Category: Education

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Massage Regulation: A Comedy of Errors

I’ve spent the last hour reading legislative updates pertaining to the regulation of massage…in the past, I’ve sometimes referred to this as the good, the bad, and the ugly. This time, I’m just going to call it a comedy of errors. I don’t know whether to laugh or cry.

I’m not even going to address all the discrepancies in the number of hours of required education and/or exams required for licensure, or the discrepancies in the hours of required continuing education, or even the wide variances in licensing fees. I’ve commented on that a number of times, and that situation isn’t likely to change at any time in the near future.

Everybody has seen those “outdated laws” posts before, silly laws that are still on the books, like “It’s illegal to ride a horse without a saddle on Main Street after 5 pm every other Sunday.” You get the picture. Some of our massage laws seem about as archaic. You just have to wonder at the logic that goes into some of these things…and you also have to believe that these most assuredly were not proposed by, nor are they likely supported by, massage therapists. It’s the bureaucracy at work.

Many of the statutes that have been proposed or enacted in the past few years are a direct result of the economy and state governments being so deep in dept. Several states are now taxing, or considering taxing services (like massage, hair and nail services, even grass-mowing). Even self-supporting boards have in some cases had their monies raided in the interest of feeding the state’s general operating fund. NH is seeking to abolish their massage board altogether, in the interest of saving money. And in the state of West Virginia, HB 2502 seeks to combine the administrative functions of the massage board with the acupuncture board (not so weird) and with the forestry board (weird), the board of licensed dietitians, and the hearing aid dealers board (at least the last two are still health-related). It makes you wonder what we have in common with foresters. Are foresters out there planting trees while naked or committing some other unethical act? Maybe so.

A lot of states don’t require any fingerprinting and/or criminal record submissions of applicants for a massage license. A convicted rapist or violent criminal can get one. Some states require licensees to provide proof of liability insurance, but most don’t. I personally think that one’s a good idea.

There is so much discrepancy between the states on modalities that have to be licensed. In NC, where I live, Bowen therapy, craniosacral, Rossiter, Zero Balancing, and 24 other modalities are specifically spelled out as requiring a massage and bodywork license.  We don’t regulate reflexology, which I really don’t get. I’ve had plenty of reflexology and I would have to say that there is at least as much tissue manipulation going on as there is during a session of acupressure, which we do require licensing for.  NY licenses both acupressure and reflexology, and Polarity therapy. I know practitioners who will argue that every modality mentioned in this paragraph is energy work and not massage. You might as well agree to disagree and get a license if it’s required of you.

Speaking of NY, earlier this year SB 1030 was proposed, got stuck in the Higher Education committee, and may have expired due to lack of action. It provides that the commission of prostitution offense by any person upon premises at which a massage therapist regularly engages in his or her profession, or the commission of any such offense by a massage therapist constitutes professional misconduct; provides that upon 3 or more convictions of such offenses upon such premises, or any conviction of a massage therapist of any such offense, the massage therapist’s license shall be revoked. So basically, you can prostitute once or twice, but don’t do it three times or you’ll lose your license. You might even lose it if you weren’t personally prostituting but someone else on the premises was. It’s worded a little vaguely, in my opinion.

In the summertime, not much is happening, because legislatures tend to pack it up and go home. Some things are always left on the table for the next session, and some (hopefully) will never see the light of day again. And some things are urgently needed, like regulation in the 8 states that don’t have any. In each of those states, there are therapists working for licensing, and just as many fighting against it.

You can find regular updates about what is going on in the regulatory world of massage on the legislative briefing pages on the websites of both ABMP and  AMTA.

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A Sermon on the Science of Massage

This isn’t one of my rants about massage research–although that’s definitely a sermon I plan to keep on preaching. It’s about the basic things that we all ought to know, if we’re calling ourselves massage therapists.

I love anatomy and physiology, and the study of pathology is fascinating to me. The human body is an amazing thing, and the more I know about the way it works, the more competent and empowered I feel to do a good job as a massage therapist. Sadly, that sentiment isn’t shared by everybody.

I’ve been tutoring students and teaching my class in how to pass the exams for over ten years. I can’t tell you the number of times someone has said to me “I just want to do massage. Why do I need to know this stuff?” A few weeks ago, I actually had someone who has graduated from massage school (but not yet passed their exam) ask me where the trapezius is located. I didn’t know whether I should feel sorry for them at their lack of education, or whether to give them a swift kick in the butt and point out how lazy they must be not to know this by this time.

Due to the lack of regulation in some places (there are still 8 states where anyone who wants to may call themselves a massage therapist with no education at all), and the time-honored tradition of grandfathering people when legislation does come in, there are thousands of people practicing massage who know nothing of the sciences associated with it.

Massage is an art form, to me anyway, as well as a science. And I’ll concede that there are people who can give an amazing massage that don’t know what the trapezius is. But the fact is, I don’t want a massage from any of those people.

If I go to get a massage and say “It hurts when I do this,” I feel much better about getting it from someone who knows what muscle does that. If I make an appointment for a hot stone massage, and then put on the intake form that I am suffering from a severe case of peripheral neuropathy, I’d like for that therapist to know that I shouldn’t be receiving that type of massage. If I’m taking muscle relaxers, I’d like for the therapist to know that my muscle reflexes are inhibited and my sense of pain tolerance is dulled, and that therefore a lot of deep thumb work could leave me bruised and feeling battered. If I have a raging case of shingles, I’d feel better knowing that the therapist would send me back home without a massage. I might have walked in the door as an uneducated member of the public thinking that a little cream spread around on me would make me feel better. I’ve had that happen during my career.

I don’t know everything there is to know–yet.  But I’m happy to say my education didn’t stop at the massage school door. It’s never over, and it will never be over. That doesn’t mean I’m sitting around reading an A&P book cover to cover for entertainment, but I figure the more I know about it, the better I become. When a client comes in and mentions a condition I’ve never heard of, or that they’re taking a drug I’ve never heard of, I’m going to take five minutes to look that up before I put my hands on them. When I can help someone by showing them a stretch, or giving them a few hints about how their body mechanics or the ergonomics in their work space can be involved in their pain, I’m empowering them to feel better and improve the quality of their daily living.

