Massage Therapy Journal Winter 2024

Winter 2024

CE How to Integrate Manual Lymphatic Drainage Into Your Practice

TIPS FOR · Hybrid Education · Choosing a Specialization for your Massage Practice · Successful Mentoring Plus Updates in Research: Massage Therapy for Dementia

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Massage Therapy Journal Vol. 63 No. 4 Contents

FEATURES

14 THE CURRENT STATE OF HYBRID EDUCATION IN MASSAGE THERAPY Online learning appears here to stay, but does

20 IS SPECIALIZATION RIGHT FOR YOU? Choosing a specialization for your massage therapy practice comes with a host of benefits, but you need to find what is right for you.

28 UPDATES IN RESEARCH: MASSAGE THERAPY FOR DEMENTIA Someone is diagnosed with dementia every 3.2 seconds. Massage therapy may help ease the symptoms of the disease. By David Malone

34 THE LYMPHATIC SYSTEM AND MASSAGE CE Learn the basics of manual lymphatic drainage and how you can best integrate the technique into your existing massage therapy practice. By Nicola McGill, LLSA, LMT, NCTMB, CLT

it work for entry level education?

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FEATURES 64 HOW MENTORING CAN

SUPPORT PERSONAL AND PROFESSIONAL GROWTH Mentoring has been valued for centuries across a broad variety of professions, and massage therapy is no different. By Jeffrey Montoya

JOURNAL

Massage Therapy Journal® | Official Publication of the American Massage Therapy Association® Winter 2024 Vol. 63 No. 4 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

Mateusz Feliksik /

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

DEPARTMENTS

6

LETTER FROM THE PRESIDENT Savor the Joyful Moments

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

Fitness, & Mind New York City Steve Jurch, MA, ATC, LMT Director of Allied Health Training at the Community College of Baltimore County

AMTA Illinois Chapter Communication Chair

9

SHAREABLE RESEARCH Massage for People with Dementia

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

12

ADVOCACY Massage Therapy and Research for Veterans

Publication Management SPARK Publications sparkpublications.com

Project Manager: Jaclyn Yepsen Creative Director: Larry Preslar

72

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 . ADVERTISING: 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

SOOTHE Self-Care for People in Strenuous Professions: Prioritizing Mental and Physical Well-being

74

TOOLS OF THE TRADE Spindle-Stim Techniques: Wake Up Inhibited and Weakened Muscles By Erik Dalton

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6 • Massage Therapy Journal

Letter from the

President

Savor the Joyful Moments

Dear Amazing AMTA member! As we begin to hunker down for the winter season (at least here in Pennsylvania!), I am filled with immense gratitude and joy. Serving as your AMTA President has been a tremendous time of leading, learning and lots of engagement within the massage community. Collaborating with stakeholders, talking with countless members, and working closely with AMTA staff and Board of Directors broadened my perspective, allowing me to grow both personally and professionally. For this, I am truly thankful. When we work together for the “greater good” of our association, share knowledge generously and foster an environment where everyone feels included and celebrated …, we create tremendous opportunities for EVERYONE! This is the magical element of AMTA! The Not-So-Secrets of OUR Success The success of our association has always been, and continues to remain, a direct result of people like YOU, who are dedicated and incredibly loyal. Take a moment to delight in that while I share with you three important skills that helped shape—and continue to sustain—my massage career. 1. Showing UP. My journey of showing up started 20 years ago when I answered an email about an AMTA event. I’d just graduated from massage school, and while I had wonderful mentors, the truth was, I felt alone in this grand profession of ours. But attending that first AMTA Chapter meeting in Allentown, Pennsylvania, gave me my first connection to massage therapists in my area, and I truly felt like I’d found my home , my community . Then, I volunteered to be Chapter Secretary, and … I just kept showing up.

