the journal of the association of massage therapists ltd september 2008
President’s Report
By Alan Ford
Association of By the time you read this report, the And yet, the vast ranks of the unnamed Massage Therapists Ltd Beijing Olympic Games have been run play as much a part in the success of the Olympics as the ‘stars’ of the event. Office hours: and won. But as I write, 08/08/08 is just a Monday-Friday 10.00am - 4.00pm few days away ... Like the Olympics, any well run Level 1 Suite B, With the assistance of some friends and organisation needs the full support of 304 King Street sports administrators, the founder of the its administrators, staff, volunteers and Newtown NSW 2042 modern Olympics, Baron De Coubertin, members to function at the highest level. refashioned the traditional Olympic Leadership is given by the Executive Postal address: Games to what we know today. For Board - the Directors lay out the current PO Box 792, Newtown NSW 2042 an event of that scale to work, certain and future direction of the organisation T: 02 9517 9925 groups of people are needed to give to best position it in the marketplace. F: 02 9517 9952 their time, expertise and dedication. Staff is employed to implement this [email protected] Without sheer hard work, it would vision at an operational level. Sub- www.amt-ltd.org.au be impossible to stage the Olympics committees are formed to tackle particular areas of policy within the Workshops advertised in this Journal are not every 4 years. Without direction, necessarily endorsed by the AMT. The views, the venues would not be built to scope of the organisation. In the case of ideas, products or services in this Journal are not AMT, we have sub-committees in the key necessarily endorsed by the AMT. host the events. Without rules and regulations, the sporting events would areas of Education & Research, Discipline, not be considered fair and would be Finance, Ethics, Strategic Planning & unmanageable. Without referees and Marketing, and IT. umpires, the contests would not be able Members of the Board have taken on the to be managed. And, of course, without responsibility of developing ‘Terms of the athletes themselves, there simply Reference’ for each subcommittee. These would not be an event in the first place. specific terms of reference outline how the committees operate (how they are Since the beginning of the Modern constituted, what they do and how often Olympics the focus has almost always they meet etc). These will be available on been on the athletes. Names like Jessie the AMT website soon. Owens, Mark Spitz, Daley Thompson, Dawn Fraser, Flo Jo, Nadia Comaneci and Just like the Olympics, these Ian Thorpe are but a few of the legends subcommittees require people power in the annals of Olympic history. to make them effective. If you feel you have expertise in a particular area and, However, if you ask me to rattle off the like those fantastic volunteers at the names of administrators, referees, judges Games, would like to get involved please and volunteers, I can only manage a few: let us know. You can do this by making John Coates (of Sydney Olympics fame), contact with Head Office or our ever- Juan Antonio - the winner is Sydenee efficient company secretary. - Samaranch and Mr Julius Patching, ABN 32 001 859 285 a former Navy PTI who held several I look forward to catching up with you at administration positions with Australian the AMT Conference in Melbourne. Olympic teams for more than 50 years. amt association of massage therapists ltd
Secretary’s Report
By Rebecca Barnett
Two significant pieces of legislation “the health care provider providing The good news for AMT members is that – one already in force and one due to be the treatment must be a member of a your Association meets the specified enacted on July 1 next year – will have a professional organisation which covers criteria and is well-placed to continue significant influence on the way Massage health care providers who provide that promoting the membership to the private Therapy is being practised in Australia. type of treatment (the profession) and health insurance industry. You will no Members of AMT should benefit from a which: doubt have noted the requirement for shift in thinking at a government level, (a) is a national entity which has professional associations to administer which effectively acknowledges Massage membership requirements for the a continuing professional development Therapists as healthcare professionals profession; and scheme - something that AMT has been and recognises the need to set minimum (b) provides assessment of the health doing for 14 years now. We were well standards of education and professional care provider in terms of the ahead of the pack in this regard. conduct. The effect of this shift in thinking appropriate level of training and The Private Health Insurance Accreditation and legislative change will be a tightening education required to practise in that rules for Massage Therapists are due to of the net around poorly-qualified profession; and come into effect on July 1,2 009. The practitioners who are working “outside the (c) administers a continuing professional DHA have been generous in allowing system”. development scheme in which the professional Associations plenty of time Let’s look at the two relevant pieces of health care provider is required, as a to fall into line with the requirements, legislation, starting