Sunday, May 24, 2009

Sustainable Massage Practice

Fundamentals of Massage
By Sam Steven Due Date: 25 May

Describe how issues of sustainability relate to massage practice.

For a business to survive in the modern climate there are certain parameters that should be considered in order to maintain the sustainability of the business and subsequently quantify its performance and longevity. I have outlined some of these parameters below using the example of a massage therapy practice.

Environmental sustainability describes the effect on the environment of running a massage clinic. We can take steps to reduce the detrimental effect on the environment by considering the way in which we operate our business and the products and resources we use. For example:

  • By using energy efficient light bulbs to reduce the toll on electricity. This is beneficial to the environment but also for economic sustainability.
  • Using natural light where possible. This reduces the need to use of electricity (reducing the electricity bill) as well as being healthier for the practitioner and the patient by providing a natural source of vitamin D.
  • Sources of heating and cooling of the room.
  • By using biodegradable or environmentally friendly laundry powder when washing linen.
  • Using recycled paper when taking notes.

Social sustainability:
Marketing: By educating the public on massage and its benefits you will produce an informed population and thus, an informed/educated client list. Consequently, this education is likely to lead to ‘word of mouth’ marketing for your business ultimately expanding your business through positive feedback cycles.

Forming allied healthcare: By building and maintaining communication and referral lines between other healthcare providers (particularly those of which patients may well ‘trust’ such as doctors) exposes your massage practice to those practitioners as well as establishing trust and respect between the professions. This is not only beneficial and sustaining for the individual practices involved, but for the future exposure and therefore sustainability of massage therapy alongside ‘mainstream medicine’. Note: I say ‘mainstream medicine’ in the context of the most common therapies to date (doctors, physiotherapists etc). Regarding massage sustainability, the future of the profession will be much more prosperous if it can become a ‘common popular therapy’. This does not mean sacrificing the foundations of massage therapy to fall into line with general practice, but educating society so that massage is regarded as a therapy to credit for all it offers.

Working within the massage scope of practice: This allows practitioner safety against any potential future jurisdiction, and patients awareness of the parameters of your practice. Communication lines should be kept open to ensure the scope of practice is fully understood and likewise any personal considerations of the patient are respected appropriately.

Economic sustainability. Essentially a massage practice is a business, the operation of which requires money, and essentially is a medium by which the operator earns a living. Economic sustainability requires that ‘money in’ at least equals money out (or more equals profit).

Expenses must be reflective of the money coming in (how many patients you are seeing). An example is office/room rent. Although practice location is important for marketing, if the rent exceeds what is being made, this is unsustainable. In saying that, marketing can assist in the development of a company/business. Start small, once marketing strategies have been put in place and actual growth (i.e. client list) is seen, you can look into expanding and relocating to a practice that more adequately reflects your earnings or spending more on extra expenses. However it is suggested that extra expenses always be spent with the aim of further promoting the growth of your business. Always aim at your current cash-flow and expenses, rather than what you aim to be making/doing. This is sustainable investment. Alternative expenses such as the implementation of a receptionist, cleaner and advertising are the kind of expenses that may be justified (and required) with growth of a business.

Personal sustainability for the therapist is also a vital avenue to be considered to ensure the long-term health and well being of the practitioner. This will ensure productivity and efficiency in the treatment they are performing. There is no point exhausting the therapist so they are unable to work efficiently in the future – *the broken healer. Areas to consider include:

  • The techniques being used, for example using correct technique – entire body to apply manual therapy, correct body position etc.
  • Diet
  • Exercise
  • Hygiene
  • Adequate recovery time/sleep to avoid exhaustion
  • Lifestyle balance
  • Using products (oils/waxes, linen etc) that are safe for both the patient and the therapist.

Areas where I can improve sustainability which I have picked up from this study and which I will employ in my massage practice include:

Using more natural light in my treatment room. By opening the curtains during daylight hours I will be able to save costs on electricity and also reducing the strain of electricity production on the environment. The light will also give a more natural aura to the room.

Likewise to control the temperature of the room, I can either close the curtains to retain warmth or open them to allow the suns heat to warm the room as opposed to a heater. Opening windows to cool the room as opposed to using a fan will also be more sustainable both environmentally and economically by reducing electricity usage.

I find I often fall into incorrect body position while giving treatment. By ensuring I use correct posture and technique while applying massage I will be ensuring my own sustainability by reducing the chance of injuries and will be able to provide more sessions and a more efficient and productive service to my clients.

