|
|
Re: "Medical" Massage Therapists
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: "Medical" Massage Therapists - May 17, 2005 11:11:00 AM
|
|
|
dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
Status: offline
|
Zack,
Not only might a patient feel like, hey I can get a nice massage and not have to pay for it, but the massage therapist at the charleston clinic stated above claims that she can PERMANENTLY take away their pain and at the lowest healthcare cost available. She even gives a personal gaurantee! Talk about a happy ending!
(Sorry)
Rick
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 1:05:00 PM
|
|
|
TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
|
I'm not renewing my PT license. Just open a clinic as Manual Massage Physical Therapist (non licenced of course except in massage) cash pay only, rub a few backs and I'm in the money. No more insurance, POPTS, or direct access to deal with. If I keep going I'm going to talk myself into it. ;)
_____________________________
Todd
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 1:35:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
I certainly can't speak for each of the state medical associations, but overall, regulation of health care is a good thing.
I don't think the AMA cares for the time being, as tort reform and reimbursement is higher on the concern list.
Unlike PT, most doctors don't pay alot of attention to the AMA...we usually follow state medical associations and our colleges of our own specialties.
The better question is what does the college of PM&R say...the AOA also likely has an opinion, but I have no idea what it is. Right now the concern is also regarding tort reform and graduate medical education funding.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 1:38:00 PM
|
|
|
karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
Status: offline
|
TLB, Why don't you add a DC degree, then you'll be a triple threat. You can just laugh at us battling over territory. I shall call you a Manual Medissage Physical Therapractor.
_____________________________
Zack Solomon MPT, OCS, CSCS
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 1:52:00 PM
|
|
|
karmzack
Posts: 181
Joined: March 20, 2005
From: Hawaii
Status: offline
|
Wags, I'm not sure why the AMA would care anyway. As long as a referral is required by an MD or DO for reimbursement they are still in the loop and getting their piece of the pie.
_____________________________
Zack Solomon MPT, OCS, CSCS
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 4:54:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Honestly, there is no piece of the pie. The political structure and medicolegal environment self limits people. One would have to be an absolute idiot to claim too much without much science to back it up. There is too much risk out there.
I just think "medical" is a goofy term to place in front of massage...like "medical toe nail clippings". No one takes that seriously. But I could see how that may directly affect PT's.
Personally the APTA should have paid more attention to the regulation of LMT's than the developement of a DPT. Who cares about the degree if the LMT down the road makes twice what you do and barely went to school. I would be pissed off if I were you guys. The APTA once again have their heads up their @sses.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 8:43:00 PM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
I agree that there is a problem with the term "medical" massage, but I think you are missing the message.
How many people will walk in off the street to see a PT if they are just stiff and sore or maybe have a little ache. Even if there is a problem but not an injury. Not many, even with Direct Access, not many. Why? Currently it is too much hassle with the Dr. visit, scheduling, waiting in a waiting room reading 2 year old magazines. Then I get hit with a bill for a couple of hundred dollars and I never get the TLC I was looking for.
I can go to the MT, get a nice, relaxing massage in a nice comfortable setting, no waiting, no hassle, and I'm treated like I'm the CUSTOMER, the man in charge, and I walk out feeling like a million bucks. Cost. (Not priceless) $40/hr.
PT has done a good job of following the medical model, in the case of injury and rehab, they are better than anyone else in most cases. But where they are dropping the ball is in all those "less than injured cases". PT's have also followed the medical model of the practitioner dictating the treatment. Is this the best care? Certainly from a PT's POV it is but I doubt for these type of patients it is.
I've been pounding this out over and over and it meets with a lot of resistance or dismissal but if PT's want autonomy then they have to look at patients as customers, to be satisfied, and scientific outcomes is only part of what customers want. If you ignore this, then you will continue to see only injured and post-op patients that are referred by doctors, no matter what legislative changes take place.
Another point. Does anyone have any information on the dangers of MT?
|
|
|
|
|
Re: "Medical" Massage Therapists - May 17, 2005 9:59:00 PM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
This was the first article I pulled up on a search:
A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain.
Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG.
Group Health Cooperative and University of Washington, Seattle, Washington 98101, USA.
BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 3:21:00 AM
|
|
|
dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
Status: offline
|
Randy, I have no problem with people going in to see an LMT for general aches and pains, in fact I often go myself, feels good, gets you over the weekend of yard work, whatever, I am usually very grateful and leave a nice tip. The problem I have is when not only individual massage therapists but schools and associations begin to make claims that don't stand up to scrutiny. Claims that they can evaluate and rehabilitate injuries effectively, claims of permanent pain resolution. Claims that they know the first thing about mobilizing joints. I have seen multiple LMT's over the last several years and I would be willing to bet my house that not one of them knew convex vs. concave, the direction of 90% of the muscle fibers in the body, origins and insertions, ect. They simply do not have the educational background.
