Out With the Old and In With the New

By: Amanda Cooke. RMT

Spring has Sprung and so have new ideas, creativity, and a feeling of lightness as we pack up our boots and parkas, detail our cars, and clean out our homes to make room for the lighter, brighter days ahead. With each new season, there are recurrent themes that I cannot seem to ignore. In winter we talk about resting and slowing down, while in spring the theme seems to be the rebirth- coming out of hibernation re-energized and refreshed and ready to take on new things. This theme led me to investigate some “old” ways of thinking, speaking, and practicing that may not be serving therapists and their patients the most optimally. In this issue we will talk about de-bunking myths, upgrading our language, and removing old thoughts and techniques that current research and evidence have shown simply do not hold up when applied in clinical practice the way we once thought.

Language has been a recurring theme in the realm of manual therapy for a few years now. Much of the current evidence in manual therapy has to do less with the techniques being applied and more about how therapists explain what they are assessing, palpating, and how they are affecting the tissues. Much of what therapists once thought has been revealed to be myth or has not shown validity with the most current research. With that said, the techniques have been proven clinically to yield positive outcomes and that is why much of the debate surrounding evidence-based medicine is regarding language. Not all the controversy is about language though. There has also been a welcomed new way of treating that gets rid of some old school ideologies such as “no pain, no gain” and “I need deep tissue massage to get results”.​​

In my 14 years as an RMT, I have evolved and changed my approach regularly. Interestingly enough, patients who have been with me for over a decade haven’t appeared to change their opinions of my skills as a therapist or request that I revert back to my old ways. For example, I fell victim to the no pain no gain ideology when I first went out into practice. Although we had always learned that relaxation was an important component of a therapeutic massage treatment, I was always so focused on my technical skills of assessing and treating the dysfunction that my brain continued to make me believe that the joint mobilizations, PNF stretches, range of motion, and deep myofascial work were the bread and butter of each treatment. I would caution my patients that post treatment soreness was to be expected and that they might feel worse before they feel better on their road to recovery. Although these techniques are extremely valuable, my former approach left out a key player, the nervous system. These days my approach still addresses deeper structures, and I still use the above techniques but with a slower, more gentle approach that allows the patients nervous system to reap the benefits of relaxation rather than white knuckling through a “deep tissue” massage. As I mentioned, the patients are continuing to get great results and I like to believe that through my openness in communicating with them what their treatment plan entails, and all of the new information I receive from continuous learning, they have grown with me and can truly appreciate that manual therapy can look and feel different to what they previously believed.

In terms of the research surrounding language, it focuses mainly on how therapists explain themselves. But what about the impact of language on patient-centered care? What we say has more weight than we sometimes even realize, and it is important for us to evaluate our clinical language from time to time to ensure that we are having the impact that we intend to have. Impact and intent are two very different things and as healthcare professionals, we should always consider the impact of what we say in our treatment room. The article on breast massage addresses this issue and I believe it is an important reminder as many of us have been treating for years and may not think before we speak, especially with our regular clients with whom we have built a trusting therapeutic relationship.

I hope that each and every therapist remembers how valuable their foundational knowledge that they acquired in school is in their clinical practice while also acknowledging that science is forever evolving and in order to continue having a seat at the table, massage therapists must continue to evolve as well. In this issue we will revisit types of scars and a reminder of what healing is, discuss clinical language in a sensitive area, and discuss and debunk old myths in manual therapy. Massage therapists do their best work when they take time out of their treatment room and learn and network with other therapists in order to stay on top of their game. Let’s continue to improve for ourselves as therapists, our patients, and the profession as a whole. Out with the old and in with the new!