Tuesday, May 19, 2009

The Ethics of Professional Practice

Fundamentals of Massage
By Sam Steven

Describe ethical and legal considerations in massage practice
Describe the scope of massage practice

Task 4 – The ethics of Professional practice Due Date: 20 May

Client-centered care is the focus of the treatment towards the greater benefit of the client. Aspects which should be considered are:

• The relevance of the treatment to the presenting issue of the client
• The consideration and respect of the clients goals, boundaries, ethical,cultural and religious
beliefs and emotional state
• The Awareness of power differentials (D. McQuillan, personal communication, 2009)
• Benefits should outweigh the costs of treatment (Perle, 2006)
• Communication should be with compassion, respect of the client and strictly professional.

Informed consent from the client is an essential initial measure in massage practice. Your client should have a full understanding and be in agreement to your treatment procedure and scope of practice, your terms of payment and effects of treatment.

The therapist needs to inform the client prior to the massage session of their treatment intentions and which areas of the body they will be applying massage. More importantly the client needs to give the therapist consent to the treatment. There may be areas that the client is not comfortable being touched and the therapist needs to respect this. During the treatment itself it is also necessary to inform the client which areas they would like to massage and again to gain consent before doing so.

Scope of practice. This is defined as the therapists ability knowledge, skills and limitations of application as their role as a therapist in relation to their education, qualification, experience, competency and training. It is vital that the therapist is honest about their abilities and that they are safely able to perform the treatment required by the client. The client should be informed of the therapists scope of practice during the informed consent stage so that there are no inhibitions or misunderstandings about what the roles are of the therapist and those of the client and that the clients goals are appropriate to what the therapist can offer as treatment.

The therapist is responsible for ensuring that they:
• Provide a service relevant to their knowledge and ability and any limitations are acknowledged to the client where necessary. This may require referring clients to a more appropriate health care provider
• That they conform to the scope of practice as stated by Massage New Zealand
• The treatment and techniques used are appropriate to the clients requirements.

Confidentiality is an integral factor a massage therapist should employ in their practice. Not only is it part of the Privacy Act 1993 to protect the privacy of the individuals concerned it is also important to build trust between the therapist and client.

Massage therapists should comply with the following points as indicated by the Privacy Act 1993;
“It is your responsibility as your client's therapist to ensure the privacy of their records. This may be achieved by storing client records in a locked filing cabinet, and never leaving them lying around when you are not in the room.” (Massage practice, 2008)
Massage prctice is also bound by the Privacy Act in that apart from the therapist and the client involved, no-one else shall have access to any of the clients personal information or records. The exception to this is if the client has given authorization to someone else in writing to access their information. The client is entitled to have access to their own records.
“The only times that it is acceptable to breach confidentiality is when you believe that your client may endanger someone else, or be in danger themselves in the future.” (Massage practice, 2008)

Boundaries are personal values which will affect the way in which the massage treatment is performed and the establishment of the relationship between therapist and client. They may include sexual, religious, cultural beliefs, area of personal space, touch, touch to certain body areas, inappropriate language or conversation topics or any range of personal morals or beliefs. Boundaries should be defined during the informed consent stage of the massage treatment. These should include the clients personal boundaries as well as the therapists boundaries. Honesty and assertive communication is essential in relaying these boundaries so they can be understood and respected throughout the massage treatment. Everyone is different and has individual boundaries. What some people are sensitive to or may be offended by can be completely different to anothers so it is important to establish an understanding of what is appropriate and what is not early on in the relationship. Again informed consent should be used in communications throughout the session to ensure these boundaries are respected.

Power differentials. There is a natural power differential between the therapist and the client due to a culmination of psychological, physical, emotional and educational parameters related to the massage setting.. These may include the positioning of the client compared to the therapist, the therapists knowledge and skills, the clients emotional or psychological state and also the clients level of consciousness during the massage session. The therapist is therefore empowered by being in control of the setting. It is important that this power differential is minimized to ensure the comfort of the client during the session and that their boundaries are not abused but also that it is present to an extent so that the client can trust the therapists abilities.

Relationships. It is important for the therapist to build a trusting relationship with the client. The relationship is influenced by first impressions and developes over time. It will promote the longevity of the custom of the client to the therapist and ensure a comfortable setting for each massage session. The relationship is the product of appropriate communication, the building of trust, compassion, respect and consideration of client goals, beliefs, boundaries and understanding of each others roles in the massage setting.

The relationship between the therapist and the client should be kept strictly professional at all times.

“A practitioner shall not enter into an intimate or sexual relationship with a patient whilst the patient is under their care”. (Massage New Zealand, 2007)

Transference and Counter-transferrence
“Transference is the personalization of the professional relationship by the client.” (Fritz, 2009)

There is a state of vulnerability within clients in a massage setting due to the power differential between client and therapist. It is important that the therapist does not abuse this situation. The client may show signs of dependency toward the therapist, offer gifts or invitations outside of the professional environment.

It is the therapists responsibility to deal with these occurrences as they arise by communicating and maintaining clear boundaries with the client. If necessary the client should be referred to an alternative therapist.