with the one with a condition of membership, to although several health funds have already national focus. participate; and made contact with AMT seeking definitive (d) maintains a code of conduct which confirmation of whether we meet the Private Health Insurance the health care provider must uphold criteria. (Accreditation) Rules 2008 in order to continue to be a member; What does this legislation These rules have been drafted under and mean to me? the Private Health Insurance Act 2007 (e) maintains a formal disciplinary In essence, these rules should have a and are part of a broader quality procedure, which includes a process positive impact on legitimate service assurance initiative being pursued by to suspend or expel members, and providers. As a private health fund the Department of Health and Aging an appropriate complaints resolution provider, the primary onus on you is to (DHA). The rules set eligibility criteria procedure.” maintain your Association membership. for practitioners who wish to offer In other words - and this is a bit AMT will continue to monitor your CEU private health insurance rebates for their surprising - practitioners who do not and insurance currency, our disciplinary treatments. Before I go into more detail, hold membership to such a professional policy and review or update our admission let me assure you that AMT members body will not be eligible as health fund criteria as required to reflect national who continue to hold current insurance providers. This is an unusual thing for the training standards. and maintain their CEU status will meet government to codify in legislation since the criteria and do not need to take any However, as a professional community, we there does appear to be Trade Practices specific action (other than maintain their should focus fresh energy and attention issues with setting such a requirement association membership!). to establishing a national standard of which effectively freezes out individuals professional conduct and practice that is The rules are interesting in that they who choose not to take out professional specific to our discipline. specify that therapists must hold association membership. I can’t help but The establishment of the Australian membership to a professional Association wonder whether this will be challenged Commission on Quality and Safety to be eligible as a provider of rebatable at some point due to the apparent anti- in Health Care in 2006 should send a services. The onus is then on their competitive ramifications of the Rule. Association to monitor and fulfil specific clear signal to our industry. The current criteria. Rule 10, which applies directly to government mantra is accreditation and our industry, states that: we can anticipate further quality assurance initiatives as part of the Commission’s program of work.
september 2008 journal association of massage therapists ltd
Already, the registered professions (such The emphasis in this code is on the kinds as GPs, nurses, physiotherapists and of professional conduct that AMT has optometrists) have been rolled into a actively promoted since inception – for Attention all National Accreditation scheme. example, ongoing education, insurance, Engagement in these issues has never appropriate referral and integrity in AMT members been more crucial to our community. promotion of the service being provided. I encourage all AMT members to What does this legislation Professional Indemnity involve themselves in the task of policy mean to me? development so that we set the standards Obviously, this Code only applies to Insurance that are adopted by government rather AMT members working in NSW. It does HAVE YOU RENEWED YOUR than relying on bureaucrats to do this on have several important ramifications for PROFESSIONAL INDEMNITY our behalf, with little or no understanding NSW practitioners though. Firstly, if you INSURANCE? of our education standard or the realities allow your insurance to expire, you are in HAVE YOU POSTED OR FAXED of professional clinical practice. breach of the code. This applies equally A COPY OF YOUR CURRENT If you haven’t been to the AMT wiki to to all practitioners, whether you are full CERTIFICATE OF CURRENCY check out our own program of work in this or part time, working in a commercial TO AMT HEAD OFFICE? area, do it now! clinic or from a home clinic, only doing Please forward a copy to us now relaxation treatments or specific remedial so that your name remains current www.amt-ltd.org.au/wiki work. Good record-keeping is also on the Health Funds lists. I’ll be talking more about these issues at crucial as a reference to maintaining the AMT conference in October but would contemporaneous records is included in Senior First Aid happily discuss them individually with the code. AMT members who are keen to become Certificate All NSW members should be familiar with an active part of the solution rather than the contents of this Code of Conduct and, passively reacting to the problem. Have you sent obviously, you must display it with a copy a copy of your current You can email me at secretary@amt-ltd. of the HCCC notice as instructed. If you Senior First Aid certificate org.au if you are interested in finding require any assistance with this or have to AMT Head Office? out how you can contribute. And if you any questions about compliance, please All health funds now require whinge to me