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Re: "Medical" Massage Therapists
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Re: "Medical" Massage Therapists - May 19, 2005 8:11:00 AM
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karmzack
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This issue isn't just about massage. If you look into some of the medical massage curriculums you will see manual therapy, therapeutic exercise, and therapeutic modalities.
Now we are back to semantics. Should LMT be performing joint "mobilizations"? Sounds a lot like the Chiro vs. PT topic on "manipulation".
I wouldn't consider the massage component the real threat, but when LMT begin to prescribe exercise and perform mobilizations on joints for specific pathology - then the patients and the PTs are in trouble.
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Zack Solomon MPT, OCS, CSCS
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Re: "Medical" Massage Therapists - May 19, 2005 8:28:00 AM
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TLB
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From: Arizona
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Randy,
[QUOTE] 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. [/QUOTE]My bad. When you said push for expansion and compared it to the direct access debate I took it to mean MT's performing not only massage but rehab also. I tend to think this is certainly where it's headed.
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Todd
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Re: "Medical" Massage Therapists - May 19, 2005 6:44:00 PM
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pwrandall
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From: Elk Grove, CA
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PTs do massage. Many PTs do not want to massage. Most of us don't want to be massage therapists. Most of us had massage as a part of our PT education. I'm not sure why we don't use it more often, it has more evidence behind it as a successful modality than many of our other treatment choices. Yes, we and our professional association have dropped the ball. Just today I had a patient tell me she goes to her chiropracter not for adjustments, but because her prescribed US, MHP /c IFC, and massage treatments with the DCs in house massage therapist. It just kills me.
PETE
PETE
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Re: "Medical" Massage Therapists - May 19, 2005 7:21:00 PM
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TLB
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From: Arizona
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Randy,
??
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Todd
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Re: "Medical" Massage Therapists - May 20, 2005 12:43:00 AM
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Randy Dixon
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Perhaps I expanded this topic more than it was meant. I think some people are upset with the claims of these particular MT's. I think they are ridiculous also.
My thinking about MT is that what I see is PT's trying to protect turf they don't want, and then getting upset because customers want it. There also seems to be some arrogance demonstrated in this that "we can do everything better than everybody" Massage seems as medical as any other modality and I'm having a hard time understanding Jason's claim that it is a "personal service" and not a medical treatment. How is it different than most other modalities that therapists use?
When I combine this with the discussion about DPT. What is the value of the DPT if you continue to do the same things you did as therapists with Associate degrees? If you gain new responsibility and opportunity, you give up others. That's what evolution is about. A phlebotomist or a nurse doesn't take away from the value of an MD even though they do some of the things could be part of their scope of practice. I don't know about you but I'd rather an experienced phlebotomist, with little formal training, takes my blood rather than a doctor. The reasons are the same, cost, skill(due to lots of practice), and allowing the MD to do what they should be doing. Will MT's want to advance their skills and scope of practice? Of course. Why would they be different than you? Should they? Of course, and it will require more education and training, just like you. I think it likely they will be doing a lot of the jobs you are doing now.
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Re: "Medical" Massage Therapists - May 20, 2005 2:31:00 AM
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JLS_PT_OCS
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I guess I really don't see the "turf" issue in the debate.
I have no problem with LMTs, I just want them to be subject to the same rules as everyone else. If they were, their 300 hours of training would be about the same training period of a medical clerk in a PT office.
Right now, they have virtually unlimited access to patients, with barely any education, esp compared to us.
My problem isn't with turf, it's with rules of access and education requirements. As long as the rules of the game are fair and similar for everyone, I think anyone should be able to play. I don't want a world where the only people "allowed" to do rehabilitation or to do manual therapy are PTs. But I do want the rules to be the same for everyone in the market.
We've been fighting for independence for years, and now it has become obvious that we need to evolve to a doctoral degree to be able to get that in this system. Now these people have that or are getting that with 300-500 hours of training. How insulting is that? Or better yet, what a reflection of the inherent unfairness of this market.
Randy, I think that is a great example, the physicists/mechanics/engineers one. Very insightful, and I really see what you mean. You may be right that getting more education will force us more off the maintenance of the machine (hands-on healthcare) and more time supervising or directing that as engineers. I hope that all of the options will be available for us, and I also hope that we do not go the way of the physicians, even most DOs, in that they touch their patients less, talk to them more, and "order" more services, diagnostic or otherwise, that don't involve their hands.
