Change in Instructor Qualifications for All New Approved Providers
NCBTMB continues to monitor instructor qualifications within Approved Provider applications to ensure that instructor knowledge matches courses taught. On June 19 2017, NCBTMB will implement instructor qualifications for all NEW Approved Providers of Continuing Education applicants.All Approved Providers must follow state rules prior to applying. In addition to state rules, Approved Providers must meet one of the bulleted points below:
Holds a minimum of a Bachelor Degree from a college or university accredited by a regional accrediting body recognized by the U.S. Department of Education, or a substantially equivalent accrediting body of a foreign sovereign state, with a major in a subject directly related to the content of the program to be offered;
Has completed at least five years of professional experience in the practice of massage therapy; AND
Has a minimum of two years teaching experience in the subject matter;
Has completed a NCBTMB approved teacher training program in the modality of interest;
Has completed at least 100 hour of non-entry level education in the subject matter to be offered and has a minimum of two years of professional experience in the subject
NCBTMB Announces Change in Energy Work Acceptance, Introduces New Instructor Qualification as of July 11, 2017
Burr Ridge, Ill. (July 11, 2017) The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) announced today key updates to its Approved Provider for Continuing Education Program, including a change to Energy Work Acceptance and the addition of Instructor Qualifications for all new Approved Providers. Both changes are effective immediately.The full statement is below:In 2013, NCBTMB began a new adventure in elevating its Approved Provider for Continuing Education Program in response to the needs of an evolving profession. The evolution of this program has led to further improvements within the massage therapy and bodywork profession by purposefully evaluating the needs of the profession; including massage therapists, peer organizations, continuing education providers, and state boards.
Energy Work Acceptance
As stated in NCBTMB past communications, its APCE program will continue to evolve as the profession grows. To this end, NCBTMB has worked with the profession regarding the acceptance of energy work.
There are several types of energy work that have been created and built upon throughout the years. In truth, some forms exceedingly reach outside of the Massage Therapy Scope of Practice, according to state laws and NCBTMB policies for acceptable content. This means that though a massage therapist may practice such techniques, and courses containing such content may have been previously accepted, NCBTMB will continue to re-evaluate courses and policies to align with the needs and demands of the profession.
In refining this category, NCBTMB will only accept energy work courses that include application of professional therapeutic touch as of June 19, 2017. Translated, this means that distant healing, aura techniques, crystal work, Qi Gong, Tai Chi and other techniques that do not include professional touch between therapist and client will no longer be accepted. Courses that are currently approved will be honored through the Approved Provider expiration date; however, when the time comes for an Approved Provider to renew his/her/its status, any energy work course (not including anatomy, physiology, kinesiology, ethics, professionalism, research, pathology, business, safety) that does not include the application of professional therapeutic touch will be retired.
NCBTMB will continue to accept home study and distant learning course delivery in subject matter that is within its acceptable content, following the above guidelines.
There is much confusion in the industry to the differences between Deep Tissue and Deep Pressure.
Mainly, when a client requests Deep Tissue, they are actually seeking a Deep Pressure Massage which is exactly how it sounds – an overall massage which combines forearms, elbows, fists, knuckles and thumbs – and pressure!
Deep Tissue massage also utilizes the forearms, elbows, knuckles, fists and thumbs, but the differences between the two approaches are vast.
Deep Tissue, as it is known generically, includes the use of techniques and theories developed by Ida Rolf and has been integrated with other approaches to massage.
Deep Tissue is a technique of massage that focuses on “deliberate intention” and utilizes slow gliding movements which encourage the unfolding or unwinding of tissue.
The “approach” is “focused”, working slowly from superficial to deep fascia, recognizing areas of resistance, working (and waiting) on these specific areas before moving on. The technique takes time and the patience of both the client and therapists.
The appropriateness of staying and working on an area or moving on will depend on several factors such as:
Therapists Comfort Level
Tissue resistance to lengthening and elongating can be found in all layers of fascia. The reasons behind chronic contraction and pain are many and varies.