2. Self-Care. Self-care looks different for us all, right? For me, self-care comes from finding a work-life balance—as well as staying hydrated and making nutritious food, being in nature and practicing gratitude. Self-care is also connection . Connecting with other amazing AMTA members, massage therapists, and learning new skills. (Oh, the connections I’ve made this year!) 3. Savoring. What do I mean by savoring? I mean being aware and present for moments in your life that are important. Life is a collection of moments, some big, some small (like the stack of pancakes I sometimes like to enjoy at breakfast!), and each one holds the potential for contentment and joy. By developing the skill to savor, we can maximize those joyous moments. In other words, we can make those moments last! So, as my year as your AMTA President wanes, I want to remind you , remind us: • Let’s continue to show up—for ourselves, for our profession and for each other. • Let’s prioritize self-care, not just as a way to sustain our careers, but as a commitment to living fulfilling lives. • And above all, let’s savor both the big achievements and the small joys that come our way. Let’s commit to practicing kindness to others, to yourself and to the world. May your days be filled with wonder and your heart be light. It takes ALL of us! Kim Fun Fact: The current world record for longest massage chain included 1,600 people! Can you guess where this happened? (Also, with more than 105,000 members, AMTA could top this record by a mile! Who’s up for the challenge?).

ENGAGE WITH AMTA AMTA’S local chapters are a great place to start getting involved. Find yours at amtamassage.org/ chapters.

Kim Kane Santos AMTA President

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Shareable Research

Massage for People with Dementia The massage therapy profession is not young, with some estimating the practice is over 5,000 years old. Even so, research is changing how both massage therapists and the consumers who benefit understand the difference massage therapy can make for a wide variety of conditions.

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

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10 • Massage Therapy Journal

Updates in research are common, sometimes shattering myths (like massage being contraindicated for people with cancer), but oftentimes further solidifying the benefits massage provides. The latter is true for massage and dementia.

Massage + Older Adults with Advanced Dementia Researchers wanted to assess the acceptability and preliminary effects of Namaste Care, a specialized program that offers health care providers, volunteers and families ways to meaningfully engage with individuals with dementia using activities like music, massage, reminiscing, socialization, aromatherapy and snacks. The study. This 2024 mixed methods multiphase design was used to assess effects of the approach using trained volunteers for older adults with mid- to late-stage dementia. The program was delivered over six months with focus groups, as well as individual interviews with one volunteer and two family members. A prospective pre-post-test study design was used to evaluate preliminary results. Outcomes measured include quality of life, neuropsychiatric symptoms, and pain for patients with dementia and family carer role stress. Quality of visits for the family was also measured. Data were collected from June 2018 to April 2019, and descriptive analyses of participants’ characteristics were expressed as standard deviation for continuous variables and percentages for categorical variables. Thematic analysis was used to analyze focus group and individual interview data. The results. A total of 15 patients received the intervention. Families, staff and volunteers all perceived patients experienced benefits from the approach. Staff, volunteers and families reported feeling fulfilled in their roles, and the activities included in the program were perceived as necessary for the patients. “There were no statistically significant improvements in patient outcomes,” researchers noted. “There was a statistically significant decline in family carer role stress.”

Aromatherapy + Dementia

This meta-analysis of randomized controlled trials explored the efficacy of aromatherapy on behavioral and psychological disturbances (BPSD) in people with dementia. The study. BPSD is common in people with dementia. This 2024 meta-analysis investigates what research says about how aromatherapy may reduce the frequency and severity of BPSD and improve the functional ability in people with dementia. A literature search was conducted using PubMed, Emboss and Cochrane Library for randomized controlled trials published before March 2024 comparing aromatherapy with control treatments in patients with dementia. There were 15 trials comprising 821 patients included in the meta-analysis. The results. Significant reduction in BPSD was observed after one month of aromatherapy treatment. Meta-analysis results showed significant improvement in Cohen Mansfield Agitation Inventory scores in patients receiving three to four weeks of aromatherapy compared with the control group, and four of the five trials reported improvement in depressive mood. Significant improvement in functional ability was shown in three trials. “Aromatherapy is a safe and viable nonpharmacologic treatment to improve BPSD in people with dementia and its combination with massage showed higher efficacy,” researchers noted.