after the fact in the face contact Head Office on2 0 9517 9925. current Senior First Aid certification of legislation that is a poor fit for our A note to our chiro and osteo members as part of their provider professional community, I promise to - even Registered Practitioners need to recognition criteria. come around to your house and rip your display the code as it relates to any work Please post or fax or copy of your bloody arms off. you do outside the remit of your scope of First Aid Certificate to Head Office so your name remains current on NSW Code of Conduct registration. the Health Funds lists. for Unregistered Health Insurance Renewal Time Professionals It seems topical to include a reminder NSW members will already be aware of here to send a copy of your insurance this piece of legislation, which came into Advertisement Certificate of Currency to Head Office as effect on August 1. It was made as an soon as you have received it. The vast bulk amendment to the NSW Public Health of AMT members are due to renew their Act 1991 and requires all practitioners to Position Vacant insurance this month and we certainly display the code, along with information don’t want you dropping off the health about how clients can make a complaint Journal Editor fund lists because the information on our to the Health Care Complaints database is out of date. We can accept a Commission (HCCC) in the event of a In Good Hands copy by post, by fax or a scanned copy via grievance relating to lack of compliance Essential: email to [email protected]. with the code. Must have exceptional As such, it is at least partially aimed at Conference 08 written communication skills The Conference Earlybird rate closes on making clients and healthcare consumers Highly Desirable: more aware of formal avenues for Friday 12 September. Don’t forget to complaint. However, the primary aim is register before the cut-off. Are you sure Professional editing experience. to give the HCCC the ability to prosecute you can afford to miss out on the sight Please call Rebecca Barnett practitioners who breach the terms of of me frothing at the mouth during my on 0414 732 873 the code and, importantly, prevent them keynote address? Look forward to seeing for more information. from returning to practice after the breach. you there. We hope that it will help to decrease any amt rogue element in NSW. september 2008 journal association of massage therapists ltd
News from the regions
Sydney South ACT by Michelle McKerron by Robert Brown Sydney South members have been Mackay meeting every second month for around We had a great turnout for our June by Annie Caruana-Kirchner 18 months now. We are enjoying the meeting with 20 people in attendance. opportunity to network and have reached Our newly formed regional executive Our May meeting was extremely well the stage where we are comfortable consists of the following people: attended with 17 local members present, enough to listen and learn from each Chairperson: Robert Brown including 2 new members. We welcome other’s experiences. Secretary: Maxine O’Callaghan Kelly Howland and Dommie Frederickson Treasurer: Husam Sahib to AMT. We have approximately 10-15 members attending each meeting. If you haven’t We are looking forward to a great year in Alice Barron, a Physiotherapist, presented come along yet, we would love to meet massage, with a new energy in the region. an interesting session on pelvic floor you. A good referral base is an essential Last month I attended a careers market at stability. Using Ultrasound Imaging for component of treating your clientele! the AIS in Canberra where 3500 year 10 a visual demonstration, we were able to & 12 students from over 30 schools came observe the patterns of muscle activation Our next meeting will be held on October 1, where we will be hearing from local to obtain information on their future on the monitor. Alice explained many career prospects. I talked to around of the conditions that arise from pelvic Chiropractor Keiran Shanahan on how to deal with chiropractors. He will dispel 300 students with an interest in becoming floor weakness and outlined the correct a Massage Therapist! I was also invited exercises for pelvic stability. some urban myths about chiropractic treatment and provide us with insights to several schools to talk on a career in Sunday 3rd August was the first of four into how chiropractic can complement Massage Therapy. Harmony Sundays held every six weeks Massage Therapy. On the workshop front, Alan Ford ran at the North Mackay Bowls Club. Anyone a course on Chronic Pain & Structural interested in an opportunity to exhibit Our AGM is set for the first Wednesday in December. We will discuss the option of Alignment in June. Ron Alexander ran a your profession and network with a Functional Fascial Taping course in July range of other therapists can contact holding a Saturday workshop early next year for those of us who find it hard to get under the auspices of AAMT. I have invited Donna Beckett on 07 4942 8636 or him back to conduct several more for AMT 0438 281 160. out of work on a Wednesday night. If you have any thoughts or comments, email or members. call Head Office. We welcome your input Advanced notice of the dates and times to the running of the group! for ACT branch meetings is given in the AMT Calendar of Events. We look forward to seeing lots of new faces at upcoming local events.