The Deep Tissue approach is to:
1. Apply enough pressure to engage or meet the resistance (not overpower it)
2. Sustain the pressure against the resistance moving into the direction of the resistance until;
The resistance diminishes
It is time to move on
The application of this treatment should remain within the “clients’ threshold of pain”. Some discomfort may be experienced during these sessions, but, if the LMT responds accordingly, discomfort should lessen/cease in a short period of time.
Suggested LMT responses to client discomfort
A slight decrease in pressure. Pressure gauges should be set with your client in order to determine the depth of your pressure. A pressure gauge of 1 – 5 (1 being very light, 3 being perfect, 5 being too deep) will allow you the opportunity to “back-off” or “slowly proceed”.
It’s important to keep in mind that most of your movements should be slow and small, based on intention (having a goal), sensitivity (seeing with your fingertips, watching/listening to the body) taking directions from the tissue, awareness (remaining open and accepting of what you’re discovering). It’s important to listen to what the body and spirit have to say.
A slight change in the direction of your pressure. By changing your body mechanics (leaning back or forward, bending your knees, shifting your stance, moving your fingertips from points to pads, shifting your foot, etc.) will change the quality of your touch (soft, less invasive to deeper, a bit more forward moving) and the direction of your touch. There should be no quick movements, dramatic changes in direction or pressure or quick movements in/out of the tissue.
A shortening of the structure you are working on. By bringing the origin and insertion closer together, you will create a shortening of the structure or slacking in the tissue. This will decrease the resistance of the muscles at the level you are working, allowing you to move deeper into the fascia or the “tissue that binds”. Use pillow bolsters or rolled up towels to support the shortened structure. This technique may be used in conjunction with direct pressure, relax/contract techniques or breathing in order to increase the results.
A slight lengthening of the structure that you are working on. By moving the origin and insertion of the muscle away from each other, you will create a lengthening or a “tightening of the tissue”. This will increase the resistance that you are working with which may assist you in releasing contraction. This technique may be used in conjunction with direct pressure, relax/contract technique or breathing in order to increase results.
Instructing the client to focus their breath “into the structure” or settle into their body. This will assist the client in shifting their focus (from what you are doing) to their own body. It allows the client the opportunity to participate in the treatment. Also, a deep breath will assist in the release of tissue.
Contract/Relax Technique. The client creates tension or contraction within the muscle(s) you are working on. This can be achieved by the client contracting the muscle without assistance (isometric contraction) or with the aid of resistance (resisted ROM) to the muscle in order to achieve contraction.
Fomentation, Hydrotherapy. Using the application of hot, moist heat to create an expansion in the tissue (when no inflammation is present).
Return to work on the area at a different time. Tissue will decide when it’s ready to release, not the LMT. People hold onto contraction, pain, illness and disease for a variety of reasons. When the time comes to shift, soften, let go, the body will respond.
Remember, the tissue should not be forced to painful excess, but encouraged to release. If you don’t get anticipated results “let go of your expectations” and move on. There is always another time to try again.
“Three D’s” of Deep Tissue Application
Direction of pressure is determined by the direction of resistance of the structure
Depth is determined by the level of tissue to be treated and the amount of pressure required to engage the resistance of the tissue
Duration is determined by the rate of release in the tissue or the conscious understanding of “letting go and moving on”
Benefits of Deep Tissue
Free the connective tissue from a contracted state to one of elasticity
To free tissue from restricted fascia formations which distort posture or limit ROM
Assists in the realigning of posture and re-establishing independent muscle action
Re-establishes circulation and reduces tension in chronically contracted muscles
Any contraindication to massage is a contraindication to Deep Tissue. Generally, Deep Tissue is indicated for chronic contraction or Chronic Holding Patterns where there is no evidence of pathology or injury. Deep Tissue should never be applied in the acute stage of injury or if inflammation is present.