There are some brilliant minds in this profession, and the way I see it, they’ve gotten where they are not because they give a fabulous massage, but because they have knowledge. I made a FB comment one time about the way something works, and no less than Erik Dalton corrected me. I’ll defer to him in a heartbeat. It will take me years to know everything he knows, and he’s been at it a lot longer than I have. And even though he’s making a few noises about retiring to Costa Rica, I don’t think the day will come when he decides he knows enough. He’ll be basking in the tropical sun reading a fascia journal.

I’m never going to be the next Erik Dalton, and chances are you aren’t aspiring to that, either. But I think the burden is on us, as professionals, to soak up the science of massage like a sponge. At a minimum, knowing not just the names of a few major muscles but of all of them, along with their origins, their insertions, and the actions they perform. At a minimum, having an adequate pathology and drug reference handy or Internet access for looking those things up–and actually doing so–in our work spaces.That act alone will cause you to learn something new every day and it will only take a few minutes. That’s my sermon for today.

Get over the idea that only children should spend their time in study.  Be a student so long as you still have something to learn, and this will mean all your life. ~Henry L. Doherty

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Teaching the Teachers

I inadvertently insulted a massage school owner yesterday by making a FB post saying that I wasn’t impressed by a school that had only one teacher to teach the entire curriculum, and that I wouldn’t choose such a school, personally. To begin with, I wasn’t speaking of his school when I made the post, and I had no idea that he was teaching his entire program himself, as his website gives a different impression, listing four faculty members. A couple of his satisfied graduates weighed in with the fact that they were pleased with their education, and many more who didn’t attend that particular school offered comments about the need for diversity and differing perspectives. Some said they’d rather have one good teacher than a bunch of bad ones. I’m going to stick to my guns on that one, and it is just my opinion and mine alone, that it wouldn’t be for me.

There’s no law anywhere that I’m aware of that prohibits one person teaching the whole program. The standards for massage therapy education vary from state to state. The quality of massage therapy education varies from school to school, and even from teacher to teacher. I also stated in my post that I’ve seen the good, the bad, and the ugly. There are brilliant and engaging teachers; there are teachers who know their subject but who are so droll and boring you can’t bear to sit through it; and the sad fact is that there are plenty of people teaching who shouldn’t be teaching at all. A good massage therapist and one who is good at teaching are two different things, many times.

Some states allow anyone who’s breathing to teach a class, and schools often take advantage of that by using last year’s graduates as this year’s teachers. At the other extreme are states with requirements that you must have a college degree in the area you are teaching, at least for science-based classes like A&P, or that you have been licensed as an MT for X number of years before you can teach hands-on classes.  There’s no consistency.

I’m at the end of my five years of service on the North Carolina Board of Massage & Bodywork Therapy, and I have served the School Approval Committee that entire time. Since I’ve been on the inside, I can state that our system isn’t perfect…we state in our rules that teachers should be “trained” but we don’t go far enough with that…there’s no set number of hours of training required, and each school basically does whatever they please on that front. One has a year-long training program. Another has a two-hour orientation and calls it their training program. The others fall somewhere in between. My pet project recently has been encouraging schools to teach research literacy to their students. It seems to be slow to catch on. Some school owners have the attitude that if something isn’t in their board’s requirements, they’re simply not going to do it, and that’s a shame.

So who teaches the teachers? The AFMTE is working on a big project, the National Teacher Education Standards Project. I applaud that wholeheartedly, but I will point out that the AFMTE isn’t a regulatory board and all they can do is put it out there, they can’t force anyone to participate. The Massage Therapy Foundation is offering classes around the country in teaching research literacy, but the same is true of them; since they’re not a regulatory board, they can’t force participation. That’s just too bad on both counts! I’d personally like to see teaching research literacy a requirement in every school. Both of these organizations are saying, “Here we are, here’s what we can do to improve education.” But again, since there’s no law requiring it, some–and by some I mean the vast majority–aren’t getting on the bandwagon. What I fail to understand is why any school owner or program director wouldn’t want to give their school–and their students–their best shot.

While I do concede that there’s a complainer in every crowd, when I see the same complaint from multiple students/graduates, it gets my attention. There is rarely a day that goes by that I don’t get emails or phone calls from students all over the country with some tale of woe about their school experience.

On last weeks’ blog, Self-Sabotage–or How I Got Your Clients, I offered up a bunch of the reasons that clients have given me about why they left another therapist and started coming to me. So here are some of the comments that I have received from students:

“Even though it’s in our school catalog that we have a dress code, our teachers don’t follow it themselves. They dress in the same way we’re told not to.”

“There’s no substitute. If a teacher has to be out the class just gets canceled.”

“The teacher is rude if anyone questions anything. Her answer is usually because I say so. I don’t think she knows the real answers.”

“Our teacher didn’t like teaching Ethics, so at every so-called Ethics class, they would just spend the whole hour talking about something else.”

“Our teacher doesn’t know anything about the licensing laws in our state.”

“Our teachers are always contradicting each other and you don’t know who to believe.”

“The A&P teacher couldn’t pronounce the anatomy terms.”

“Our teacher lets us out early all the time because she has somewhere to go. I don’t think I’m getting what I’m paying for.”

“My teacher has had affairs with several students.”

“My teacher’s girlfriend is in the class and he uses her for every massage demo.”

“All of our tests are open-book. I don’t feel like there’s any proof that we’ve learned anything.”

“My teacher tries to impose his religious beliefs on us.”

“My school told me it wasn’t going to be a problem that I had a criminal record but after I graduated I found out I couldn’t get a license.”