References 1. Marie-Lee Yous, Esther Coker, Paulette V Hunter, Kathryn A Fisher, Joanna L Sue, Maria Nicula, Nadia Kazmie, Theresa Orsini, Tamara Sussman, Genevieve Thompson, Sharon Kaasalainen. “Acceptability and preliminary effects of the volunteer-supported Meaningful Moments program to engage older adults with advanced dementia on a hospital-based specialized dementia care unit: a mixed methods study.” BMC Geriatr. 2024 Jul 11;24(1):593 . 2. Po-Hao Wang, Ho-Wei Lin, Truc Tran Thanh Nguyen, Chaur-Jong Hu, Li-Kai Huang, Ka-Wai Tam, Yi-Chun Kuan. “Efficacy of aromatherapy against behavioral and psychological disturbances in people with dementia: a meta-analysis of randomized controlled trials.” J Am Med Dir Assoc. 2024 Aug 8:105199.

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12 • Massage Therapy Journal

Advocacy Advancing the Massage Therapy Profession

AMTA Advocates to Expand Access to Massage Therapy and Research for Veterans

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D uring National Veterans and Military Families Month, AMTA is highlighting its advocacy efforts to expand access to massage therapy for veterans and promote new research. We are dedicated to ensuring that veterans can experience the health advantages of massage therapy, which is a benefit covered by the Veterans Health Administration (VHA), when deemed clinically necessary by a care team. AMTA regularly engages with the VHA to advocate for increased funding and broader access to massage therapy services for veterans. Additionally, we collaborate with veteran researchers and actively involve our members in addressing regional issues affecting veterans. AMTA is featured in the Friends of VA Medical Care and Health Research (FOVA) 2025 Budget Proposal As a member of the stakeholder coalition Friends of Veterans Affairs (FOVA), AMTA supports access to complementary and integrative health services

for veterans, including massage therapy. AMTA has been recognized for its contributions to FOVA’s initiatives, particularly in expanding research on the benefits of massage therapy for military and veteran populations. The FOVA Budget Proposal for FY 2025 features a spotlight on AMTA’s efforts, underscoring its commitment to advancing research that demonstrates how massage therapy enhances veterans’ health and wellness. These research initiatives include exploring the role of integrative therapy nurses at the Minneapolis VA Medical Center, promoting reintegration for National Guard veterans through integrative therapies, and understanding veterans’ perceptions of massage therapy. This work is part of a wider push to secure ongoing funding for critical health programs that ensure veterans receive comprehensive care. FOVA advocates for funding and support for medical and health research programs within the U.S. Department of Veterans Affairs (VA). Its mission is to ensure veterans receive top-quality healthcare

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Winter 2024 • 13

by promoting research that advances medical treatments and technologies. FOVA also plays a key role in influencing policy decisions and securing funding to improve VA research infrastructure, with a focus on innovations in prosthetics, mental health, and complementary therapies. Growing Evidence of Massage Therapy’s Benefits for Veterans Recent research continues to affirm the positive effects of massage therapy for U.S. veterans, showing its potential to improve overall health and well-being. An evidence map of massage therapy offers a structured overview of existing studies, categorizing them by the strength and certainty of their findings. This tool helps researchers, clinicians and policymakers quickly assess where strong evidence exists and where further investigation is needed. Since 2018, the VA Health Services Research & Development Department has updated its evidence map, which tracks the benefits of massage therapy for veterans. Recent findings highlight six reviews with moderate certainty of evidence showing that massage therapy can improve conditions such as chronic back

pain, fibromyalgia and myofascial pain. This represents significant progress compared to earlier maps, which included only low certainty conclusions. The growing body of evidence strengthens the case for massage therapy as an effective treatment for specific conditions commonly faced by veterans. The Need for More Research on Massage Therapy for Veterans Despite the increased use of massage therapy within the VA healthcare system since 2016, further research is needed to advance its role in integrative healthcare for veterans. High quality randomized controlled trials are crucial to building a more robust evidence base for the effectiveness of massage therapy in managing pain and other health conditions. AMTA continues to support new research through the Massage Therapy Foundation, including a study with the Defense and Veterans Center for Integrative Pain Management. This study focuses on an evidence-based approach to using massage therapy to reduce the burden of chronic pain within the Department of Defense and the VA .