september 2008 journal AMT Preferred Business Directory
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News from the regions (cont...)
The highlight of the evening was a draw for a massage table kindly donated by Firm N Fold. Esther Vass from Shellharbor was the lucky winner. Thanks to AMT for providing the bags which housed the Mid North Coast samples! Northern Rivers by Jan Crombie by Keryn Rose Guest speaker at our February meeting Firstly, a big thankyou to local members was Nick Sandman-Allen. Nick’s talk Michelle Graham and Kathy Deprez for focused on aged care issues including: volunteering their hands at this year’s • Mobility and aged care products and Kokoda Challenge on the Gold Coast. exercise equipment Kathy and Michelle reported that they • ‘Active and Old’ newsletter put out had a great day - they hope to see you all by Area Health queuing up to help out next year! • A fall prevention program run at the Recent events in the region include a Port Macquarie Base Hospital meet and greet at the Tweed Heads and • A Gofer (scooter) training course that is Coolangatta Surf Club held on Tuesday commencing in Laurieton. 2nd September. We hope to establish April saw the region coordinating another Esther Vass - winner of a a distinct regional group in South East huge effort at the Australian Ironman. Firm N Fold massage table Queensland to assist in overcoming the At our April Meeting AMT member immense distances that members in the Ianthe Paterson gave an informative region travel for local meetings. Also in presentation on Steve Lockhart the planning stages is a Self Care event Myotherapy (SLM). SLM is best defined at Clunes, including a Yoga session and as manipulation of the body’s soft group sharing on how to make your tissues using a unique combination of hands last the test of time. Keep an eye acupuncture and massage techniques out for more details soon. that put length and function back into muscles and balance the body, allowing it Volunteer therapists to function normally. Need CEUs? at the Australian Ironman At our June Meeting: we viewed a DVD We had 120 volunteer therapists from presentation on Orthobionomy from our the following TAFEs: Port Macquarie, branch library. Journal question - Randwick, Kingscliff, Loftus and September edition Shellharbor. The students were ably assisted by our dedicated group of local Is Hautant’s test therapists. The Ironman involves 4 days of Deadline performed seated, pre-race massage then, on race day, some 800 massages were completed including Deadline for the standing or supine? post-event treatments. Massage was December 2008 issue of Please write your answer also carried out in the medical tent and corporate areas. In Good Hands is: in the space provided on your For this year’s Ironman, we also held a BBQ 1st NOVEMBER, 2008 CEU record sheet and retain it until you submit the form for volunteer MTs on the Saturday night Please email before the race began. Event sponsors with your annual renewal. kindly donated product samples for this contributions to: Blank CEU forms can be function. A very big thanks to Melrose Rebecca Barnett downloaded from: Oil, Tiger Balm, AOK Health, Jeff Murray [email protected] http://www.amt-ltd.org.au/ and Rowo Herbal Sports Gel for their or phone: 02 9517 9925 involvement. index.php?Page=Members_ CEUs_1.php september 2008 journal association of massage therapists ltd
Ron Alexander’s FUNCTIONAL FASCIAL TAPING® LEVEL 1, WORKSHOP FAST, DRUG-FREE PAIN MANAGEMENT - Friday 7th & Saturday 8th November 2008
FFT® is a unique way to apply tape for musculoskeletal pathologies creating an immediate analgesic effect and increase in range of motion. FFT proprioceptively encourages muscle firing and normal movement patterns allowing therapists to instantly control their client’s pain to facilitate rehabilitation. • Recent research into FFT for Low Back Pain. • Real Time Ultrasound Investigation the effects of FFT. • CT/Neuro Taping: Global Trunk Flexion / Specific Median Nerve. • Predetermined Load Taping: Cervical / Plantar Fascia / I.T.B. • ain Management: Low Back / Knee. Tip for Tennis Elbow and Shoulder. • Enhance hand on treatments: Global and Specific MFR / TrP’s treatment. Founder/Presenter: Ron Alexander [RMT / FFT]. Ron travels Australia and the world presenting FFT to Healthcare Professionals who’s treatment focus is Musculoskeletal Conditions. He has recently completed as co-investigator a randomised double blind clinical trial of FFT for low back pain. PhD study cand Shu-Mei Chen Deakin University. FFT is used in Finland, Israel, Gernsey, Germany, USA, Hong Kong, Singapore, England, New Zealand and Australia.