“The teacher just graduated last  year and in spite of the fact that she has failed the exam three times and doesn’t have a license, the owner feels sorry for her and is letting her teach.”

“There’s no diversity. One teacher teaches everything.”

“One of the female teachers gives every male student a hard time and picks on them constantly.”

“When I complained to the owner about the unprofessional behavior of one of the teachers, she told me I was free to drop out but I wouldn’t be getting my money back. She didn’t even listen to the complaint.”

“My school experience has been very disappointing but I’ve already paid the money and I’m just trying to stick it out until graduation.”

I honestly could go on for days with the comments. And like I said, when it’s just one whiner, I don’t pay much attention, but when I hear the same thing repeatedly about a school, I encourage those students to report it to the board. If our board gets a half-dozen complaints about the same school or the same teacher, you can bet we’re going to investigate it. I sometimes get emails from students who say they are afraid of retaliation if they complain, and that’s too bad. It just means that whatever problems are there will be perpetuated for the next class of students.

As a school owner or program director, your priority should be to get the best people you can get to teach your students, and to ensure that they are not only familiar with the subject, but that they are trained in teaching adult learners, that they incorporate research references into their class, that they are trained in teaching to diverse learning styles, and that they present themselves and behave themselves in a professional manner. If you allow your teachers to come to class looking like a homeless person, then the blame is on you as much as it is the teacher. If you look the other way while your teachers are having affairs with students, the blame is on you as much as it is the teacher. If you don’t listen with an open mind whenever a student has a complaint about an instructor, shame on you. If you’ve heard the same complaint more than once and haven’t discussed it with the instructor, double shame on you.

If you really want the education that you’re offering to be the best that it can be, you’ve got to teach your teachers. Don’t just hire someone and hand them a syllabus and think they’re going to do a good job. There are resources available and you should be using them.  If you’re not conducting a thorough teacher training program, or requiring your instructors to attend one, or not having teachers trained in research literacy and teaching that to students just because it isn’t a state law, then I urge you to step up to the plate and go beyond what the state law requires. Your school will benefit from it. Your students will benefit from it. The massage-seeking public will benefit from it.

Resources:

ABMP Massage School Instructor Resources

Alliance for Massage Therapy Education

AMTA Schools Resource Center

 

 

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American Massage Conference Bats 1000

I spent the weekend with over 1000 massage students and therapists, plus all the great vendors and support staff in Atlanta this weekend at the inaugural American Massage Conference. I’d have to say they definitely batted 1000! A good time was had by all!

There were just too many good moments to talk about them all, so some of my personal highlights:

Teaching my exam prep class Friday and ethics on Saturday, great people in both classes…dinner with Allissa Haines, fellow blogger of Writing a Blue Streak fame…sitting on a panel with Whitney Lowe, Felicia Brown, Les Sweeney, and Tony Zak…sitting with BioFreeze Bob, Lynda Solien Wolf, James Waslaski and his assistant, Michael McGillicuddy and Gloria Coppola at the awards dinner…getting the award for Massage Therapist of the Year and seeing my friends be recognized, including Ryan Hoyme (the MassageNerd) as the winner of the Innovation Award, Anita Shannon as Educator of the Year, Felicia Brown as Volunteer of the year…hanging with Sandy Pearce from Massage Today…hearing the great keynote speech at the One Concept awards…getting a 30-minute foot massage at the Sanctuary…playing music on stage at the gala with Errol N Schroeder of ASOMAssageMusic…

Playing some tunes with Erroll and Schroeder

Then there was eating the homemade ice cream provided by BioFreeze Bob…hanging with Paul Lewis, who is one of the nicest people in the massage business…having a group picture made with all the WIBB bloggers in attendance…eating lunch with Lynda Solien Wolf…getting interviewed about CE by Gloria Coppola…the Pirate Party out on the roof at Stat’s…the totally awesome vendor booths… getting interviewed alongside Angie Patrick by Karen Menehan of Massage Magazine…watching James Waslaski dance the electric slide with about 20 women on the dance floor…getting foot massage of the automatic variety at two different booths…chatting with Glenath Moyle…seeing Michael Reynolds of www.spinweb.com, one of my personal idols…chatting with the folks from FSMTB…Elizabeth Langston, Exam Development Director of the NCBTMB sitting in on my exam prep class…having a visit with Rick Rosen of the AFMTE...visiting at the ITEC booth for about 45 minutes and finding out all about what they do and how they do it…meeting so many FB friends for the first time and seeing a lot of people I haven’t seen in awhile…watching Paul Lewis and Donna Sarvello performing an energy dance on the party bus…visiting with Christopher Alvarado and Angela Palmier…watching Tina Allen’s little son Otis out on the dance floor…

I could go on and on, but to make a long story short, it was simply fabulous, so kudos to Scott, Angie, Eric, Monica, Melanie, Robyn, anybody I missed, the staff of the Holiday Inn for doing a great job, and all concerned. It was one of the high points of the year and they all deserve to be congratulated for pulling off such a huge and successful event!

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A Matter of Opinion

Last week, the AFMTE released a position paper authored by Executive Director Rick Rosen, “Alliance Offers New Vision for National Certification.” Update 09/20/2025: This no longer exists on their website and I was unable to locate a copy online.

The AFMTE also recently announced that it is partnering with the FSMTB in their initiative to begin approving continuing education.

Both of these have attracted quite a bit of discussion on the various social media sites. And like any discussion, people agree, disagree, and agree to disagree.  I’m glad to say there hasn’t been any mudslinging of the nature that goes on at times in some of these venues. I think these discussions are useful and informative.  They sometimes bring to light a lot of misconceptions that people have about which entity does what, and how they do it.

