Massage Therapy Journal Fall 2024

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Massage Therapy Journal Vol. 63 No. 3 Contents

FEATURES

16 CREATING SAFE SPACE FOR YOUR NEURODIVERSE CLIENTS There is a greater need for education and awareness around neurodiversity across most every health care profession, including massage therapy. By Michelle Vallet

24 TAKING CARE OF YOUR TRANSGENDER AND NONBINARY CLIENTS Tips for creating a welcoming environment for your LGBTQ+ clients, and why doing so is important, especially now. By Amber Briggle

32 CREATING AN INCLUSIVE SPACE FOR CLIENTS WITH DISABILITIES AND IMPAIRMENTS new CE Learn about varying disabilities and impairments and what you can do to make massage therapy and your practice more accessible. By Susan Salvo

74 MASSAGE FOR

INDIVIDUALS WITH PTSD AND TRAUMA Massage therapy has shown promise in helping to alleviate some of the symptoms associated with PTSD. By David Malone

Photo by Mark Hanson Photography

amtamassage.org/mtj

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The Secret Advantage for Massage Therapists: The CHI Palm! The Secret Advantage for Massage Therapists: The CHI Palm! The Secret Advantage for Massage Therapists: The CHI Palm! The Secret Advantage for Massage Therapists: The CHI Palm! The Secret Advantage for Massage Therapists: The CHI Palm! The Secret Advantage for Massage Therapists: The CHI Palm!

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HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked all the next day as a massage therapist without issue. HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked all the next day as a massage therapist without issue. HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked all the next day as a massage therapist without issue. Sally Wright, LMT Murfreesboro, TN HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked all the next day as a massage therapist without issue. Sally Wright, LMT Murfreesboro, TN HORSE STEPPED ON MY FOOT!!! After using the CHI Palm on acute for an hour, the pain and swelling decreased. Slept on Deep Calm and by morning, there was no swelling, minimal bruising, and wrinkled skin. I worked all the next day as a massage therapist without issue. Sally Wright, LMT Murfreesboro, TN all the next day as a massage therapist without issue. Sally Wright, LMT Murfreesboro, TN Sally Wright, LMT Murfreesboro, TN Sally Wright, LMT Murfreesboro, TN

In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING In a study on ten horses, one leg was treated with Infratonic sound therapy while the other served as a control. The treated leg’s temperature dropped by over 3°C within thirty minutes, as shown in the accompanying photo. After two twenty-minute treatments, twelve hours apart, the treated leg stayed significantly cooler than the control leg for over one hundred hours, showcasing the effectiveness of Infratonic sound therapy in reducing joint inflammation. REDUCE INFLAMMATION ENHANCE HEALING

LEARN MORE ABOUT THE CHI PALM LEARN MORE ABOUT THE CHI PALM LEARN MORE ABOUT THE CHI PALM

LEARN MORE ABOUT THE CHI PALM LEARN MORE ABOUT THE CHI PALM LEARN MORE ABOUT THE CHI PALM

PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery. PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery. PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery. PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery. PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery. PROVEN HISTORY OF SUCCESS Over the past 30 years, over 20,000 massage therapists have used CHI Palms., previously known as Qi-Gong Machine, CHI Machine (QGM), or Infratonic. Forty years ago, researchers at a China National Laboratory discovered a magneto-acoustical signal from Qigong Masters’ hands and created a simulator that provided similar benefits. The CHI Palm, the latest in eleven improved models, enhances these frequencies to relieve pain, inflammation, swelling, and even faster accelerated recovery.

WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN WIN A CHI PALM! Enter the drawing at Booth 537 at the AMTA Convention in Tampa or enter now at HTTPS://CHI.US/WIN

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FEATURES 82 SAFE TOUCH IN MASSAGE PRACTICE

Learn how being present and practicing with intention can help make your clients feel safe during a massage session—and why doing so is imperative to building trust. By Jules Wyatt

JOURNAL

Massage Therapy Journal® | Official Publication of the American Massage Therapy Association® Fall 2024 Vol. 63 No. 3 ISSN: 0895-0814 USPS 0010-218 Cover credit: Pixel-Shot / Shutterstock.com / Photo illustration by SPARK Publications Michelle Vallet Senior Publications Manager AMTA BOARD OF DIRECTORS (effective March 1, 2024) Kimberly Kane Santos President Christine Bailor-Goodlander Immediate Past President Cindy E. Farrar President Elect

Jaime Bernardo, Jr. Director Heber J. Blackner Director Donald Goodale Director Rick Greely Director Robert C. Jantsch Director

Jane Horton Johnson Director Cheryl L. Siniakin, Ph.D. Director Lee Stang Director LaDonna Ward Director

Publication Management SPARK Publications sparkpublications.com Image by Wellness Stock Shop Firefly image based on Enjebe / Shutterstock.com and Eliana Valerio/ Shutterstock.com with MariMuz / Shutterstock.com Fitness, & Mind New York City Steve Jurch, MA, ATC, LMT Director of Allied Health Training at the Community College of Baltimore County

DEPARTMENTS

EDITORIAL REVIEW OPERATIONAL COMMITTEE Jacqueline Herbach, LMSW, LMT President, Momentum Massage, Jane Neumann, BS, LMT, NCTMB Private Practice

6

LETTER FROM THE PRESIDENT All About Community

AMTA Illinois Chapter Communication Chair

Jessica Libero, LMT, NCTMB Connecticut and New York Licensed Reiki Practitioner Martha Brown Menard, Ph.D., CMT

9

SHAREABLE RESEARCH Massage for Neurodiverse Clients

Project Manager: Jaclyn Yepsen Creative Director: Larry Preslar

Massage Therapy Journal is published quarterly by the American Massage Therapy Association (address below). Periodicals postage paid at Evanston, Illinois, and additional mailing offices. POSTMASTER: Send address changes to Massage Therapy Journal , 500 Davis St., Suite 900, Evanston, IL 60201-4695. SUBSCRIPTIONS: All subscription matters and notice of change of address should be sent to: Massage Therapy Journal Subscriptions, AMTA, 500 Davis St., Suite 900, Evanston, IL 60201-4695 (877-905-2700). Subscription rates: U.S. and Canada, $25 for one year (four issues); $45 for two years (eight issues). Foreign, $70 for one year; $120 for two years; available on a limited basis. Contact AMTA Member Experience, 500 Davis St., Suite 900, Evanston, IL 60201-4695. Phone: 847-864-0123 info@amtamassage.org EDITORIAL COPY: Queries should be sent to Michelle Vallet via email: mtj@amtamassage.org . Visit amtamassage.org/mtj for writer guidelines. Information contained in Massage Therapy Journal does not necessarily reflect the opinions or beliefs of AMTA and/or the staff of Massage Therapy Journal . ADVE RTISING: Contact the AMTA sales team at Smithbucklin to learn more about advertising and exhibitor opportunities: (301) 215-6710 Ext.130 or hbrown@smithbucklin.com. Copyright © 2024 American Massage Therapy Association MTJ-024

12

ADVOCACY AMTA Advocates for Crucial Massage Therapy Legislation at the State Level

88 SOOTHE

6 Exercises for Upper and Lower Body Strength and Stamina That Are Easy on Your Elbow and Knee Joints

92

TOOLS OF THE TRADE Using CBD in Your Massage Practice

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1 Medical Massage Practitioners™ are the most highly compensated in the industry. 2 the number of hospitals offering massage increased by 1/3 in just two years. source: american Hospital association 3 Your largest competitors (franchises and day spas) generally do not participate in Medical Massage. 4 Medical Massage Practitioners™ are not limited to working in a doctor's office or hospital, but can practice in their own office or even a home based outcall practice. 5 Helping their clients get well with physician prescribed massage therapy is a source of tremendous personal satisfaction for lMts.