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14 • Massage Therapy Journal

The Current State of Hybrid Education in Massage Therapy Online learning appears here to stay, but does it work for entry-level education?

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Winter 2024 • 15

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16 • Massage Therapy Journal

T hey say necessity is the mother of invention. In the case of hybrid education in the massage therapy profession, nothing could be truer. During COVID, hybrid education became the new normal for many massage schools across the country. Now, we’re revisiting the topic to see if hybrid education has proven its staying power.

Additionally, low-achieving students had higher total scores in both MCQ and CSQ in the online teaching model. The study concluded that online teaching was not statistically significantly different from offline in cognitive domains, and was more desirable than offline in strengthening lower-order cognitive skills. The study does note that offline teaching may be more effective in reinforcing higher-order cognitive skills among high-achieving students. A separate 2023 study 2 explored blended (hybrid) learning compared to completely online and offline learning in an evidence-based medicine course. The study compared the examination scores of 2,100 undergraduate students in clinical medicine across a blended learning group, an online only group, and a traditional offline group. Exam scores were then collected and compared. The study found that the blended group’s exam scores and pass rate were significantly higher than those of either the offline or online groups. Additionally, in a survey administered by the researchers, 71.6% of students preferred the blended teaching mode. “Using a blended education approach in evidence-based medicine courses can improve students’ learning motivation, autonomy and satisfaction,” researchers noted. Hybrid Learning for Entry-Level Massage Therapy Education One of the trickier aspects of hybrid learning is considering how it's integrated into entry level education. Entry-level education is the foundation massage therapists build the rest of their careers on, so it is vitally important for a hybrid model to be effective. “I believe a hybrid model can be appropriate for entry-level education, provided it is carefully balanced,” says Davonna Willis, owner and founder of 4 Nineteen Education & Training. “Theoretical courses, like anatomy or business practices, can be effectively taught online. However, hands-on skills, which are crucial in massage therapy, require substantial in-person training to ensure students develop the necessary tactile skills and confidence .”

What we found is that the answer may very well be “Yes,” with many massage schools having some form of hybrid education offerings. “I would currently describe the state of massage education as being marked by a significant shift toward quicker, more flexible learning options,” says Kathleen Mazy, owner of Texas Massage Academy. “This is driven by student demand for accelerated courses and online options.” For example, schools with a 600-hour massage program that takes between six to 12 months to complete might offer the theory portion for each course in an online format, with the hands-on instruction portion requiring in-person attendance. For many prospective students, this option can make massage therapy A 2023 comparative study 1 examined the impact of online and offline teaching methods on the cognitive abilities of medical students. During the study, survey data were collected from entry-level students who participated in online teaching during 2018, as well as entry-level students in offline teaching in 2019 at Xiangya School of Medicine, Central South University. The study examined the total score of a physiology final exam, score of each type of question, and National Quality Open Courses learning engagement in different score segments under the two teaching models. The study found no statistically significant difference in the total score, short-answer questions score (SAQ), and case study questions (CSQ) score between online and offline teaching models. The multiple choice questions (MCQ) score, however, was higher in the online teaching model. education much more accessible. What Does the Data Say?

“I would currently describe the state of massage education as being marked by a significant shift toward quicker, more flexible student demand for accelerated courses and online options.” —Kathleen Mazy, owner of Texas Massage Academy learning options. This is driven by