I encourage everyone to read Rosen’s paper in its entirety, but to make a long story short, it is a plea to the NCBTMB to reorganize, and get out of the continuing education business and the entry-level exam business. The FSMTB has been stating the opinion since their founding 5 years ago that NCBTMB exams are inappropriate for licensing purposes, and encouraging the states to drop those exams and use the MBLEx exclusively. That hasn’t happened.  If the map on the FSMTB is current, 33 member boards are using the MBLEx. If the map on the NCBTMB website is current, 38 states are still accepting their exams, meaning the majority of states are accepting both, and offering their licensees a choice. The AFMTE is also supportive of the Federation’s stance, as is AMTA and ABMP. Still, the facts show that either the 38 states are doing the wrong thing, or else they are exercising their undeniable right to conduct their business the way they want to.

I haven’t been in this profession nearly as long as Rosen or some of the other players here. I became a massage therapist in 1999, and it seems like I joined at a time when everything was just really starting to swirl. I was in the first wave of licensees in North Carolina.  Mr. Rosen actually has license #00001…first person licensed in our state. He has seen and been instrumental in a lot of things happening. I would never try to minimize the contributions he has made to this field. I won’t criticize his career, his integrity, or his belief that he is suggesting something for the good of the profession on the whole.

My criticism is this, and it isn’t directed entirely at him; it’s directed at the concept of any organization trying to mandate to another organization how to run their affairs. We get enough of that from the feds, don’t we?

I believe that the FSMTB and their mission of public protection is a great thing. The member boards come together for the purpose of discussing common problems and looking for workable solutions. Anytime people sit at the table together to try to solve a problem, that’s wonderful to me. I also believe that the AFMTE was started with the noble intent of acting as the voice, advocate, and resource for massage schools and educators. What I don’t believe is that either one of them can unilaterally force the NCBTMB to change their way of conducting business, nor do I think they should have that right.

The FSMTB is developing a model practice act, in addition to developing a CE approval program. They can and do suggest to the member boards that their exam is the appropriate exam, their CE approval (will be) is the appropriate approval, their model practice act (will be) the premier example of an appropriate act, and so forth.  It’s part of the quest to streamline things  in a uniform fashion and promote portability.

However, suggestion is the key word. The member states aren’t bound by any legalities to do what the FSMTB offers in the way of suggestions. If they want to keep the NCBTMB exams, they can. If they want to keep their own practice act, they can. If they want to keep NCBTMB approved providers or continue to approve their own, they can. They all have the right to conduct their business as they see fit within the law.

There is certainly room for improvement, on the practice act front, in particular, when you see all the variance that’s out there between the states. Keith Eric Grant has summarized that. You can access it here.

The bottom line, to me, is that all of these entities, including the NCBTMB, also have the right to conduct their business as they see fit. Unless and until there is a federal law governing massage, the individual entities can continue to do whatever they do however they want to do it. The FSMTB and the AFMTE could spend days pointing out past shortcomings of the NCBTMB, but it wasn’t “the NCBTMB” as an entity that had the shortcomings. It was the human beings running the organization.

As the FSMTB is only 5 years old, and the AFMTE less than half that, neither of these organizations have been in business long enough to have been plagued with the personnel problems, inefficiency problems, financial problems and so forth that happened in the past at the NCBTMB. Board members come and go. Executive directors come and go. Priorities of boards and organization come and go. Even organizations come and go. Last week I learned from Dr. Kory Ward-Cook, CEO of the NCCAOM, that there was previously a Federation of State Acupuncture Boards that fell apart.

AMTA and ABMP have their own missions and their leadership has their own opinions. As do we all. And any organization, just like any individual, has the right to run their business as they please, as long as they are not breaking the law. The NCBTMB is not breaking any laws by continuing to conduct their business as they see fit. The other organizations are not breaking any laws by conducting their business as they see fit. They all have that right. You don’t have to like it. I don’t have to like it. One organization doesn’t have to like what the other organization is doing. But until the federal government steps in and says, “you must do this,” they can all do as they dang well please. If any of them don’t do well enough at whatever it is they choose to do, they won’t survive.

Everybody has their own opinion on what’s good (or not good) for this profession, what’s good for licensing, what’s good for certification, what’s good for teacher standards, what’s good for education, what’s good for continuing education. There are just as many opinions on all of that as there are opinions on what kind of massage oil you ought to use.  Everyone is entitled to that. And everyone is entitled to conduct their business the way they choose to, as long as it’s within the law.

The AFMTE posted on LinkedIn that they had posted Rosen’s position paper directly to the NCBTMB. I suggest that if the folks at the NCBTMB are interested in hearing more about it or discussing it that they will get in touch. And if they don’t, then I suggest that the AFMTE, and in fact all organizations, concentrate on being good at what they set out to do for their organization, and leave the NCBTMB to do as their board and their leadership sees fit. Their Board is elected by their certificants, and their ED serves at the pleasure of their board.  They may well thrive and survive by doing things their own way, or they may fail altogether.

Either way, I think the burden to make it or break it is on them, just like the burden that is on all the organizations, and on any of us as practitioners and business people. And any insinuation of the NCBTMB being “uncooperative” is an opinion, not a fact. I can tell you how to run your business, you can decline to take my advice, and I will not refer to you as uncooperative. I will assume that you are exercising your right to conduct your business in the manner that you see fit, whether it suits me or not.

That’s just my opinion.

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Report from the NCBTMB Approved Provider/CE Meeting

I just got back from Chicago, where I participated in the Massage Approved Provider Panel convened by the NCBTMB. I have to say it was one of the best meetings I have ever attended. Everybody left their egos and their agendas at the door…not one single moment of tension or dissension occurred, in spite of the fact that competing entities were represented.

MAAP Meeting at the NCBTMB

I spent the weekend sitting next to Bill Brown, Deputy Director of the AMTA. I’ve heard through the grapevine that Bill has wanted to strangle me a few times over my blog, and I’m glad he got the opportunity to know me a little better. I might have managed to convince him that I have a few redeeming qualities and I’m not just the crazy blogger he thought I was.