I know there have been meta-analyses done on massage therapy for back pain. I can understand why you're not sure how I define my terms. My delineation between medical care and personal service is simple. Any layperson can rub or stroke a muscle. It does not require any knowledge of anatomy, physiology, indications/contraindications, safety of patients, etc.
The fact that someone has made a profession of this, and that the states have been foolish (or greedy?) enough to "license" them, has led them to be considered something more than a personal service, which is not warranted.
A layperson can give someone a hug and cuddle them for 30 minutes at a time. I bet this might improve outcomes for a few painful problems. That also is not medical care, for the same reason massage isn't.
I say let the massage people go crazy, let them do what ever they want, and good luck to them. But if they are going to be in the market, they had better be held to the same standard as everyone else. That's the only fair way to do it.
J
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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**
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Re: "Medical" Massage Therapists - May 20, 2005 3:03:00 AM
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TLB
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From: Arizona
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[QUOTE] I have no problem with LMTs, I just want them to be subject to the same rules as everyone else. If they were, their 300 hours of training would be about the same training period of a medical clerk in a PT office.
[/QUOTE]Ditto from my end Jason.
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Todd
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Re: "Medical" Massage Therapists - May 20, 2005 3:55:00 AM
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Dr.Wagner
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If I was a betting man, you will see licensing of LMT's very soon, regulation of LMT's, and possibly the expansion of LMT practice. I really think they have grabbed the market share of "muscle work".
Honestly, I think PT needs to take back much of this practice, it is a unique part of PT. It may put PT in a bad position...and I would also bet you see more PT's getting their LMT.
Why? Primarily because LMT's will gain legitimacy and it will be necessary to increase revenue
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Dr. Wagner DO
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Re: "Medical" Massage Therapists - May 20, 2005 4:33:00 AM
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OaksPT
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Dr. Wagner,
Are you implying that a PT would need to get their massage therapist certification, maybe ok for a PTA, but for a PT that would be nuts. That would be like a MD/DO having to get their license in phlebotomy. We are already capable of performing massage if warranted. If I wanted to get a 300-500 hour certification/license, it would be for something I wasn't already trained in, like hairdressing or herbals, something I could really use in the clinic.(that last part is a joke)
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Scott Oaks PT,DPT
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Re: "Medical" Massage Therapists - May 20, 2005 4:51:00 AM
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JLS_PT_OCS
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Wags makes a good point here, in that PT has not done a good job of informing the public about what exactly it is we do.
As far as "taking back", I'm not sure about that, as I'm sure those who want to use it will and those who don't, won't. Kinda the same thing with manipulation. Or Ultrasound, for that matter. I think it's important that we retain the option to do it in our practice acts, that's for sure.
Just as most DOs don't use OMT, they could if they chose to and would not have to go back to school or get additional training for it. Same with PTs and massage.
The interesting thing about what Wags is suggesting is that LMTs have such an unrestricted access to people, that working "as a massage therapist" (just happening to also have PT degree and license) you can do, it would seem, everything that a PT would want to do, with none of the scope of practice issues.
This is my point about a fair marketplace. I have no problem with anyone deciding to expand what they do. I have no turf issue at all. I should not be telling any other practitioner what they can or can't do.
That is, as long as they don't CALL what they do physical therapy or physiotherapy.
But what I'm saying is that the standards of education, access, and reimbursement need to be applied evenly, to all providers in the marketplace.
If licensing is a way to do that (i'm not sure that it is) then I guess that would be a good thing in the end.
As it stands now, it only serves to legitimize a practice that has shown only limited benefit for limited conditions, and is now couched in terms of "medical care".
Think of the perspective from the 3rd party payer or employer. If massage is medical care, then don't I have a duty to provide such to my beneficiaries? How much massage? For how long? For what kinds of complaints or injuries? Or need there even be a complaint to "justify" all sorts of payouts on this supposedly medical care?
This is a scary road to go down...
J
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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**
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Re: "Medical" Massage Therapists - May 20, 2005 6:04:00 AM
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Diane
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Catching up
This is always an interesting discussion. The link provided by Jon/Ian higher up on the "manual therapy" group is great, in terms of content of thought, depth of investigation, and wideangle view. I wish it had been a PT who came up with that! It provides sort of an overhang for people including PTs (mentioned in one place but not in another), PTs who haven't painted themselves into a corner, who might like to have a manual practice and treat actual nervous systems, not perform quantitative feats for insurance companies.