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6 • Massage Therapy Journal

Letter from the

President

All About Community

chronic pain, from marketing to managing risk, attendees can get a year’s worth of high-quality continuing education in one place. Just look at the diversity in the continuing education available, which showcases that no matter your interests, no matter your practice focus, no matter your experience— “[No] matter your interests, no matter your practice focus, no matter your experience— YOU belong at AMTA.” The real magic, however, is in the shared community I always experience at AMTA conventions. Spending time with massage therapists as passionate about the profession as me, meeting new friends and reconnecting with friends I’ve known for years is always a highlight for me, and gives me the inspiration and motivation to keep doing what I love: working hard for the massage profession and my clients. On behalf of the entire Board of Directors, we look forward to saying “Hi” to as many members as we possibly can! Happy Fall Y’all! In heartfelt service, Kim Fun Fact : According to the Guinness Book of World Records, the largest pumpkin pie weighed 3,699 pounds and was 20 feet in diameter, and made by the New Bremen Giant Pumpkin Growers. Can you guess which state? (No Googling!). YOU belong at AMTA . The Real Magic: Shared Community

It’s the most wonderful time of the year! For parents, now is the time you might be starting back-to-school shopping and thinking (or dreaming?!) of the day your kids return to school. Some of you may be watching your favorite sports team either gear up for playoffs or head home to rebuild. Others are watching the summer wane and squeezing every last ounce of fun from every day (count me in on this one!). Many of you might be doing all of these and more! But, there’s also a lot of excitement in our profession because … it’s AMTA National Convention time! AMTA National Convention is the bomb diggity, and whether you’re able to attend or not, there is so much to be proud of, not only as massage therapists but as a whole profession, too. Inclusive Community AMTA has always been committed to making space for everyone. The massage profession is incredibly diverse, from personal experience to practice interest to techniques used. There is no single way to be a massage therapist. At this year’s convention held in Tampa, FL, September 12–14, AMTA’s commitment to inclusion will be central to your convention experience, whether you follow along on Facebook or Instagram or attend in person (I’m hoping you attend in person!). From the start, our Keynote Speaker, Dolly Chugh , will lead us through an empowering discussion on Diversity, Equity and Inclusion and how we can enhance our massage community by building a more inclusive and supportive environment for both massage therapists and their clients. Don’t forget the continuing education! From sports massage to Thai massage, from working with pregnant clients to clients in

DON’T MISS THE AMTA NATIONAL CONVENTION CLOSING PANEL Bridging Science and Practice: Empowering Massage Therapists Through Research I have the honor of moderating a panel of massage therapists and thought leaders who will explore how emerging research can better inform your massage practice and improve client outcomes. Register now at amtamassage.org/ convention.

Kim Kane Santos AMTA President

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Shareable Research

Massage for Neurodiverse Clients

There has been an increase in diagnoses of neurodiversity in recent years, both in children and adults. This increase, at least in part, can be attributed to the fact that science is starting to better understand the various conditions that fall under the neurodiverse umbrella. The benefit of these advances, of course, is that more people are getting the support and health care they need—and that can include massage therapy.

READ MORE IN THIS ISSUE Read more about making your massage practice safe space for neurodiverse clients in this issue’s “Creating Safe Space for Your Neurodiverse Clients.” Two neurodiverse massage therapists talk about the benefits massage therapy can offer, as well as what you can do to make massage more accessible.

Image courtesy of Wellness Stock Shop

Share this research with clients and colleagues by visiting amtamassage.org/mtj.

