PhysioPotential: An Otago Undergraduate Experience.: 2014-2015 Summer Holiday!!

I passed my exams! Woohoo!! I'm sitting on a B average... but that doesn't mean I will strive to be average! ...Always strive to do your best. A pass also means that this blog will be continued in 2015!

"Where the love of man is, there also is the love of healing"

Over summer I have been working as a massage therapist. This isn't something a second year physio student would normally do. As I already have a degree, knowledge and experience in the area of massage, this is my income while I study. Physio and massage therapists are distinctly different health services. Massage in New Zealand is largely unregulated which means that anybody can call themselves a 'massage therapist'. The distinction of quality lies in the health provider in which they are employed - the job application and interview process usually filters the alternative practitioners from 'true' massage therapists. Massage New Zealand is the professional body that allows massage therapists to be recognised as having an acceptable level of proficiency and professionalism. Anyway, I actually wanted to share some of my experiences and thoughts from practicing as a massage therapist with you because it will give you an insight into the culture of New Zealand and the musculoskeletal rehabilitation setting. This is, after all, similar to what may be experienced in a physiotherapy setting.

Thoughts and experiences of working as a massage therapist.

Notes written in short-hand format are a lifesaver! More accurately, it's a time-saver! When you've got back to back patients, there is an expectation by the client that you'll spend the whole time engaged with them... leaving little or no time for writing notes on the session. Having a great short term memory is helpful, but shouldn't be relied on!
There is a misconception that relaxation massage is easy. It is not easy. With hands trained to detect tight muscles, the last thing they want to do are gentle sweeps. Relaxation can, in itself, promote good patient health - it's a technique that shouldn't be overlooked.
There will be clients with medical mysteries. Some will seek a range of professional services and referrals, have medical imaging carried out, try alternative medicine and still not have any improvement in their condition.
Some clients will turn up at 8:30am at the clinic doorstep (clinic opens at 9am) wanting an appointment to help relieve their pain, even though the appointments are booked up for the day.
Some clients have unrealistic expectations: either they want you to turn their pain off like turning on a light or they expect you to have studied their complete set of previous treatment notes from other health professionals before they arrive, then treat them exactly as other healthcare providers have done but expecting better results.
Some clients think massage therapists are either physiotherapists or are miracle healers. However, they are not. Some clients think physios only care about giving them exercises to do, and if this doesn't work then that physio is no good. This is not strictly true either.
Massage therapists don't tend to perform extensive initial consultations - the patient wants a massage, and that is that! Massage therapists then must carry out a brief consultation and continue that consultation in to the treatment.
A lot of clients will joke about their old age... let them joke but also inform them that there are things that they can do to promote healthy aging.
Some clients are 'hard cases'! They will wink to the receptionist and joke about getting 'beaten up' in their session due to the firmness of some techniques over trigger points etc. "They had their iron thumbs out today".
Massage therapists have a reputation for finding all the sore or tender points in a body of tissue - the clients will generally let you know about it one way or another.
Some clients will chat your ears off, so much so that half-way through the treatment you may have to pause the conversation to ask about reproduction of symptoms or if the pressure you're applying is fine. Other clients are deathly quiet - this is okay provided they are happy to be present in their own mind (and the occasional client will fall asleep and snore!) - it's always good to ask them of this before letting the room go deathly quiet.
Some clients don't listen or mishear what you've said, a common experience has been... Me in a clear, slow voice: "If you're comfortable to do so, you only need to take your t-shirt off. I will leave the room while you do so, here is a towel/blanket to cover yourself with. I'll wait just outside the door so sing out when you're ready". Sometimes they forget to sing out. Sometimes you find that they've taken off everything but their underwear (even for just a back massage)... but thank goodness they are good at remembering to drape!
Some clients say they have high pain threshold - some do, some don't (let them think they do).
Some clients say 'don't be gentle, if you need to dig in, do it. It has got to be good for you."
30min massage, minus 1min hand washing, minus 1min setting up workspace (removing towels & used face tissue, putting down new towel & face tissue, putting new towels on the heater), 1min reading previous treatment notes & mental preparation, minus 2min pre-massage discussion, minus 1min patient changing clothes (either side of treatment), minus 3min if there is no receptionist (rebooking and taking payment), minus 2min writing brief notes, equals ~18min of massage. Furthermore, if they want multiple body parts massaged then there's even less time available for a treatment dose.
"Oh I have had a sore shoulder for the past three months, but I thought it would go away by itself" or "Oh the pain through my neck is normal - I've had it for many years now, I've learned to live with it" or "I've had hip pain for a while, but it wasn't more than a dull ache, it's just now I have a sore low back which stops me sitting for too long"
It is a privilege to treat or to touch somebody in a professional manner.
It is a privilege to have a receptionist!
Massage therapists and Masseurs are completely different: Massage therapists aim to treat signs and symptoms to achieve therapeutic benefits, mainly for musculoskeletal or psychosocial conditions (n.b massage therapists cannot diagnose conditions, and should always refer to a health professional that is qualified to do so i.e. a physio, chiro, or osteo). Massage Therapists are answerable to the health and disability commission whereas the nature of work carried out by masseurs would be seen as professional misconduct in the eyes of the health and disability commission i.e. that of sexual nature.
Oil will ruin your shirts. Generally massage therapists use their thumb, fingers, knuckles, palm, forearm and elbow to achieve different outcomes (e.g. applying wide spread pressure they will use their forearms). Sometimes after using our forearms, we may relax our arms against our torso leaving oil on our nice clean shirts. Our shirts need a good scrubbing with dishwash liquid before being washed in the machine to remove any oil stains.
Hairly, disfigured, moley, crusty, smelly, pimply, dirty bodies are my least favourite bodies to massage - fortunately they don't always present all at once.
People will not come prepared for a massage session e.g. not bringing shorts or a water bottle. Thankfully, we can drape effectively and can offer a glass of water.
Remembering previous sessions with a patient: thankfully the most common position for treatment is in a prone lying position - which allows us to read their patient notes off the computer as we work (should we forget anything - we don't document their holidays though).
The clinical software we write our notes on, book clients in & add payments etc is most likely to be internet based and therefore will be forever changing... a button or tab e.g. to save a payment will be shifted or renamed.
The best part of my job is talking to clients about their lives - this is on par with having a satisfied customer at the end of a treatment (ideally, at the beginning of a follow up appointment too).