Venue: The Centre, 14 Frances St, Randwick Early Bird: $435: By Friday 24th October Date/Time: Friday 7th November (5.45pm to 9pm) Places are limited, best to book early. Saturday 8th November (9am to 4.30pm) Contact: Karen Robinson Cost: Level 1 - $465 inc GST, pre-reading, DVD, Phone: 03 9376 3652 notes, products, case study proformas, Email: [email protected] statement of attendance and light meals.
Ron Alexander’s FUNCTIONAL FASCIAL TAPING® LEVEL 2, WORKSHOP FAST, DRUG-FREE PAIN MANAGEMENT - Sunday 9th November 2008
This workshop broadens the range of pathologies that you will be able to treat using FFT. • Refining of your technique. • Advanced assessment and tape applications. • FFT when pain can not be reproduced. • Pain reproduced on dynamic movements. • Inhibitory Taping: Global and specific uses. • Impingement syndromes, Shoulder, hip and ankle. • POST OP. Neuroma’s. Muscle tears (acute/repair phases). • Functional Restrictive Taping. Used for acute or sub-acute injuries. (limits harmful range, while allowing full ROM to undamaged ranges)
Venue: The Centre, 14 Frances St, Randwick Early Bird: $220: By Friday 24th October. Date/Time: Sunday 9th November (9am to 5pm) Places are restricted. Cost: Level 2 - $250 inc GST, pre-reading, notes, Contact: Karen Robinson products, case study proformas, statement Phone: 03 9376 3652 of attendance and light meals. Email: [email protected]
For further information about FFT check out www.fft.net.au
september 2008 journal association of massage therapists ltd
A Clinician’s Perspective on Vertebral Artery Testing
By Colin Rossie
Over the years I have heard many I think perhaps the biggest problem with Rather than dismiss me out of hand, they perspectives on the efficacy and safety of the supine VAT is the over-enthusiasm of now consider my concerns and either performing a Vertebral Artery Test (VAT) the clinician in applying, however slight, respond to my letters or talk to me over before commencing work on the cervical an over-pressure in the extension, lateral the phone. spine. Some research appears to indicate flexion or rotation component of the And now, to finish with a not so happy that it is completely useless in detecting testing. I’ve always performed these tests story... potential vertebral artery insufficiency or gently and never had a problem with the One of my regular clients sent her PA to compromise. Nonetheless, I continue to client (other than the occasional positive). see me. The PA was in her late 20s and a perform the test before I commence any In my clinical experience, there will be a classic A-type personality: well-organised, work on the neck. I believe it is better to significant incidence of clients recording fit, gym junkie, very bright. Her major be safe than sorry. a positive response to these tests without complaint was “sore neck & shoulders”. I know at least two versions of the VAT. actually having vascular compromise. In The very first thing I did in her session was Version 1: any one year, I’ll have at least ten clients the VAT. She came up positive so I calmly The Cervical Quadrant Test test positive to the VAT. I always advise explained what this could possibly mean Client is supine. The head and neck are these clients to see their doctor for further and advised her to visit the doctor before very gently taken into passive extension testing. Half do, half don’t. I proceeded with any work. She didn’t and side-flexion, and held for3 0 seconds, In most cases it turns out that I am just return and answered my subsequent Version 2: being overly cautious: in the last ten phone queries with “I’ll get around to it deKleyn Nieuwenhuyse Test years, most of those who have seen their one day”. Eight months later she died of a Client is supine. The head and neck are doctors have had absolutely nothing cerebral stroke on her regular 6a.m. run. taken into passive extension and rotation wrong with them. A few have recorded 1. Magee, D. J. “Orthopedic Physical Assessment” (rather than side flexion) and held for high cholesterol levels; some have had Saunders 