amtamassage.org/mtj

10 • Massage Therapy Journal

Tuina Massage + ADHD Symptoms

Massage + Heart Rate Variability and Gait in Children With Autism Researchers wanted to know the effects of parent delivered traditional Thai massage (TTM) on heart rate variability (HRV) and gait in children with autism. The study. This 2024 two-armed, randomized controlled trial included 48 children with autism between the ages of seven and 12. Participants were randomly divided between the parent-delivered TTM group and a control group. The control group received no intervention. The TTM group received twice-weekly sessions measured at baseline, at completion of the eight-week intervention and at two months post-intervention. The results. Researchers found that the TTM group had notable positive effects on HRV, with a significant reduction in low-frequency value and increased high-frequency value when compared to participants in the control group. These benefits remained at follow-up. Regarding gait, results indicated that only stride length was affected in the TTM group, with participants increasing stride length when compared to the control group. None of the other parameters of gait comparison showed statistical significance. “Parent-delivered Thai massage increased HRV levels and stride length in comparison to the control group,” researchers noted, “and some effects of the intervention were maintained over the follow up period.” that lasted 50 minutes, for a total of 16 TTM interventions. HRV and gait parameters were

There is some evidence to suggest that pediatric tuina massage may have beneficial effects on the symptoms of attention deficit hyperactivity disorder (ADHD), including improvements in concentration, flexibility, mood, sleep quality and social functioning. Researchers want to know: What are the preliminary effects of parent-administered tuina massage for ADHD symptoms in preschoolers, and is this massage protocol feasible? The study. This 2022 two-arm, parallel, open-label pilot randomized controlled trial included 64 participants randomly assigned to either a parent-administered tuina massage group or a parent child interaction group. Parents in the parent-child interaction group attended online training about progressive muscle relaxation exercises to be done with their children at home. Both interventions were carried out every other day for at least 20 minutes for a two-month intervention period. The results. Outcomes were assessed at baseline, week four and week eight. The Swanson, Nolan, and Pelham parent scale was the primary measure of outcomes. Secondary outcomes measured included preschool anxiety scale, children’s sleep habits and parental stress. A mixed-method process evaluation embedded in the outcome evaluation was also performed. “The study design and the parent-administered pediatric tuina massage intervention were feasible,” researchers found. “Parent-administered pediatric tuina massage provided beneficial effects on improving core hyperactivity/impulsivity symptoms in preschool children. Parents perceived improvements in children’s appetite and sleep quality.”

References 1. Ruan H, Eungpinichpong W, Wu H, Aonsri C. “Effects of parent-delivered traditional Thai massage on gait and heart rate variability in children with autism: a randomized controlled trial.” J Integr Complement Med . 2024 Mar;30(3):269–278. 2. Chen SC, Yu J, Wang HS, Wang DD, Sun Y, Cheng HL, Suen L, Yeung WF. “Parent administered pediatric tuina for attention deficit/hyperactivity disorder symptoms in preschool children: a pilot randomized controlled trial embedded with a process evaluation.” Phytomedicine . 2022 Jul 20:102:154191.

WANT MORE INFORMATION? For more information on some of the research being done on the benefits of massage therapy, browse the Research section of AMTA’s website at amtamassage.org/research.

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12 • Massage Therapy Journal

Advocacy Advancing the Massage Therapy Profession

AMTA Advocates for Crucial Massage Therapy Legislation at the State Level A s the 2024 legislative season winds down, AMTA has been advocating in states across the country to champion massage therapy

• AMTA worked with Minnesota on Senate File 967 and House File 973 , which are companion bills, to establish

licensure and advance legislation on massage therapy for pain. Read on to learn more about AMTA’s top legislative priorities at the state level on behalf of the massage therapy profession.* AMTA Continues to Champion Massage Licensure in States AMTA is committed to helping champion licensure for massage therapists in all 50 states across the country. Legal recognition of massage therapy and clearly defined requirements will help advance the profession, as well as protect the health and safety of massage consumers. AMTA has been focused on helping Kansas and Minnesota, two remaining unlicensed states, pass legislation on massage therapy licensure: • AMTA continues to advocate for the passage of Kansas

state licensure for massage therapists as well as Asian bodywork therapists. These bills were held up again due to other priorities in the legislature and will need to be reintroduced this fall for the 2025 session. AMTA will continue to support this effort by building our stakeholder support and communicating the value of licensure for massage therapists in Minnesota. AMTA Helps Advance Massage for Pain Legislation in States AMTA monitored 30 bills related to non pharmacological approaches for managing chronic pain at the state level this legislative session. Many of these bills specifically include massage therapy and other complementary approaches to care. The following crucial bills could help remove barriers to non-opioid pain management, require insurers to cover non-pharmacological therapies such as massage, and study alternative treatments for pain:

Senate Bill 305 , the Massage Therapists Licensure Act. This

bill, which would provide for regulation and licensing of massage therapists, remains in play and is on track to be heard in a special session this summer.