fizkes / Shutterstock.com

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Winter 2024 • 17

Mazy believes, in some instances, a hybrid model could even be superior to a traditional model. “With our program, the students have the flexibility to go back and review concepts they didn’t get the first time around. If they are in the classroom, there is no rewind button,” she says. “When the students come on-site, we incorporate a lot of discussion of the material they have already learned online to allow them another opportunity to gain additional knowledge.” It is also important to note that not all online classes are created equal. At Texas Massage Academy, for example, the online classes incorporate 3D animations, games and learning activities. The school is also looking into the use of wearables such as VR (virtual reality) and AR (augmented reality) for online education in the future. Many massage therapy students have full-time jobs while in massage therapy school. For people like this, a hybrid learning model is invaluable. “For students who work full-time while attending school, the hybrid model is particularly beneficial, especially for science courses like anatomy,” says Willis. Mazy also mentions flexibility as a key benefit of the hybrid learning model. “It has allowed our students the flexibility to complete the online portion at their own pace,” she says. “Since we are in a rural area, it allows our students to only have to travel to our campus for half the time to complete their program.” This is not just beneficial for the students, however. By allowing students to attend school who may not have been able to otherwise, the hybrid model will also benefit massage therapy schools. “I believe hybrid education can help increase enrollments, which in turn positively impacts the school’s financial bottom line,” Willis says. As with most everything that touches broad systems like education, however, these benefits What are the Benefits of a Hybrid Learning Model for Massage Therapy?

Andrey / Shutterstock.com

are not universal. Different students thrive in different situations. “Research, including a study I conducted, found that asynchronous learning is best for students with high GPAs, those who excel in any academic environment,” says Susan Salvo, author, educator and massage practitioner. “Conversely, live or synchronous learning is best for the average student.” Salvo also notes that students whose primary language is not English, or students who may be neurodiverse, do better in live, synchronous learning environments. The Challenges of Hybrid Education “As a continuing education instructor, I’ve observed that students who were in school during COVID and began with hybrid classes tend to struggle more with the hands-on portions of the training,” says Willis. “They often face challenges with mastering technique.” Hybrid learning still includes hands-on portions, but learning the basics of different techniques online, via distance learning, can lead to students starting the hands-on portion with a less firm grasp on the techniques than if they were in the classroom learning the basics.

“As a continuing education instructor, I’ve observed that students who were in school during COVID and began with hybrid classes tend to struggle more with the hands on portions of the training. They often face challenges with mastering technique.” — Davonna Willis, owner and founder of 4 Nineteen Education & Training

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18 • Massage Therapy Journal

SHARE YOUR THOUGHTS ON MTJ: Scan the QR code and take a five-minute survey to help us make Massage Therapy Journal even better and more helpful for you and your practice!

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Willis suggests a possible solution for this issue would be to increase the hands-on hours for those who primarily took online classes. “This adjustment would help ensure that all students, regardless of the learning format, develop the necessary practical skills and confidence needed in the field,” she explains. Additionally, some students may find getting and staying motivated is more difficult with online learning. “Since our program is self-paced, it is very easy to put it on the back burner and forget about it or feel alone,” Mazy says. To try and combat this, Texas Massage Academy has set up a community for its students where they can chat with other students who are going through the same program. The hybrid model also comes with consistent check-ins and discussions, so students are always aware that the school and its resources are there to help.

Despite these challenges, online learning appears to be here to stay. “Technology is going to become even more important,” says Mazy. “For any school to survive in the future, they will have to have some additional tools other than traditional lecture in the classroom.” References 1. Xu Y, Wang L, Li P, Xu H, Liu Z, Ji M, Luo Z. “Exploring the impact of online and offline teaching methods on the cognitive abilities of medical students: a comparative study”. BMC Med Educ. 2023 Aug 8;23(1):557. 2. Zhang Y, Liu J, Liang J, Lang J, Zhang L, Tang M, Chen X, Xie Y, Zhang J, Su L, Wang X. “Online education isn’t the best choice: evidence-based medical education in the post-epidemic era-a cross-sectional study”. BMC Med Educ. 2023 Oct 10;23(1):744.

WE WANT TO HEAR FROM YOU! Tell us: What are the benefits and challenges of hybrid education models? Share your thoughts at communications@ amtamassage.org!

S

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20 • Massage Therapy Journal

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Winter 2024 • 21

Is Specialization Right for You? Choosing a specialization for your massage therapy practice comes with a host of benefits, but you need to find what is right for you.