Chronic or Remodeling Stage (Last Stage Of Healing)
Long Term Signs and Symptoms
No visible signs of inflammation
Scar tissue has developed and is maturing and shrinking in accordance to stresses placed on injured area.
General muscle weakness
Pain is felt with stretch, past the available ROM
Chronic and re-occurring pain ranging from mild to severe
Decrease in ROM (Range of Motion) and LOF (Loss of Function)
Chronic Holding Patterns
Duration: 4 days>
Increase muscle strength and function
Re-align scar tissue
Hydrotherapy: Ice & heat or ice (alone) or heat (alone) depending on inflammation
Massage: All types, esp. DT, Frictions, CFF (at site to re-align scar tissue/increase circulation)
Muscle Energy Technique or Proprioceptor Neuromuscular Facilitation to reduce spasm, re-educate muscle function and increase muscle strength
Active>Passive>Resisted ROM to maintain or increase mobility
Stretching to lengthen muscles
Notes on Chronic Stage
Scar tissue has developed and is maturing/shrinking according to stresses placed up it
Collagen fibers shrink, pulling and torqueing all structures it has adhered itself to
If appropriate treatment is followed, treatment can progress with greater intensity until function is restored
Effects of Scar Tissue
Scar tissue needs to be re-aligned in a way that allows normal functioning of a muscle during contraction and lengthening.
When injury occurs, scar tissue forms “like pick-up sticks”, every conceivable way – which limits muscle broadening and causes uneven tension in surrounding muscle tissue. This leads to further tissue damage.
Areas Most Affected in the Muscle
In the muscle belly, there is usually enough area for broadening and lengthening to occur. At the musculo-tendinous junctions, less broadening/lengthening occurs and less healing takes place. These are areas that need further stimulation.
Physiology of Pain
The network of nerves branch off and break down into tiny nerve ending fibers. At the end of these fibers are three types of specialized nerve endings which respond to stimuli; pain, touch/pleasure and thermal. Touch/pleasure and thermal fibers are much larger and arranged more densely throughout the body. Therefore, sensations of touch/thermal travel quicker to the brain and over-ride the pain receptors.
Pathways of Pain
Pain messages are sent to the brain via nerve fibers to the spinal cord, up the cord to the center of the brain (thalamus). The message then becomes more defined, adding emotional components from the cerebral cortex. Since the brain can only send one message at a time, the pain is either altered by overriding the sensations (touch/temperature) or the pain is felt at full force. This “switching” on/off from pain is known as the “Gate Theory”.
Sol and Gel States
Massage influences pain stimulation and proprioception. Physical removal of waste is achieved by muscle kneading which increases the circulation. This allows oxygen, nutrients and blood to replace the toxic buildup and reduce the chemical neurostimulators which irritate nerve endings.
The fascia which encases the muscles and fibers vary from a thin liquid state (sol) to a thick and solid state (gel). The consistency of the fascia substance can be influenced by heat and friction. When the muscle becomes warm from an increase in blood flow; various massage strokes, stretching, yoga, hot packs, and etc. the fascia becomes more supple and pliable. The physical pressure (pulling, tugging, stress) of the muscle itself and on surrounding fascia bones, lessens. In a “sol” state, the muscle lengthens, decreasing joint and muscle pressure, which reduces the neurostimulating input into the spinal cord.
As we are touched, the brain may release chemicals which act as pain inhibitors such as kephalin or serotonin, vasoconstrictors which are believed to inhibit a nerve from firing to the next nerve, reducing or eliminating the pain response. Other chemicals such as endorphins product opiate like substances, increasing the pain threshold.
Deep Tissue application is an “art” – not a magic trick. Anyone can learn the art of Deep Tissue application with time and practice. Moving slowly with intention are the basics of Deep Tissue massage. With patience and the “willingness of letting go of expectations”, tissue will unwind, unfold and dance under your fingertips!
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