• Massachusetts HB 1962 is still active and would require that the Department of Health develop and publish

Pixel.X / Shutterstock.com

amtamassage.org/mtj

Fall 2024 • 13

an educational pamphlet on the use of non opioid alternatives for treatment of pain, including massage therapy. • Massachusetts SB 659 is an act relative to removing barriers to non-opioid pain management. This bill is still in play and would not require insurance preauthorization for alternative pain management services. It does, however, mandate that insurance carriers annually distribute educational materials to providers and members about the pain management access plan. • California AB 1751 would have required the health care prescriber to discuss the availability of non pharmacological treatments for pain before directly dispensing or issuing a first prescription to a patient for a controlled substance containing an opioid. Although this bill has died, similar legislation has passed in other states. We are hopeful that comparable, from the opioid crisis. This legislation which involves strengthening the patient and health care provider relationship and making potential new treatments available upon FDA approval, stalled in the house in May. We hope to see similar legislation in the future. • Missouri HB 2182 was enacted and signed by the governor in April. This new law requires that the Department of Health and Senior Services develop and publish on its website an educational pamphlet regarding the use of non-opioid alternatives for the treatment of acute, subacute and chronic pain. The information in the pamphlet must conform to the most current clinical practice guidelines for prescribing opioids for pain issued by the Centers for Disease Control and Prevention. or more expansive legislation, will be introduced in California in the future. • South Carolina S 1282 calls for continued examination and implementation of best practices towards recovery

• Washington SB 6244 (The Pain Parity Act) stated that the Department of Health will develop and publish an

educational pamphlet regarding the use of non-opioid alternatives for the treatment of pain on its website. This type of bill often takes multiple sessions to move through the legislature, and we are hopeful we will see similar legislation again in 2025. • Montana HB 751 was of Public Health and Human Services develop and publish an educational pamphlet on its website regarding the use of non-opioid alternatives for the treatment of acute non-operative, acute perioperative, subacute or chronic pain. • Illinois HB 5355 would create the Non-Opioid Alternatives for Pain Act. We will continue to monitor this bill, which would require the Department of Public Health to develop and publish an educational pamphlet regarding the use of non-opioid alternatives for pain treatment. The legislation also states that health care practitioners shall exercise professional judgment in selecting appropriate treatment modalities for pain, in accordance with specified Centers for Disease Control and Prevention guidelines, including the use of non-opioid alternatives. If a health care practitioner prescribes an opioid drug, they must provide certain information to the patient, discuss certain topics and document the reasons for the prescription. • New Hampshire HB 303 is related to the insurance coverage for pain management services, including massage therapy. This bill has been referred for interim study, which means it will be studied between now and the start of the next legislative session in 2025. enacted and signed by the governor in April. This new law requires the Department

Visit the QR code to learn more about AMTA’s award winning advocacy efforts and how you can get involved.

amtamassage.org/mtj

14 • Massage Therapy Journal

AMTA’s Award-Winning Advocacy Work

• New York A 1769 would have required that non pharmaceutical alternative treatment options, including but not limited to treatment provided by a licensed acupuncturist, licensed massage therapist,

AMTA produces award-winning advocacy campaigns on behalf of our members to help elevate massage therapy and the profession! In 2024 alone, AMTA won an

licensed chiropractor, and yoga instructor, be covered by the medical assistance program and by private health insurers. Although this bill did not progress this year, we expect similar legislation to be introduced in the future.