“Counter-transference is the inability of the professional to separate the therapeutic relationship from personal feelings and expectations of the client; it is the professionals personalization of the therapeutic relationship.” (Fritz, 2009)

The therapist may develop an emotional or sexual attachment to the client. Signs may include thinking about the client outside of the professional relationship and feelings of inadequacy when the client does not show signs of improvements after treatment. Common traits of people who experience counter-transference include the need to fix other peoples problems, to be perfect, need to be loved and are dependent on affirmation or acceptance.

Again it is the therapists responsibility to deal with these occurrences as they arise. They may be required to refer the client to alternative therapist. The therapist needs to think about and analyse the clients boundaries and assess your behaviour accordingly.


Perle, S. (2006). It’s All Greek to Me. Retreived May 20, 2009 from

Massage practice and the Privacy Act 1993. (2008). Retrieved 20 May, 2009, from"

Massage New Zealand (MNZ) (2007). Code of Ethics. Retreived May 20, 2009, from:

Fritz, S. (2009) Mosby’s Fundamentals of Therapeutic Massage (4th ed.). Missouri: Mosby Elsevier.

Saturday, May 9, 2009

Research Methods - Blog 4

Research Methods
Assessment Task 1 – Blog 4 – Evaluation of Research Findings
Sam Steven
May 2009
Unraveling the Mysteries of Unwinding

Unraveling the Mysteries of Unwinding. (2008).
Retrieved May 6, 2009, from

The first thing that occurred to me when I downloaded this article was that the authors name was not published. After a more in-depth search of the website I was still unable to identify who had written the article so I figured the next best method of evaluating the articles source was to evaluate the source in which the article was published.

Terra Rosa ‘Your Resource for Massage Information’ is an online site full of educational information relating to massage therapy. It offers a wide range of articles, learning tools and links to relevant topics. The article itself is published in the Terra Rosa Bodywork e-news, issue 2, December 2008. I was unable to identify how frequent the newsletters were.

The newsletter itself contained a dozen articles by different authors. This suggested that perhaps the authors were all experts in the specific fields they were writing about. Therefore I assumed that the author of ‘Unraveling…’ was also at least a fairly credible source of information.

I found the article itself informative in parts. Unwinding is an unfamiliar method of treatment to me so I was interested to learn the basic principles behind it. It had a good introduction where it highlighted the terminology “unwind” describing the significance of the treatment and the basic principles of the technique. However I felt there was a lack of definition in regards to when this treatment would be used compared to other treatment methods, what type of tissue damage would benefit from this treatment and perhaps an example of how the muscles or tissues respond. After reading on I found what I thought perhaps should have been included in the introduction:

“Tissue Memory
The metaphors used to explain fascial unwinding include: unwinding tangled telephone wires or twisted rubber bands. Most common explanation is that our tissues hold memory of trauma, and unwinding will allow the client’s body to move to self correction. Fascia may become short and tight due to trauma, poor posture, and physical stress. Upledger and Vredevoogd (1983) described it as follows: “When an injuring force occurs, the tissue which receives the force is changes. Perhaps it retains the energy of the impact. The human body the either dissipates that energy and returns to normal; or the body somehow localizes the impact energy and walls it off.” Unwinding attempts to free these stored energy. (Upledger, 1987)”

Perhaps the following subtitle identifying the ‘Benefits’ also would have been more suitably located if it was chronologically toward the beginning of the article after the introduction rather than in the middle.

Another aspect of the article I found odd was the instructional descriptions of how to perform Unwinding techniques on a client. Firstly the article appeared to be a broad insight to the treatment, its background and principles, to inform people of Unwinding. Then all of a sudden it gives a range very information lacking instructions on how to perform the treatment itself including pictures, which certainly helped get an idea of what the instructions were unable to describe but which I found rather inappropriate for what I thought was the purpose of the article.

The Author identified a host of references - 14 to be precise, which I thought might have been a little over the top, all of whom were however current and credible sources relevant to the topic.

In summary I believe the purpose of the article was to inform the reader of the Unwinding treatment and to give an insight to how it is performed, how it works and its benefits. The author achieved this however I think there was too much information. It was sometimes unclear and poorly structured. There are grammatical errors and some parts of the article were irrelevant to what I figured was the purpose of the article. In fact, I would have been satisfied had I simply read the introduction, the information on ‘Tissue Memory’ and ‘Benefits’ and the summary.


Upledger, J.E., Vredevoogd, J.,
1983. Craniosacral Therapy.
Eastland Press, Seattle, WA.

Upledger, J.E., 1987. Craniosacral
Therapy II. Beyond the Dura.
Eastland Press, Seattle, WA.

Unraveling the Mysteries of Unwinding. (2008).
Retrieved May 6, 2009, from