Cynthia Ribeiro, President-Elect of AMTA, was also present, and what a class act she is. I had supported Cynthia during the AMTA election, and there’s no doubt in my mind that was the right move. She is one fine lady who has made many contributions to our profession, and had a lot to contribute to the task at hand this week.

Bob Benson, Chairman of ABMP and Anne Williams, Director of Education for ABMP were there. Bob brought his considerable business acumen to the meeting. I’ve worked with Anne before and she’s just a go-getter who shares my philosophy of “make it happen.” She has a great sense of humor, too. There was a lot of laughing this week, which is always a great ice-breaker and good for the cohesiveness of the group.

The facilitator, Drew Lebby, provided exactly the right balance of keeping things moving, listening, and explaining. We had breakout groups and larger discussions and the whole meeting just had a great flow. Having been in meetings with some very boring facilitators in the past, I thought he was wonderful and I would highly recommend him to groups who are looking for a great facilitator. He has 35 years of experience at it and it shows.

I heartily applaud the Federation of State Massage Therapy Boards for sending Kathy Jensen, VP of the FSMTB, and kudos to the NCBTMB for inviting the Federation to participate. Since the MBLEx has taken a huge chunk of the NCBTMB’s exam market share, and the Federation has also recently announced plans to jump into the CE approval arena, I can think of past administrations at the NCBTMB that would have spent the time sniping about the Federation as competition instead of inviting them to attend, all the more reason why I appreciate their willingness to play in the same sandbox. That theme was reiterated by Ribeiro and several others this week–this isn’t about your organization, or my organization, or who’s the biggest or the best–it’s about massage and increasing the quality of massage education.

COMTA was also represented by Commissioner Randy Swenson. Several state board members were in attendance, as were approved providers and a couple of nationally certified massage therapists.

The AFMTE was not represented, although they were invited to participate, and as a founding member of that organization I personally found their refusal to attend distressing. This meeting was about education, and in my opinion, they should have been there. I contacted Rick Rosen to give him the opportunity to explain their absence, and his response was that since the AFMTE has decided to partner with the FSMTB in developing their CE program, he felt it would blur the issue and divert their focus to attend.

Nice try, Rick, but since the Federation was invited, and in fact chose to participate in the meeting, I don’t buy it. The mere term “Alliance” suggests that you are representing education, and not just one faction of it. The Alliance could have made some great contributions to the meeting and you missed out on a good opportunity to do so. Rosen is of the opinion that the Federation should replace the NCBTMB and the individual states who do their own approvals as the only provider/CE approval entity. We’ll just have to agree to disagree on that issue.

No one has been a more vocal critic of the NCBTMB than I have in the past, and I have defended the right of the FSMTB to offer their competing exam, as I don’t believe that any entity is entitled to a monopoly. I will go further and say that I don’t believe any entity is entitled to a monopoly in any arena, so I am not in support of the Federation having a monopoly on continuing education. They have the undeniable right to jump into the market if they choose, and the marketplace will decide. I am personally not going to be dictated to of which entity I have to throw my CE approval business to unless my state makes it a law that I have to choose one or the other. I’m not going to hold my breath waiting for that to happen.

There are 42 member boards in the Federation and so far, although many states have voted to accept the MBLEx, and some have adopted it exclusively, many others have refused to throw out the NCB exams, and continue to give their licensees a choice in which exam to take. I believe the same thing will happen when it comes to continuing education. Some states will go with the FSMTB CE program, and others will continue to allow providers to make their own choice. It’s the American way. Furthermore, in many places legislative changes will be required in order to switch from one to another or add another approval entity, and we all know that legislation most often moves at the speed of molasses. That is also the American way.

There were a number of problems identified with the NCBTMB’s current system. For one thing, some providers have taken advantage of the fact that once they received approval, they could add on classes at will. Some have ignored the fact that there is a prohibition on classes that are based on a product they sell. Some have ignored the fact that there is a prohibition against classes based on religion and/or spiritual practices. Some have ignored the fact that they need to be genuinely qualified to teach in their subject area.

Bruce Baltz, an NCBTMB Board member, mentioned people who teach NMT techniques suddenly throwing in a class in lymphatic drainage needing to be looked at carefully…sorry, but your attendance at a weekend workshop does not qualify you to suddenly start teaching it yourself. The people who have been guilty of these offenses are going to have a little awakening when some of the changes to the program are implemented.

The suggestions for solutions were great and it was interesting to see that when we broke up into small groups to do problem solving, most of the groups were on the same page. Some of the suggestions included requiring providers to submit videos of their classes, a much stricter and more frequent auditing process, an improved evaluation process where students can go online anonymously and evaluate teachers and class content, a required online class for teachers themselves to improve instructor competence…lots of good ideas that the NCBTMB is going to consider and decide which ones to implement.

Every organization and individual at the meeting expressed a genuine interest in assisting the NCBTMB in this endeavor. Even better, they all agreed that all the organizations, not just a choice few, need to come together once or twice a year for the good of the profession. Bob Benson stepped up to the plate on that front and good for him for doing so…AMTA and ABMP can take a few swipes at each other, but in the final analysis, there is room in the sandbox and he knows it.

All in all, I thought it was a wonderful gathering of some of the best and brightest, with the intent of creating a positive outcome, and I was honored to have been included. Paul Lindamood and his team did a great job in organizing the gathering and assembling the best people they could get. And hey, any meeting that includes keeping chocolate on the table at all times does it for me.

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More Myths of Massage

Last week I wrote a post on Facebook about some of the myths of massage. My statement on this issue was and continues to be that I am not accusing anyone of telling a deliberate lie, nor am I attacking the character of any teacher who has helped to perpetuate these myths. I choose to believe that everyone has good intentions.

Before I became interested in the evidence-based practice of massage, I’ve been just as guilty as sharing some of them myself. There seem to be so many of them, and in my opinion  people tend to blindly accept what they learn in massage school. We view teachers as authority figures, but the fact is, teachers have a tendency to repeat what they were taught in massage school…so they pass that on to their students, who in turn share that false information with their clients, with the best of intentions. Some of those same students go on to become the next generation of teachers, and those same myths just keep being perpetuated.