American Society of Association Executives Gold Circle Award, an Academy of Interactive & Visual Arts Communicator Award and an Association of Marketing and Communications Professionals Platinum Hermes Award for our Advocacy Campaign on Advancing the Role of Massage Therapy in Integrative Healthcare. These prestigious honors underscore AMTA’s steadfast dedication to forging new pathways in health care for massage therapists.

In Other Advocacy News: AMTA Joins the Circle of Advisors for Pain Collaborative

This year, Christine Bailor-Goodlander will represent AMTA as an appointee to the Circle of Advisors as part of the Pain Collaborative to Advance Equitable Value-Based Solutions. The group’s mission is to expedite access to quality whole health care for individuals living with pain by fostering meaningful collaboration among diverse stakeholders and promoting innovative, equitable and evidence-based solutions.

* Please note: The status of the bills discussed in this article is accurate as of the publication date .

Free resources & grant funding to help you grow your knowledge and increase your practice!

www.MassageTherapyFoundation.org Elevate Your Massage Therapy Practice! Explore E-books: Strengthen your skills to better serve your clients and collaborate with physicians. Listen to Podcast: Unlock insider tips for integrating research into your practice. Free Resources & Grants: Fuel your growth with funding and invaluable knowledge. Join Webinars: Learn why evidence-based content is vital and hone your research skills. Inspiring Research Posters: See what's shaping the future of massage therapy. Vibrant Infographics: Stay updated with colorful, easy-to-digest research summaries. Transform your practice today!

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Creating Safe Space for Your Neurodiverse Clients There is a greater need for education and awareness around neurodiversity across most every health care profession, including massage therapy.

By Michelle Vallet

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T he Cleveland Clinic describes neurodiversity this way: “Neurodivergent is a nonmedical term that describes people whose brains develop or work differently for some reason. This means the person has different strengths and struggles from people whose brains develop or work more typically.”

Common Conditions You May See in Your Neurodiverse Clients—And How Massage Might Help Kennedy cautions that massage isn’t likely going to help all neurodivergent clients, but may be a great intervention for some neurodivergent people looking for help addressing some of the sensory, emotional and physical challenges common in some conditions like Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Sensory Processing Disorder (SPD) and Dyspraxia. ASD. For some autistic people, body awareness is challenging. In the simplest terms, body awareness in this context is often referred to as proprioception and describes a person’s sense of where their body is in relation to the immediate space around them. “Massage may improve the sense of where their bodies are in space,” Kennedy suggests, “thereby assisting with coordination and spatial orientation.” Additionally, many people with ASD have sensory processing issues that include sensitivities around sights, sounds, smells, touch and balance, to name a few. “Massage can provide a regulated sensory experience, which may help reduce hypersensitivities and improve sensory integration,” Kennedy notes. Pohl accounts for some of these known sensitivities in their practice. “Keeping a scent free room is the first step to making any massage space sensory-friendly,” they explain. “Giving clients the ability to change the temperature of the table, volume or type of music playing, and making weighted blankets available are all sensory accommodations.” Pohl explains you probably won’t be able to make everything in your practice customizable, but doing what you can within your own limitations and giving your neurodiverse clients choices when possible is helpful. “Being explicit about the client being able to request changes is also important,” they add. ADHD. Kennedy suggests that the relaxation and stress relief that is a hallmark of massage therapy may prove helpful for people with ADHD who are looking for ways to increase focus and

But broad and general descriptions should not be mistaken for singular definitions that can be used to encompass every neurodiverse person. “When you know one neurodiverse person, you know one neurodiverse person,” explains Sam Pohl, RMP and co-owner at Metta Integrative Wellness Cooperative, who, as a late-diagnosed autistic person, are themselves neurodiverse. “Everyone is different, and we all have different needs, and those needs can change from session to session.” Ann Blair Kennedy is the associate professor and director of the Patient Engagement Studio at the University of South Carolina School of Medicine Greenville and a massage therapist with 25 years of experience. Her experience with neurodiversity began young, growing up with an autistic brother and having ADHD herself. Now, she’s raising two neurodiverse kids and describes herself as neurospicy. Kennedy suggests looking at how other fields address meeting the needs of neurodiverse people as a helpful starting point. “Two that come to mind are universal design in education and trauma informed care in health care,” she notes. “Both of those approaches focus on inclusivity, accessibility and the assumption of diverse needs among individuals. Additionally, both these approaches provide frameworks that are proactive rather than reactive, and both emphasize the importance of creating environments where people feel safe and included.” Here, you’ll learn about some—not all— of the common conditions that affect neurodiverse people, along with some helpful ways you can make massage therapy more accessible and comfortable for these clients.