I read Jason as being frustrated while remaining magnanimous. Randy is pointing out absurdities. I agree.
How does massage fit in?
I'm an oldfashioned PT who wants to keep it all: A PT lisence to touch people should include all the ways we've historically touched people, our entire lineage or "gene pool" which includes massage. (Physiotherapy in England was once known as the "Association of Remedial Gymnasts and Therapeutic Masseuses".)
I don't "do" massage; I think other kinds of "soft tissue work"/handling don't bully the nervous system or my hands as much and therefore I prefer them. I was trained in massage but I choose not to do it. I'm sure all treaters have their own signature (the book Blink by Malcolm Gladwell), and that some are more capable than others at getting desirable outcomes. Some people have hands like bludgeons and I would prefer they stick to managing or manipulating.
Hands-on or off?
Speaking of evolution, I wonder if PT selects pro-touchers or anti-touchers these days? Massage by definition will attract pro-touchers who want to develop their kinesthetics/talents.
I've noticed that generally speaking the less patients are touched in/as treatment the more the practitioners earn. I guess there's a bluecollar aspect to touching for a living that runs deep through our cultures. Not touching must lighten the color of the collar or something, then adding the prefix Dr./suffix DPT must bleach it completely.
Context
The whole lack of direct access for PT in your country is still weird to me.. It reminds me of an abused spouse who could leave the abusive relationship but won't. There is too much fear of the unknown, and the perks, like getting health insurance paid by the employer/abuser, is blown up out of proportion as a reason to stay a slave to the relationship.
Meanwhile, all these 300-hour trained massage therapists (who are likely decent people with good hands, for the most part) are rapidly absorbing all the info the "pain revolution" has brought our way, are growing into this area that is free, entreprenurial, legitimate, sensible, and "soft tissue"! As long as I have a breath I'll be fighting to keep this work (soft tissue manual therapy) as legit PT work. If we decided it was our growing edge, it easily could be, and all our other hardwon "tools" would be still available on the rotating tray in our mind. Of course, you'd need decent hands and a desire to learn use them as sensors/effectors in a new way, palpating lots of layers ahead of joint/bone.
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Re: "Medical" Massage Therapists - May 20, 2005 3:15:00 PM
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Dr.Wagner
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I would imagine it is agreed that LMT's likely learn more massage than does a PT (I don't remember learning alot, I took myofacial CEU's)...becoming a LMT may be a MARKETING choice. It is NOTHING like a Doctor being a phlebotomist, as they do not gain revenue...unless you are a Vampire you don't say "sure would be nice to have some blood drawn". While I would imagine, a LMT does a fantastic job with massage, sports massage etc (maybe even better than the average PT).
Regardless, they will begin invading the market.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: "Medical" Massage Therapists - May 21, 2005 12:30:00 AM
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Randy Dixon
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Originally reading the PT practice act in Texas I thought that PT's couldn't give massages without referral, this was absurd. However, I looked at it again, and there is this:
(c) A physical therapist may provide physical assessments or instructions to an asymptomatic person without
a referral from a referring practitioner. (V.A.C.S. Art. 4512e, Secs. 19(a)(4), (5).)
This to me says that a PT can perform massage, prescribe exercises, etc. to someone that is asymptomatic without referral.
I believe this is the intention of the statute but it is confusing to me. If a PT performs an assessment and finds a problem, is the person still "asymptomatic"? When do they become symptomatic or should you just not check.
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Re: "Medical" Massage Therapists - May 21, 2005 7:58:00 AM
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pwrandall
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Randy,
This has become a new concern in CA where we just amended the practice act to allow us to provide health and wellness services. At this point, the recommendations I have read state we are still required to evaluate each client and if a pathology is identified, referral to a diagnostician is required before PT intervention can continue. In CA we can evaluate without referral, but need a diagnosis to begin treatment. It's a murky area at this point that frequently creates confusion.
PETE
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Re: "Medical" Massage Therapists - May 28, 2005 4:43:00 PM
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chiroortho
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The LMTs are thinking 'market' and the PTs seem to be thinking...well, what are the PTs thinking? It seems that so much of what I see here is a reaction to another type of provider's action.