Yesterday I heard from Lee Kalpin of Ontario, who shared a few more of these massage myths with me. I am presenting them here, and if anyone has any valid research references that will back these up as fact, please feel free to post it for our enlightenment.

– Massage removes toxins from the muscles.

– Lactic acid is responsible for DOMS (Delayed Onset Muscle Soreness).

– Massage can get rid of cellulite.

– It is contraindicated to massage a person who has cancer (or had cancer).

– If you massage a person who has consumed alcohol, it will increase the effects and make them more intoxicated.

– You can strengthen muscles by performing tapotement.

– You can straighten a scoliosis by doing tapotement on the weak side and stretching on the tight side.

– Manual Lymph Drainage causes the lymphatic channels to collapse for 20 minutes so you cannot do any other manipulations after MLD.

– You should never do more than 3 trigger point releases in a treatment (no reason stated for this one – it was just stated as a fact).

– Ischemic compression for trigger point release should be done as deep as possible.

– Only deep massage is therapeutically effective – as deep as possible. Lighter massage is just for relaxation.

– You should not massage pregnant women during the first trimester.

– You should not massage the feet and ankles of a pregnant woman as it may cause her to miscarry.

– Drinking lots of water flushes toxins out of the system – encourage the client to drink water after a massage.

– You cannot massage a person who has “high blood pressure” – definition needed about how high is high, and cause of hypertension.

– You must massage toward the heart or you could damage the heart valves.

– It is contraindicated to massage pitted edema.

I must say that I have heard all of these at one time or another. Where did they come from? I don’t know. As one FB friend said “I heard it from some reputable teachers.” And they probably heard it from their reputable teachers.  So let’s just let the buck stop with us. If the words “research shows” are going to come out of your mouth, then back that up with the actual research reference, and if you can’t produce any, don’t say it–to your students or to your clients. If all the evidence you need is that massage helps people feel better, then let that stand for itself and don’t make wild claims. And please, as I said above, if you have the research to prove any of these statements, share that with the rest of us.

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10 Questions for Alexa Zaledonis, New Chair of the NCBTMB

Alexa Zaledonis, LMT, CPT, NCTMB, is the new Chair of the National Certification Board for Therapeutic Massage & Bodywork. She is the owner/operator of Even Keel Wellness Spa, a therapeutic massage and skin care center in Annapolis, Maryland. Even Keel employs seven full-time and several part-time employees who specialize in Thai, sports and rehabilitative massage.

A graduate of the Baltimore School of Massage, she passed the NCE in 2002 and has spent the past seven years building her practice in the community. Zaledonis is a certified Lotus Palm Thai Yoga Massage practitioner and a Certified Personal Trainer through the National Strength Professionals Association. Zaledonis currently is completing her Yoga Teacher Training (RYT200). She also teaches Thai Massage at Even Keel Institute for Continuing Education and is an NCBTMB-approved provider.

A former Certified Public Accountant, Zaledonis specialized in healthcare and nonprofit organizations for more than 15 years. She received her bachelor’s degree from Albertus Magnus College in New Haven, Connecticut.

I am NCTMB myself since 2000, and I’ve seen the good, the bad, and the ugly at the NCBTMB. They had a few rocky years and have been the target of my pen on numerous occasions…and in the past year or so, have received my accolades as well, as I feel they’ve made a big effort to right themselves. I don’t expect perfection from any person or organization, but I do expect effort, and I’m glad to report it when I see it happening. I’m glad to see Zaledonis take over the helm of the 9-member Board of Directors, and recently took the opportunity to find out more about her and her future plans for the organization. I recently seized the opportunity to ask her a few questions. My interview follows, and her answers are printed verbatim:

1. How long have you been involved with the NCB, and what previous roles have you been in there, if any?

By definition, I am not your “normal” volunteer. I joined NCB as a Board member in 2007, became Chair Elect in 2009. I had no prior volunteer experience with NCB before joining the board, outside of being a proud certificant. Volunteering prior to 2007 was not a possibility. I moved to Annapolis in 2003 and began my practice while still working part time as a CPA—there was no time for sleep, much less time to be a valuable volunteer. I believe if you can’t commit then don’t raise your hand.

2. What first led you to volunteer?

I raised my hand. I had figured out how to be a competent therapist, teach the community the value of quality massage and help other therapists to succeed in a viable career. Then, one morning, I asked myself, “What is the future for my employees, for myself, for the industry?”  I was one person helping a village. I knew that I needed to belong to a bigger village, and because national certification was always the backbone of my career as a CPA, becoming a volunteer at NCB was a natural next step for me.

3. What do you feel are the biggest challenges facing the NCBTMB today?

While massage therapy may be an ancient art, the industry in this country is young and will continue to evolve. There are incredible opportunities for our profession, but that can be a double-edged sword. What I mean is, it’s easy to lose focus without input and guidance from stakeholders. That’s why we always base what we test for and what we do programmatically on what the profession tells us is important. So the challenge is really to listen—and to always make sure that the individual therapist is heard, has a say and stays involved.

Ralph Waldo Emerson said, “Do not go where the path may lead, go instead where there is no path and leave a trail.” At NCB we are trying every day to listen, and then help lead our industry to grow in new ways. Sometimes, that requires forging new paths—like the advanced practice credential for example.

4. What are your priorities for your term as the Chair?

We have so many great things going on, but my top priorities surround the execution of the National Certification for Advanced Practice, or the NCAP, and future specialty credentials. Also, addressing the issues of continuing education and nurturing and enhancing our school compliance program. I look forward to seeing all of our programs work hand in hand, each one helping the next one to add value to and take the industry to new heights.