Broad and general descriptions should not be mistaken for singular definitions that can be used to encompass every neurodiverse person.

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5 Quick Tips for Making Your Practice Welcoming to Neurodiverse Clients Ann Blair Kennedy is the associate professor and director of the Patient Engagement Studio at the University of South Carolina School of Medicine Greenville and a massage therapist with 25 years of experience. Her experience with neurodiversity began young, growing up with an autistic brother and having ADHD herself. Now, she’s raising two neurodiverse kids and describes herself as neurospicy. Here, she offers five tips to help massage therapists make their practices more welcoming to neurodiverse clients. Consider sensory adaptations . Understanding that individuals with autism spectrum disorder (ASD) and sensory processing disorders (SPD) may experience sensory inputs more intensely is crucial. It’s important for therapists to be adaptable, as clients’ reactions to sensory stimuli like touch, sound and smell can change rapidly. Techniques such as using weighted lap pads and blankets, adjusting room lighting and noise levels, and being mindful of the textures of sheets and massage oils can help create a more comfortable environment. Employ communication strategies . Establishing clear communication methods, especially for non-verbal cues, is essential. This can involve using hand gestures or other signs to indicate comfort levels or the need for a break. Building rapport through initial sessions without massage to familiarize the client with you and the practice environment can also be beneficial. Consider using deep pressure massage . For some neurodiverse individuals, deep pressure massage has been shown to be effective. Utilizing flat palms and long, firm strokes can provide proprioceptive feedback, which might help with body awareness and reduce stress. However, it’s important to communicate clearly about the process and observe the client’s reactions carefully. Ensure client-led sessions . It’s critical to follow the client’s lead, allowing them to dictate the pace and extent of the massage. This might mean that some sessions are very short or don’t involve traditional massage at all initially. Establishing trust and a sense of safety is paramount, and this often requires patience and flexibility from the therapist. Educational and collaborative approach . Continuously educating oneself on the latest research and techniques for working with neurodiverse populations is important. Collaborating with other professionals involved in the client’s care can provide a more comprehensive understanding of their needs and how best to meet them​.

concentration. “By promoting relaxation and reducing hyperactivity, massage therapy can potentially help individuals with ADHD improve their ability to concentrate and focus,” she says. The same holds true for the sometimes high levels of anxiety experienced by people with ADHD. By lowering anxiety levels, massage may be able to help people improve their emotional regulation. Some research bolsters these claims. An early systematic review and meta-analysis examining the effects of massage therapy for children and adolescents with ADHD 1 showed some positive results, though was small, comprising only eight randomized controlled trials and three case studies for systematic review. A meta-analysis of four of the eight randomized controlled trials was also conducted. “Pooled analysis showed that massage produced more improvement in ADHD symptoms in terms of effective rate compared to Ritalin,” researchers noted. “Individual randomized controlled trials suggested that massage differed significantly from waitlist control in improving the conditions of anxious-passive and asocial behavior.” A more recent pilot randomized controlled trial 2 explored the effects of parent-administered pediatric tuina massage for ADHD symptoms in preschool children. Tuina is a modality similar to Shiatsu. Participants were assigned to either a parent administered tuina group or a parent-child interaction group, where parents were coached on a progressive muscle relaxation exercise. Both interventions were carried out every other day for at least 20 minutes for a two-month intervention period. Researchers found that both intervention groups showed improvement with moderate within-group effect size. The between-group effect size was minimal. “Perceived improvements on children’s appetite and sleep quality, and parent child relationship was observed in qualitative data,” researchers noted. “Parent-administered pediatric tuina provided beneficial effects on improving core hyperactivity/impulsivity symptoms in preschool children.”