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22 • Massage Therapy Journal

T o specialize or not to specialize? As a massage therapist in a growing profession that continues to see research support and expand on the benefits massage therapy offers, you have a variety of opportunities to create a focused niche for your practice, like Thai Massage, prenatal massage and sports massage, to name a few.

But, is specialization right for you? Or, would a more general practice with more client variety be more professionally satisfying? No matter where you are on your career path, periodically asking yourself these questions can keep you continually inspired and engaged in the massage profession, and help you refine nearly every aspect of your practice, from continuing education choices to marketing efforts to the clients you choose. There are benefits to both a broader approach to your practice and viewing your practice through a more focused lens. Here, we’ll break out some of the reasons specialization might work for you, as well as different massage practice areas you might consider. Why Specialize? Some Benefits to Building A Niche Market When thinking about the value of specializing, Bruce Lee may have said it best: “I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.” Specialization gives massage therapists the opportunity to build a reputation as an expert, which can mean clients may be more keen to seek out your services. Professional satisfaction. Not only can expertise draw clients to a practice, but massage therapists who are known for specialized services can sometimes command higher rates. Additionally, by choosing to specialize in something either well-known or trending, massage therapists can help ensure they stay engaged with their work and the broader profession. More focused marketing. Specialization can also make it easier for you to market yourself. When you can show potential clients you have specialized knowledge and understanding, the ability to build trust is enhanced.

For example, if you focus your practice on prenatal massage and can showcase the continuing education and years of experience you have working with people who are pregnant, potential clients will more likely trust your expertise. Valuable expertise. Finally, specialization can lead to better client outcomes because of the increased knowledge and experience you have in a specific area. One way to gain this expertise is via continuing education courses. Increasing your knowledge through high-quality continuing education is a great way to make sure you’re staying up to date and relevant, and also means you can talk to current and future clients about the rigor of the courses you pursue, another way to build trust. AMTA FASCIAL THERAPY CE Fascial therapy is regularly used when working with a variety of special client demographics, like athletes, for example. This in-depth set of courses can help you take your practice—and understanding of fascia and fascial therapy—to the next level. Learn more at amtamassage.org/learn. How to Choose a Specialization That Works for You When you’re thinking whether or not specialization is right for you, consider some of the following: 1. What are some of your own interests within the massage profession? 2. Do you have favorite techniques that lend themselves to focusing on a specific client demographic? 3. What are your personal and professional strengths? 4. Is there sufficient market demand? “I am a sole practitioner focusing on clinical

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Winter 2024 • 23

applications of massage for clients wishing to reduce pain or improve their range of motion,” says Steve Albertson, LMT. “Prior to becoming a massage therapist, I worked as a fire department paramedic, a medical product researcher and a technical specialist for two different engineering schools. I have always embraced creative problem solving, knowledge of the human body and the ability to positively impact the lives of others. Focusing on clinical applications of massage allowed me to draw on the expertise I had developed from those previous positions.” Finding Your Niche: What Are Some Areas of Possible Specialization? There is no shortage of areas to specialize in within the massage therapy profession. Some of the more common practices that may be ripe for specialization are discussed here: Thai Massage Thai massage, also known as Nuad Bo-Rarn, is an ancient practice that originated in Thailand and is traditionally performed on a mat on the floor with the client dressed in comfortable clothing. This type of massage therapy is considered a combination of acupressure, passive stretching and rhythmic compressions that focuses on promoting overall well-being and balance in the body. Once considered a more unique modality, Thai massage has become fairly mainstream and widely accepted. This increased awareness has led more massage therapists to pursue continuing education in Thai massage. “Practiced properly, Thai massage is said to be equally beneficial for the giver and receiver,” explains Jill Burynski, president and founder of Living Sabai School of Thai Massage. “Massage therapy can be a physically strenuous occupation. Many massage therapists exit the profession earlier than they had hoped because of repetitive stress injuries and wear and tear on their bodies.” Due to its ergonomic body mechanics that are reminiscent of martial arts—as well as the use of gravity and leverage rather than force—Thai massage can help prevent the repetitive stress