Now, will massage kill anybody? Not likely. Is there a huge public safety risk, probably not. That is until they start pushing and pulling on things they don't know anything about, mobilizing joints without knowing the orientation of the facets, instability vs. restriction, seeing people who have true medical conditions and think hey this person is a medical massage therapist, maybe they can help.
By the way, I have no problem if someone calls my office and says, hey Rick, I pulled my back this weekend, can I come in and have you work on it, but I first do a full evaluation and then if soft tissue work is what they need, that is what they get, if I find something else that needs worked on or reason for MD referral I can do that as well.
On the standpoint of cost, yes, one or two massage sessions a month may prove less costly than PT but if you consider the number of injured workers, off work for a year or more, who have bounced from chiro to massage and back again before finally getting appropriate eval and tx at a physio's office, what is the cost of that? Just another way to look at things.
I appreciate the discussion as always,
Rick
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 6:00:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
Randy makes a good point, but I don't think there's anyone here who doesn't know that if the regulatory environment was truly a level playing field, we would CLEAN UP.
As it is now, we have some groups trying to keep us under their thumb, and other much less prepared, less skilled, and less educated people seeing patients/clients with no restrictions.
WTF??
I disagree with Wags that health care is self limiting. I find it to be the worst of both worlds, a market partially regulated for some groups (PTs, MDs, DOs) and mostly free market and laissez faire for others (DCs, LMTs). This is always unfair to the groups for whom the rules apply. I don't disagree that there should be rules, I just think we should apply the same standards to everyone.
If that was truly the case, you would see PTs bubble toward the top of the market, as we have the most cost-effective skill set for a very large variety of problems.
The future of PT is carried on by private practitioners, who do need to view their services as professional and subject to customer satisfaction, and therefore not a commodity.
But the current regulatory environment unfairly discriminates against some groups and not others.
If it was truly a free market, I would not be afraid of any DC or LMT. But in the chains we currently wear, their actions are much more free and they can make their way in the market much more easily. This is a huge advantage.
I enjoyed Randy's citation about meta-analysis for LBP treatments. However, I don't think this adequately addresses the service vs medical care issue. I would bet that hugs and /or a large insurance or legal settlement would improve outcomes also, but are those things "medical care"?
As Wags said, once you put 'medical' in front of something that is clearly not, the lines get blurred...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 11:47:00 AM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
Jason,
Do a quick search of massage therapy on pubmed or medline and you'll find that distinguishing massage from other "medical" modalities becomes really blurry.
Just in case I have to make this clear. The argument I'm presenting isn't MY argument. PT keeps the roof over my head just like most here. It is what I see as the markets argument. I do have a lot of thoughts on this subject, the DPT, Direct Access and others that seem to all tie in together. Probably too many thoughts to communicate any of them clearly.
One of the things I find interesting is the parallells between the MT's push for licensing and expansion and the PT reaction, and the MD reaction to PT's doing the same. Obviously there are differences, but look to your past and your origins. I see it as coming full circle. Here is my analogy of what is/has happened with the titles changed to protect the innocent (me).
Lets say that first there was a group of physicists (MD's), they were highly educated and had the field to themselves, they came up with wonderful theories and ideas and created machines to help test those theories. The machines were complex and required constant maintenance so the physicists hired technicians to maintain them (early PT's), at first they didn't know much but the physicists trained them and through experience they become very good at maintaining and repairing the machines. The decided to now call themselves mechanics, and they trained each other on how to do the job better, they started a mechanics guild, and before long there were master mechanics and schools of mechanics. They became better than the physicists at doing what they did. They then thought, we should study physics to be even better mechanics, so they did, and now with their knowledge of physics combined with their practical knowledge they had a new classification of mechanic, an engineer (DPT). This was great, they said let's make all mechanics engineers, so they did. However this created some problems. A. The best engineers didn't necessarily make the best mechanics and vice-versa. B. While it was good for the engineers to keep their hands on the machines, their best and highest use was cerebral, not physical C. The cost of using highly paid engineers rather than mechanics, while more economical than using physicists, was excessive.
So what was the solutions, some engineers just loved being mechanics and found people who would pay them, but the majority of the engineers did what they did best, problem solve, while they hired new technicians to do their old jobs, the new technicians didn't know much at first...
Last thought: (for now) Skill at hands on therapy isn't acquired through time in a classroom, it is the result of some training, thoughtful experience and guidance, and some natural talent. I don't think high level degrees are necessary to be able to do it well. For example, the current best evidence for treating LBP. You would use, maybe a simple mobilization, education, and muscular stabilization. The skills needed to be able to do this, with the patient screened and UNDER SUPERVISION OF A PT, can easily be learned in a year. So why use someone who has 3 or 4 years postgraduate education to do it?
