manipulations and mobilizations to save time and be able to work on larger number of patients.
At the middle of the seventies, various methods of manual therapy became very popular in the Eastern European countries and Manual Therapy Association was organized with its governing body located in the former Czechoslovakia.
In the former Soviet Union, manual therapy gained a lot of support and interest among physicians and massage practitioners. Professor Kish’s work was widely recognized by health practitioners and academics since he lectured a lot throughout the country. Physicians and medical massage practitioners who wanted to practice manual therapy were accepted into Manual Therapy Association and this stimulated a lot of clinical and experimental research. The public became aware of the “new” treatment modality, which resulted in new streams of revenue for those who practiced manual therapy. Thus, the initial outcomes of medical massage re-named and resurfaced as manual therapy were positive.
However, very soon things changed dramatically. As soon as it was obvious that manual therapy could generate a considerable amount of additional income, the Association changed its standards and decided that only neurologists could legally practice manual therapy. Later the legal boundaries where slightly expanded, and the Association included orthopedists as another medical profession legally allowed to practice manual therapy.
No one could explain why a neurologist or orthopedist can administer protocols of manual therapy, including medical massage techniques, safer and better than medical massage practitioners. As a result of this unfortunate decision, the number of practitioners who were legally able to use manual therapy dropped dramatically. The massage practitioners were forced to exclude mobilization maneuvers from their practice and forbidden to use term “manual therapy.” Another significant misfortune was the fact that many people, who did not have the proper training since the Association denied them access to the knowledge and clinical practice, started to practice manual therapy including medical massage illegitimately and subsequently many patients were hurt.
At that time, I was studying at the St. Petersburg’s Institute of Physical Education with Professor Alexander Dembo, M.D., who was a widely known and respected neurologist and medical massage practitioner and one of the co-founders of Manual Therapy Association in the former Soviet Union. He was great clinician but also incredible teacher who dedicated his entire life to training medical massage practitioners in medical massage methods and techniques. Prof. Dembo was outraged at the Manual Therapy Association’s decision and left it since he saw Association’s position harmful for public health and driven by monetary interests.
Why I am relating all of this and why what happened long ago in former Soviet Union in the 1970-1980s is relevant for the massage therapy community here in the United States? Unfortunately, I see similar tendencies occurring here and it greatly worries me. Of course the readers may say that what happened there will never happen in the U.S.A. Regrettably, they already have. Below are a couple of examples:
In 2003, the Chiropractic Board of Kansas worked relentlessly to prevent “manual therapy” from being practiced by physical therapists and eventually by massage therapists (http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=9121).
However, my favorite example comes from New Jersey. In 2004, the New Jersey Nursing Board, which legislated massage therapy at that time, passed a resolution prohibiting massage practitioners to practice Lymph Drainage Massage (LDM). Later during public hearings it was decided that massage practitioners can practice LDM on healthy individuals while it was prohibited for them to use this modality as decongestive therapy, i.e., in cases of Lymphedema which are primary target of LDM (http://www.njconsumeraffairs.gov/massage/minutes/mass33.htm). Conveniently, nurses who practice or plan to practice LDM immediately became the primary beneficiaries of the new law. Using the false assumption of being a danger to public safety, New Jersey, in difference with the rest of the world, not only took LDM from the massage practitioner’s scope of practice, but also took it from patients who are in desperate need. How many nurses and physical therapists will spend hour or hour and half for LDM session and how much if they do such session will cost to the patient?
These and similar regulations were done under the guise of preventing harm to the public, which is difficult for massage practitioners to confront alone. However, the real motive was money rather than any real interest in public health.
I think that if we willingly or unwillingly continue this trend of moving away from our roots, we will fragment the massage therapy profession in general. This means, we will be more and more vulnerable to similar attacks in the future by people whose monetary interests are threatened. When it happens in your state, do not anticipate that anyone will help you. Instead, consider the possibility that all the time and money you have invested in your education will evaporate the same way as LDM evaporated from massage therapists’ scope of practice in the Garden State.
Thus, before readers decided to use a “new” and trendy way of marketing their professional skills using terminology that is widely used by other medical professions, please consider my story about “manual therapy” and its negative impact on the entire massage therapy profession in my native country and similar situations which arose here in the United States.
To conclude, surely massage therapy is a manual therapy by definition, but at the same time it is only part of this wider concept. I was educated as massage therapist. I practice medical massage on a daily basis; I have taught medical massage for several decades now. I am proud to be massage therapist, and I love and deeply care about this wonderful profession of ours. This is why I think that instead of shying away from our common roots, we need to get together under this wide wonderful umbrella with our favorite techniques and methods and called ourselves exactly what we are-massage therapists!
Category: Letter From The Editor