Photo courtesy of Jill Burynsk

Thai massage: great for veteran massage practitioners who are looking for techniques that are easier on their bodies and may help extend their career longevity.

injuries and physical burnout that are all too common among massage therapists. Thai massage work also incorporates many hand-saving tools, such as Tok Sen, Herbal Compress and Pa Kao Mah sarongs. Who might be interested? For veteran massage practitioners who are looking for techniques that are easier on their bodies and may help extend their career longevity, Thai massage may be a great specialization. Professional Sports Massage Sports leagues are multibillion dollar organizations with multimillion dollar athletes. For the health of the team (and individual athletes) and success of the season, finding ways to keep physical and mental well-being a top priority is becoming increasingly more important to professional sports leagues. Today, professional sports teams spare no expense on their training and recovery facilities and offerings to keep their athletes performing

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24 • Massage Therapy Journal

What does this mean for you? You may find yourself massaging one athlete on one table while another athlete in the same room might be receiving compression treatment or chiropractic adjustments. Additionally, when working as a massage therapist in a professional sports setting, teamwork is not only beneficial but required. “I work hand-in-hand with the athletic trainer,” says Jessica Satti, a massage therapist with the WNBA’s Connecticut Sun. “She will give me a recap of what is going on with each player before they are on my table. I will always watch their away games to help me see things that happened on the court.” Similarly, Brimley makes note of the importance of both relying on the information from other health care providers around her, as well as informing them of her own findings. Who might be interested? Practicing massage in a professional sports setting may appeal to massage therapists who are already interested in sports massage, enjoy working in a faster paced environment, and who like to collaborate with other professions as part of a larger team. Pregnancy Massage Generally defined, pregnancy massage—also sometimes referred to as prenatal massage—is a massage focused on helping people who are pregnant. “Prenatal massage is performed much like any other massage,” says Julia Costello, licensed massage therapist and owner of Portland Prenatal Massage. The strokes and techniques used during prenatal massage are very similar to Swedish massage, though there are some key differences. With prenatal massage, for example, strokes may be slower and gentler, and may include techniques like feathering and craniosacral therapy. Additionally, certain areas, such as the calves, may require caution because of the increased risk of blood clots. “Therapeutic touch, gentle range of motion, and breath work can all help the mother’s nervous system shift and help her adjust to the

Sports massage: great for massage therapists who enjoy working in a faster paced environment and who like to collaborate with other professions as part of a larger team.

at their best, and massage therapy is included as part of these offerings for just about every pro sports team. One of the biggest differences between a professional athlete and a traditional massage client is body type. “The biggest difference is size and muscle mass,” says Cicily Cannady, a massage therapist who has worked with the NFL’s Jacksonville Jaguars since 2017. “The players that have a lot of muscle mass take a lot more care and time warming up the tissues and manipulating the muscle to promote circulation and flexibility.” The work environment is also different. “I typically do home visits for my everyday clients,” explains Julia Brimley, a massage therapist who has been working with the NBA’s Brooklyn Nets since 2020 and the NFL’s New York Jets since 2022. “The environment is usually private. Whereas in professional sports, they have one big room for treatment, which can include massage therapists, physical therapists, athletic trainers and chiropractors.”

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Photos by Mark Hanson Photography

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Winter 2024 • 25

10 Questions for Finding A Specialization That Works For You When you’re considering whether specializing might be a good career choice for you, the following questions may help simplify the process by narrowing down your skills, interests and career goals. 1 What are my interests and passions within the massage therapy profession? 2 What types of massage techniques do I enjoy practicing the most? 3 What populations or demographics do I feel drawn to working with (e.g., athletes, pregnant people, elderly)? 4 What are the specific needs or issues that I want to address through massage therapy (e.g., pain management, stress relief, rehabilitation)? 5 What are my strengths and areas of expertise within massage therapy (e.g., deep tissue massage, Swedish massage, aromatherapy)? 6 What additional training am I willing to pursue to specialize in a certain area? 7 What are the demands and opportunities for different specializations in my local area or desired market? 8 What is the income potential and job prospects for various specializations in massage therapy? 9 How do I envision my career evolving in the future, and which specialization aligns best with those aspirations? 10 What feedback or encouragement have I received from clients, colleagues or mentors regarding my aptitude for certain types of massage or working with specific populations?