5. In your From the Top letter on the website and the one that was recently mailed out to the associations and regulatory boards, you talk about revamping the Continuing Ed/Approved Provider program and vetting individual courses. One of the most serious problems at the NCB in years gone by was overwhelming inefficiency, which was the main reason for switching to the present system of audits instead of requiring each class to be vetted. How do you plan to keep that from happening again? Are you going to hire new staff?

Yes, NCB is developing a new National Approved Provider and Continuing Education program, but at this point, nothing is written in stone. We have invited thought leaders, subject matter experts, state board representatives, peer organizations, approved providers and certificants to engage in high-level discussions and participate in the Massage Approved Provider Panel. The response has been impressive.

I think people in the profession are ready to take the next logical step for Continuing Education. And that is to define, differentiate and identify the educational level of the wide variety of modalities and subjects offered. We are looking to design a user-friendly review and approval process, but the panel will help inform the best way to go about accomplishing that.

The magnitude of continuing education has grown far beyond the conventional methods of administering and maintaining a program. We have to think outside of the box. Forge a new path. We have a rough framework of ideas and have are asking subject matter experts to share their best thinking. This truly involves the entire profession.

Imagine this: what if it were possible that in its final form, the national program could consist of an array of industry-wide workgroups comprised of key stakeholders as part of the “engine” that vets CE for the entire profession. All-inclusive involvement. Now that would be groundbreaking! And at the end of the day, it’s everyone together working to move the profession forward while protecting the safety of the public. Blazing new trails.

6. The NCBTMB has taken a substantial financial hit in the past year or two, but as I reported in my annual financial series, there’s been a great job done in cutting expenses. Do you think the NCB can remain financially viable?

Laura, there is no doubt we have had to make some important strategic decisions. But we are proud of our accomplishments, and in fact, independent auditors have said that NCB has exhibited a textbook turnaround during the last two years.

The NCB Board, along with senior leadership, have worked hard to ensure that our current programs, personnel and operational concerns are sound, support one another and offer real benefits for our certificants and the profession. This is how we are building value. With Paul Lindamood as CEO and my love of financial statements, you can bet we will keep close watch on the fundamentals…and the finances!

7. There are now a couple of other organizations looking at getting into the approval of continuing education. Do you think the NCB can stay competitive in the marketplace if that happens?

Thus far, everyone seems to be showing great interest in being part of our Massage Approved Provider Panel. I don’t see this as competition. I see this as the industry putting forth their best effort on something, and that is a beautiful thing.

8. How is the NCAP progressing? I need to know since I plan to be the first one to take it!
And Laura we want test number one to have your name on it! NCB has spent more than a decade polling the profession and has witnessed the growing demand for an advanced credential. Not only that, but the medical industry is showing exceptional interest in it as well. We have spoken to numerous doctors who all support an advanced credential. This is incredibly exciting for the profession—and we are only scratching the surface.

Regarding our progress on the NCAP, a Job Task Analysis survey was sent out the latter part of 2010 and we have just received the preliminary report. NCB would like to thank all of our partners in the field from professional organizations to schools and students as well as industry media for spreading the word about the survey. We had a tremendous response.

Our next steps involve the development of test specifications, which will be sent out for public comment in March. After that, item writing will begin in earnest. It is a very comprehensive and rigorous process.

9. Your term is for a period of two years. Do you think you can accomplish all the things you want to accomplish?

Two years is not a long time. However, as I quoted Emerson earlier, I will be happy with my accomplishments if I can help to blaze a path to advance this profession, and most importantly leave trail markers clear enough for the next person to follow.

10. What’s your fondest hope for the organization going into the future?

I hope that the organization can help to bring this scenario to life:

Therapist calls prospective employer:

Ring Ring

Employer: “Hello, Human Resources at Community General Hospital”

Therapist: “Hello I am a Massage Therapist and was wondering if you are hiring?”

Employer: “Well your timing couldn’t be better. We are always looking for qualified  people. Tell me about yourself.”

Therapist: “I am a Licensed and Certified Massage Therapist. I hold a National   Certification in Advanced Practice, am working toward a specialty in                      Medical Massage and have a list of qualified continuing education I can                  share with you.”

Employer: “Your credentials sound great. We only hire Licensed and Nationally Certified Therapists. Why don’t you send over a resume and we can set up a time to talk.”

You gotta think big, Laura. Thanks for giving me the chance to be a part of your blog.

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Competency vs. Hours

I have long desired to see the standards for massage therapy education raised in my state and across the nation. Here in North Carolina, the requirement is only 500 hours. That varies in the US, from the unregulated states that have no requirements at all, to the 1000 hours required by New York, Nebraska, and Puerto Rico. The rest fall somewhere in between.

Our neighbors to the north in Canada have a few provinces that are unregulated, but those that are regulated have a much higher hour requirement than the norm here in the US. However, in looking over their documents pertaining to their regulations, I see that it is not really about the number of hours; it is about the basic competencies that they have set forth for an entry-level massage therapist, and I must say that I find it quite impressive.

I imagine that the higher number of hours is merely a by-product of the competencies that are required. It would take a lot more than 500 hours to pack all those competencies in. And I couldn’t find any fault with any of them. It actually bears a lot of similarities to our recent document, the Massage Therapy Body of Knowledge. That’s not a perfect document; it’s just a start on defining what an entry-level therapist should know here. I’ve heard a good many complaints about it. In fairness to the dedicated volunteers who gave of their time and expertise to work on it, they offered a long period for comments from the profession, and I was personally appalled at how few they got. I think they got about 600 or so, and about 50 of them were mine. Textbook author and school owner Sandy Fritz wrote twice that many. It was also very telling to me that when our Board sent out a survey to the approximately 40  school owners and program directors recently about raising the standards, only 7 of them bothered to reply. There is a big lack of interest in raising the bar.

The complacency here is staggering, and people just tend to complain after the fact instead of offering input on the front end. It’s the same thing I’ve seen over and over again when it comes to detrimental legislation in our profession; a few dedicated people will contact their legislators before something awful gets passed into law, and the rest will just gripe about it after it happens. That’s another blog, and one that I’ve written several times.