At this point, I thought it would be good to list some soft tissue techniques & types of massage you would expect from a massage therapist. You can seek more info on these yourself - some are more beneficial than others. I would advise caution regarding any health claims made by practitioners who practice belief-based therapeutic touch.

Soft tissue work - Effleurage & Petrissage.
Specific Soft Tissue Massage (SSTM).
Myofascial Release (MFR).
Lymphatic Drainage.
Trigger Point Therapy (TrPT).
Active Release Technique (ART).
Positional Release Technique (PRT).
Stretching (static, PNF).
Acupressure.

Common types of massage:

Relaxation (Swedish, aromatherapy, hot stone massage, Indian head massage)
Sports ('rub downs')
Remedial/orthopaedic/clinical
Deep Tissue
Thai Massage
Shiatsu / Qi Gong.

Alternative / non-scientific / belief / spiritual healing / shamanism.

Reflexology
Reiki
Bowen Therapy
Psychic Surgery

How I think physiotherapy could be improved in New Zealand.

The majority of people see physiotherapists when something goes wrong, and if something does go wrong, usually that client will have treatment based on how many ACC compensated sessions they have. It would be good for physiotherapists to encourage long term regular check ups with the patient as a means to prevent disease, promote good health or performance. For example, once every 6 to 12 months. This would be similar to other healthcare services like seeing your general practitioner, chiropractor or dentist.
Strengthen their reputation for services other than musculoskeletal. Although physiotherapists are widely known to treat musculoskeletal ailments in private practice, they are also trained to provide physical activity advice, headache relieve, cardiorespiratory and metabolic health support/training, and can coach clients to improve their wellbeing.
Within allied health, adopt the role of 'clinical exercise physiologist' & 'ESSA accreditation' (Exercise & Sport Science Australia) e.g. conduct exercise stress tests for cardiac and respiratory patients.
Have drug prescribing rights similar to physios in the UK and AUS.

Physio 100 years: for those interested in the history of physiotherapy in NZ:
http://www.100yearsofphysio.co.nz/

http://www.otago.ac.nz/physio/about/history/

It's been quite a few weeks since our last exam. Here are a few snippets of my 2014-'15 summer holiday!

Looking across to Mt Cook, New Zealand's highest peak!

I went hiking up to Mueller Hut, Mt Cook National Park for the day.

Here is why every tramping party should have a physio:

Massage sore feet.
First aid skills. Should you need a sling or walking stick, the physio will be able to improvise!
Physio's are more than likely to have strapping tape. Blister protection, locking joints, fixing that tear in your tramping pack or tent. Strapping tape is the new no. 8 Wire!
Always great communicators! Good chat & regardless if there's a wind blowing across your ears, they'll make sure you can hear them.
They'll help you with injury prevention and improving your fitness for those long ascents up to the mountain peaks through exercise prescription.

Camping with friends - @ Lake Taylor, North Canterbury.

Taking my body out of retirement for a few run, jump & throws! This was a part of the South Canterbury Decathlon in Timaru. I came second in the open men category. Sitting at the desk in the shot put photo is Ian Baird, coach of NZ shotput Commonwealth medialist Tom Walsh.

In other track and field events, Dunedin hosted the 2015 Colgate games. This is an event for the young athletes which promotes fun and personal bests rather than placings. I was working in a massage therapy capacity to help the stiff bodies out there (spectators included) - $10 for 10min, all proceeds donated back to the games! I brought along my sport medic skills to for those that needed a bit of strapping. We were positioned next to the medical tent - which allowed them to attend to injuries a lot faster. Having a V.I.P pass allowed free entry & lunch with the officials.

I was privileged to be on the medical team at the Canterbury vs Highlanders pre-season game. I worked alongside the team doctors and even featured on the national tv news!