Pregnancy massage: great for massage therapists who have a passion for helping women better deal with the multitude of issues that can arise during pregnancy.

many changes taking place,” says Danielle Dickey-Heifets, a licensed massage therapist. Many massage therapists who regularly see or want to see more clients who are pregnant consider taking advanced continuing education on the topic to stay updated on the latest research and ensure they continue to practice safely. Who might be interested? Pregnancy massage may be interesting to massage therapists who have a passion for helping women better deal with the multitude of issues that can arise during pregnancy and want to focus more of their practice on this client demographic. Regardless of the specialization a massage therapist may choose, there are some things that are true for everyone. “No matter what area of massage therapy you pursue, try to avoid working in isolation,” says Albertson. “Collaborate with others whenever you can. Stay current on the latest research within our field.”

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28 • Massage Therapy Journal

Updates in Research: Massage Therapy for Dementia Someone is diagnosed with dementia every 3.2 seconds. Massage therapy may help ease the symptoms of the disease.

By David Malone

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Winter 2024 • 29

Berit Kessler / Shutterstock.com

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30 • Massage Therapy Journal

I n 2020, over 55 million people were living with dementia worldwide, and, according to Alzheimer’s Disease International, this number is set to increase to 78 million people in 2030 and 139 million by 2050— roughly one new case of dementia every 3.2 seconds.

Massage therapy has shown promise in helping manage some of the signs and symptoms associated with dementia. “Massage therapy can improve feelings of security if the client enjoys the caring touch and responds with trust to the therapist,” says Katie Brewer, LMT. “They may not remember the therapist by name or face, but they will remember how the therapist made them feel.” A 2020 review 1 of sensory-based interventions for adults with dementia and Alzheimer’s disease included 47 articles from nine databases searched from 2002 to 2017. Some of the sensory based interventions investigated—in addition to massage—were light gardening, music, Montessori, animal-assisted therapy, dance and yoga interventions. Massage therapy was the only intervention with strong evidence supporting its benefits. “Some families of people with dementia will seek massage therapy for their loved ones for relaxation, whereas others come for relief from pain,” says Sheila Alexander, a massage educator and owner of Senior Spa. Regardless of the specifics as to why they are seeking out massage, individuals with dementia and their families and caregivers can all benefit from massage therapy. Massage for Anxiety, Agitation for People with Dementia Feelings of anxiety, sadness or anger are common with dementia and the memory loss that comes with it. These feelings can cause dementia patients to feel agitated, which can sometimes lead to aggression. Massage therapy has emerged as a non-pharmacological intervention to help manage agitation, stress and aggressive behavior in people living with dementia. “Massage therapy can calm anxiety by invoking the relaxation response if the client enjoys the touch,” Brewer says. A 2020 literature review 2 explored massage therapy as a non-pharmacological intervention to help control agitation and stress in patients with dementia. The review examined the role of massage therapy (alone or in conjunction with

As with much of the growth that occurs in the massage therapy profession, research has proved invaluable in broadening our understanding of what massage can offer people with dementia. Dementia is a blanket term that comprises several diseases that affect memory, thinking and the ability to perform daily tasks, according to the World Health Organization (WHO). Alzheimer’s is the most common type of dementia, accounting for anywhere between 60% and 80% of cases. The WHO lists the following as some of the most common early signs and symptoms of dementia:

SHOULD YOU SPECIALIZE?

Looking to more narrowly focus your practice? You may find your passion is working with clients who have dementia. For other areas of specialization to consider, read “Is Specialization Right for You?” on page 20 .

• Forgetting things or recent events • Getting lost when walking or driving • Being confused, even in familiar places • Problems following conversations • Difficulty solving problems or making decisions

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