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 11:56:00 AM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
addendum: I do think one of the big differences between the beginnings of physical therapy as a profession and MT is the healthcare business environment today, but I also think there has been a change in the medical culture and the way it is percieved by the public.
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 2:35:00 PM
|
|
|
TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
Status: offline
|
Randy,
That analogy doesn't even come close, way to many leaps made there. MT's trying to treat and diagnose with their educational background in this day and age is like a PT in WWI trying to perform surgery or handing out meds. The knowledge base just is not there. For someone without a PT educated background this is very hard to see, I know it was for me also (someone with a kineaseology degree) while I worked in a PT clinic before I was accepted into PT school. I think we all know or have worked with tech's who believe they can do a better job than the PT's they work with, they just don't have the background to know any better, know when they are doing harm or putting people at risk. If MT's were to have a sound knowledge base and held accountable through rules and regs then bring on the competition, but that's just not the case now is it.
_____________________________
Todd
|
|
|
|
|
Re: "Medical" Massage Therapists - May 18, 2005 3:47:00 PM
|
|
|
Jon Newman
Posts: 1707
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Link Master, Ian Stevens, provided this link on noigroup.com.
[URL=http://www.americanmanualmedicine.com/education/a14z2.html]link[/URL]
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 2:40:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1205
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Just a thought from another perspoective: trained in the Netherlands (a Loooong time ago), we physios were considered THE choice for massage therapy. We received extensive training and lab hours to become the providers of therapeutic massage - for relaxation or rehabilitation purposes. That's my background.
Here in Ontario, a clear seperation exists between massage therapists and masseurs and others who provide massages. Masaage therapists have their own regulatory body, their own public-protecting College of Massage Therapsist, and strict curriculum guidelines for any school wanting to teach MT. I was involved in writing the curriculum for our local college, and I have to say, I am NOT worried at all about the ability of a RMT (=LMT in US) to screen for pathological conditions. No diagnosis, no first-line practitioner - but screening for further referral. The referrals are with an explanation of suspected condition: i.e. "the piriformis is involved on the right - possibly some SI or lumbo-pelvic dysfunction". In other words, they get trained (and it's hammered in ) to screen and screen - to only treat in conjunction with another professional. The training is over three years with lotsa of supervised clinical work.
I guess the stricter guidelines make them easier to see as part of a rehab team. They cannot sign for MVA treatment plans; they can design their part - we have to approve those (or the MD). Yes, they are in many instances, competition, but there is no chance in h*ll that they are a serious threat to PT here....
WE as PTs have given away the massage therapy skills, deeming them too "time-intensive, passive therapy" - now, with the brain and perception becoming big (as well as skin and soft tissues - Diane has tons of stuff on that) in pain rehab, maybe they HAVE a valid place. Since we didnot want to provide that "spa" like setting....They have marvellous palpation skills - a valuable tool in any manual care...
I guess the standards of training absolutely essential - they have to be high..
Just thought I'd present a different slant.
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 6:03:00 AM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
TLB,
I was reading yesterday in the April 23 edition of Advance about a PT visiting New Zealand. She describes her visit 20 years ago, PT training in NZ began straight out of high school with 1 year academic training and then 1 year of supervised clinical training. Then you were a PT. She observed they did more manual therapy and used less modalities than their US counterparts. These PT's were not dangerous, NZ therapists then and now have very good reputations for hands on therapy.
MLT, I don't think I mentioned anywhere that MT's should diagnose, if I did it was a mistake. The point of my whole post was that diagnosis and problem solving should be the realm that modern PT's with their education should be concerned with, not trying to protect techniques that others can do as well.
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 6:04:00 AM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
MLT? Sorry, that was a slip, it must've just rung a bell with MT. Getting to be that age.
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 6:32:00 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
But don't you guys think there has been a "dropped ball" by the APTA? Perhaps an odd lack of focus on their part which has in turn allowed another group to grab their market share?
What do you think the solution should be...it is obvious they are not going away.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 7:19:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
I'm finding this thread confusing:
Do PTs do massage?
Do Pts want to massage?
Do PTs want to be massage therapists?
Is massage part of PT curriculum?
|
|
|
|
|
Re: "Medical" Massage Therapists - May 19, 2005 7:36:00 AM
|
|
|
jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
|
PT's do massage, there is also a CPT code for it. Do I want to massage? No. But I will do petrissage and efflurage. Don't want to be a massage therapist. Massage was part of the the curriculum in my program.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.109
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: "Medical" Massage Therapists 