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SPD. Some of the benefits massage therapy offers people with sensory processing issues look similar to the benefits massage might offer your autistic clients. “For individuals with SPD, massage therapy can serve as a therapeutic process and integrate sensory information more effectively, potentially reducing instances of sensory overload,” Kennedy explains. Additionally, Pohl encourages massage therapists to remember the importance of a person’s nervous system before and during a massage session. “Because of how neurodiverse brains work, our nervous systems are constantly ‘on,’” they explain. “Focusing on working with the individual’s nervous system first before focusing on muscles or skeletal/muscular dysfunction will always get a better result.” Dyspraxia. Again, massage’s ability to provide real relaxation may be a benefit to people with dyspraxia, a condition that primarily affects motor coordination. “Massage therapy can indirectly

help by relaxing muscle tension,” Kennedy says, “which might improve overall physical comfort and potentially enhance motor skill development through improved proprioception.” Making Massage More Accessible to Your Neurodiverse Clients “Our society is not really set up for neurodiverse folks,” Pohl says, “which can create several challenges for neurodiverse people that want to access massage therapy.” That can be true for many populations who don’t have the majority experience, like your LGBTQ+ and disabled clients, for example. With some thoughtful reflection, however, you can make sure you’re prepared to meet the needs of your neurodiverse clients. Sensory friendly space. From the start, understand that neurodiverse people, especially people who have sensory processing issues, may find spa environments, franchises or busy practice studios overwhelming. “Making sure your space, including waiting areas and common spaces, are scent free, calm and quiet can help mitigate these issues,” Pohl says. Offer sliding scale pricing when possible. According to 2024 research conducted by The Chartered Institute of Personnel, one in five neurodivergent employees surveyed experienced harassment or discrimination at work because of their neurodivergence. Further, recent data from the Employment Opportunity Commission indicates charges based on neurodiversity-related conditions has increased 10 percent since 2016, moving from 31 percent of total charges in 2016 to 41 percent of total charges in 2022. Cost can definitely be a barrier, so think of ways you might offer sliding scale fees when possible. “Especially if someone has high support needs, their financial ability to pay for massage therapy, even on a semi-regular basis, can be very limited,” Pohl says. “Offering sliding scale pricing or financial assistance is key to helping address the wealth gap for any marginalized group, including neurodivergent people.” Get educated. One of the best things you can do for your neurodiverse clients is get educated around

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neurodiversity. “Be open to hearing feedback from your clients, or even solicit feedback,” Pohl says. “Keep a growth mindset and seek out information on your own, which will help with any client, but especially neurodivergent folks.” Additionally, understanding how other identities intersect a client’s neurodiversity is important. “Understanding the intersectionality of neurodiversity with other identities, like being transgender or having chronic illness, can help any practitioner develop better skills for their neurodiverse clients, as well as neurotypical clients,” Pohl encourages. Be flexible and communicate clearly and directly. Pohl suggests making yourself available to your neurodivergent clients in a variety of ways. “I offer free 15-minute video or phone consultations to answer questions for folks who might have reservations or might just not know anything about

massage,” they say. “I also answer any messages through my website and Instagram account as quickly and directly as possible.” Giving neurodiverse clients multiple ways to communicate with you and learn about your practice and massage therapy is also recommended. “Having multiple options for how neurodiverse clients can talk with me helps encompass many different communication needs,” Pohl says. Even for clients that say they’ve had massage before, Pohl finds walking them through what to expect, see and feel during a massage session beneficial. “I let them know we can stop at any time, move away from any sensitive areas, and that they can ask for any changes in touch pressure, and environmental factors like sound, light and temperature,” they add. “I also always tell them they are allowed to talk to me, ask questions, request narration or be completely silent.”

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