It IS absurd that a massage therapist can use massage therapy on people off the street, but PTs have to get a script. Why don't you guys bombard your national association with letters about this? Get into the game a bit more and you might see some changes. The LMTs are very smart, and in the past 10 years have proceeded to leap right past you politically, at least from what I can see. In Florida LMTs can use electrical modalities/US, etc. Heck, you guys sit back and pontificate long enough and you won't have anything left. I don't mean that in a bad way, I just see so much banter about DPT training and such, and I just have to scratch my head. Sorry.
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Greg Priest, DC, DABCO
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Re: "Medical" Massage Therapists - May 29, 2005 7:41:00 AM
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Dr.Wagner
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Greg, yes it is VERY VERY odd that PT's are in this situation. Look at DC's, there seems to be very little concern over LMT's and many LMT's work in their offices...you would NEVER see that in a PT clinic. Sure, maybe one in 20, but not more than that.
One reason why DC's are still very unique, their perspective is still much different than that of physical therapy.
I see a PT getting an LMT as being a GOOD idea, many see it as insulting. I think I may have also when I was a PT...I almost REFUSED to do things that were purely therapeutic, I wanted to do things that would "solve the problem"...before too long I realized being therapeutic (ie massage) solved ALOT of problems and I should have used it much much more.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: "Medical" Massage Therapists - May 29, 2005 10:35:00 AM
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chiroortho
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That's right Dr. Wagner, and looking at things from a market/marketing perspective is what the LMTs do best. If the PTs are (dare I say this without sounding condescending) too good to do massage themselves because they're 'trained to do so much more', then fine, but then the PTs ought to HIRE massage therapists and supervise them to at least capture that aspect of the market. A symbiotic relationship. The PTs can hand off the run of the mill stressed out patients that don't need exotic rehab, and the LMTs can bill as part of the clinic. I realize that DCs have a bit of an advantage here because we can order massage therapy, but if you think about it you'll see that 'evaluate and treat' is a pretty broad order from your ortho sources, right?
In other words, why not take advantage of the situation for now, and get your national association moving in the interim to keep your turf from being overrun. I'm telling you, it can happen, and if all you guys do is debate about minutiae you'll be left behind.
DCs learned that a long time ago. We don't have the universal 'medical acceptance factor' that you do, but we are very good at making the most of what we have and always pushing for more. You're taking for granted and even squandering some good opportunities. I'm trying to encourage you here.
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Greg Priest, DC, DABCO
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Re: "Medical" Massage Therapists - May 31, 2005 12:56:00 PM
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karmzack
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DCs and LMTs are very good at marketing. Maybe PTs need to start setting up "Free exercise prescription evaluation" tents at the local fairs and community events. (just a joke, or maybe not, hmmm...)
I took a look at the marketing practices of DCs and PTs in my area. Here are the results from my phone book:
PTs 94 listed
16 small ads
3 medium ads
no half page or full page ads.
3 of the ads targeting auto accidents and work comp cases.
DCs 142 listed
28 small ads
8 medium ads
3 half page ads
1 full page ad
26 of the ads targeting auto accidents and work comp cases.
The marketing by the DCs in my phone book far exceed that of the PTs. Subjectively the DC ads are much more impressive and in most ads emergency treatment is available. The DCs are more active in targeting the high revenue patients (work comp/ auto accident). I can see how a person injured in a MVA would first go to the attorney and then to the chiropractors office just by shear marketing. I think the discrepancy between the marketing falls back onto the direct access/ insurance reimbursement issue. Even if the PTs did target the MVA/work comp patients a middle man still needs to be involved, hence no PTs providing emergency care.
One DC clinic provided physiotherapy, and a few had licensed massage therapists. From a business/marketing perspective the DCs are kicking the PTs butts, but it looks like there is a lot of competition within chiropractic so it's no cakewalk.
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Zack Solomon MPT, OCS, CSCS
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Re: "Medical" Massage Therapists - May 31, 2005 3:50:00 PM
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Jordan
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Interesting to propose the LMT - DPT coallition in the workplace, I see only benefit for my wallet and my hands.
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Re: "Medical" Massage Therapists - June 1, 2005 12:09:00 AM
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Randy Dixon
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Zack,
The ads are also slightly different,the DC's mention thing like Pain, Worry and Getting
Better. Things that people are actually concerned about. PT ads mention injury and surgical rehab., which is what PT is already tapped into.
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