I’ve actually been pushing for our Board to raise educational standards, which like anything a public board is considering gets passed along to a committee for study. It is unfortunate that we could not find any concrete evidence that requiring more hours leads to better test scores. Then again, is that what it’s all about? The ability to pass a test? In our paradigm, yes, it is. We are lacking here in measuring competency in any other way.

I am the author of a popular book on how to pass the exams that are required here, and for over ten years I’ve been teaching a test-prep class as well as tutoring students privately. Let me tell you what I’ve observed. There are some people who can’t pass a test. Does it mean they can’t give a good massage? Not at all. They might be perfectly capable of putting me to sleep on the table or helping my aching back. And on the other hand, we’ve got the people who happen to be good test-takers and who are good at regurgitating information, who couldn’t give a decent massage if their life depended on it. They just don’t have what it takes. The ability to pass a test doesn’t make you competent, in my humble opinion. It just demonstrates that you know a certain amount of information.

When I was reading the Canadian document, I was more than a little envious of it. I kept comparing it to what I learned in massage school, and thinking, “Wow, I wish I had been taught that at the beginning.” In the dozen years since I went to massage school, I have managed to learn most of it through continuing education, self-study, and on-the-job experience. I’m the resourceful type and a go-getter, and I’ve had a modicum of success in spite of not knowing these competencies right out of the gate. I’ve learned a lot of them through the school of hard knocks. There’s no doubt I could have avoided some of those hard knocks if I had known these things at the outset of my career.

As a provider of continuing education, I’ve often been distressed and appalled when people call me up and say something like, “I need 6 hours, do you have any classes that long?” They don’t give a rip if the subject matter interests them or not. I’ve also been informed that “I don’t know why I have to get continuing education, I already know everything I need to know.”  They are clueless.

One of my North Carolina colleagues stated on a forum this week that his poll showed that people were very satisfied with the 500 hours, and of course, a lot of people are. Going beyond that requires money and effort, and many people don’t want to spend any more money or effort than they can get by with. I’m personally not interested in just getting by.

Education is never wasted, and hopefully, I still learn something new every day. That’s my goal, anyway.  My education didn’t end at 500 hours. It hasn’t reached 3000 yet, but I intend for it to, and I still won’t know everything there is to know.

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Report from the Federation of Associations of Regulatory Boards

This past weekend, I attended the annual FARB conference in New Orleans.  FARB, the Federation of Associations of Regulatory Boards was formed in 1974. Members come together for the sharing of information; public boards of all types are welcome to join, as are industry supporters such as testing companies that provide exams to the membership and the law firms that represent the Boards.  The Federation of State Massage Therapy Boards (FSMTB) is a member, as is the North Carolina Board of Massage & Bodywork Therapy, and it was on our Board’s behalf that I attended.

The conference was quite enlightening. It was my first time attending this particular meeting, and the panel included speakers from various boards, everything from medical boards to social work, optometry, and even mortuary boards. Debra Persinger, Executive Director of the FSMTB, was one of the dozen or so panelists. The primary topic of discussion was the various problems facing public boards today and how those can be addressed. It seems that no matter what kind of board was represented, we all have the same problems: unethical behavior from licensees, problems with public perception about what a board actually does, problems with education and exam breaches, lawsuits, interference from lobbyists, and a lack of transparency, among other things.

The first speaker was Meghan Twohey, a reporter from the Chicago Tribune, who for a year or more has been reporting on problems surrounding the medical profession in IL. She has repeatedly been denied access to medical board records surrounding physicians who have been accused of rape and sexual assault–and who have not been disciplined–they’re still out there practicing on the public. It really brought to light how professions with powerful lobbies can close ranks around their members and continue to abuse the public trust.

Persinger spoke about various problems with massage and bodywork exams, including one association who is still giving handwritten exams in public libraries with no security measures at all in place. A representative from Pearson Vue, who administers the exams for both the MBLEx and the National Certification Exams, explained that Pearson Vue is now using something called Palm Vein technology to identify candidates at their test centers. It is reportedly much more reliable than fingerprints and should eliminate the problem of proxy test-takers who use fake ids to take a test on behalf of someone who can’t pass it.

Quite a bit of legal advice was dispensed by attorney Dale Atkinson, who represents FARB, the FSMTB, and numerous boards and agencies all over the country. Among his advice to boards, that got my attention because as a board member myself I have seen it happen: never accept voluntary surrender of a license but to instead insist upon a consent order.  He also advised boards not to be afraid to permanently deny an applicant, something that in five years I have never seen happen. We have refused to license people based on their criminal record, but they are usually told they can reapply in X number of years, usually 1-5 years. The logic, which makes perfect sense, is that some people will never be suitable candidates to place their hands on the vulnerable public. Boards have had a tendency not to permanently deny anyone for fear of litigation, such as being accused of prejudice and subjected to a discrimination lawsuit.

The same issue has affected schools, according to several educators from public institutions who spoke. Admissions departments in public universities who have a limited number of places in an educational program can and do refuse applications based on academic merit and other reasons. According to Dorinda Noble, an educator and member of the Texas Department of Social Work Examiners, one of the major issues facing licensing boards today is the proliferation of for-profit career schools who don’t turn anybody down–if you have the tuition, you’re in whether you are unsuitable to the profession or not, and if you don’t have it, they’ll bend over backwards to get it for you, in the form of crippling student loans. Incidentally, I thought Ms. Noble was the most informative and engaging speaker of the conference.

I have often preached the sermon of the need for massage therapists to stay informed and to be involved in their profession in the interest of 1) knowing the law (how can you abide by it if you don’t know what it is?) and 2) rising up together to prevent legislation that is detrimental to us. It doesn’t do any good to complain after the fact. My attendance just reinforced that. All in all, it was very informative, and from my perspective of being one who has a vested interest in the regulation of massage therapy, I’m glad I went.

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