30 seconds. vestibular compromise; one (a seemingly 2. Petty N.J. & Moore A.P. “Neuromusculoskeletal healthy, fit32 year old male) had a cerebral Examination & Assessment” Churchill Livingstone In addition to these two supine versions, aneurysm; another (a yoga-practising there is also the Hautant’s Test (performed vegetarian in her late 40s), had an amt in the seated position) and Barre’s Test, atheroma in her left carotid artery; and yet which is done in the standing position. another had over-the-top hypertension. If dizziness, nausea, dipoplia (or other Last year, one of my clients who recorded Policy vision disturbance), disorientation, ataxia, a positive VAT was diagnosed with a impairment of trigeminal sensation or condition known as Cerebral Arterio development nystagmus are provoked by the test, Venous Malformation. None of these Wiki launched! then your client is recording positive and people would be walking on the planet testing should cease immediately. I always today had they not been made aware of a refer clients to their doctor under these possible problem via the test. • Be a part of the future circumstances. All those clients were thankful that the test of your industry I would recommend familiarising yourself was performed. Several local doctors, who • Contribute to your national with all of the above tests. They can be initially found it amusing that a Massage Code of Conduct found in a suitable examination and Therapist would write them a letter • Engage with policy assessment text. (1,2) explaining their observations, now have as it develops Since a client sustained an injury in a a different attitude to Massage Therapy. • Shape our 20/10 vision for the student clinic due to a VAT, it is no longer Even though I tend to err excessively on Massage Therapy profession taught at some massage training colleges. the side of caution, these doctors are no longer surprised by my referrals. To interact with AMT’s Wiki, please go to www.amt-ltd.org.au/wiki/ september 2008 journal association of massage therapists ltd
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SITCM Delivering practical courses: • Advanced Diploma of Traditional Chinese Medicine – 91133NSW (double modalities of acupuncture and Chinese herbal medicine) Accredited by VETAB. Approved by AUSTUDY, Recognised by major Health Funds and TCM professional associations.
• SITCM – 22 years establishment • Providing a 4 year course in Advanced Diploma with flexibility in time and classes • Exemptions applicable according to previous qualifications and experience download an order form Affiliated clinic consultation with TCM experts • Short courses for interest, such as TCM cosmetics, Taichi, TCM dietary, from the merchandise section TCM gynecology, health maintenance, acupuncture, etc of the AMT website Tel: (02) 9281 1173 Email:[email protected] Web: www.sitcm.edu.au www.amt-ltd.org.au
september 2008 journal association of massage therapists ltd
10 june 2008 journal association of massage therapists ltd
june 2008 journal 11 association of massage therapists ltd
Ethics and Risk-Management for the Massage Therapist
by Natalie Millan
Natalie Millan is a Massage Therapist, Okay, so we know that ethics is For example, if you experience repeatedly Social Science researcher, Communications complicated. This is because the situations late clients - have you self-appraised Trainer and author of the book ‘Professional that involve ethics are often intangible. For what your contribution to the concern Esteem - a practical guide to ethics and risk- example if I were to ask you what car you could be? What could you do differently management for the busy therapist’. drive, your answer is based on facts. You to improve the situation? How specific Natalie has 20 years experience as a therapist would possibly describe the model, make, are you when discussing what your and is an advocate of healthy esteem. If you colour and what logical reasons helped professional boundaries and policies would like to learn more please visit you decide on the purchase. You can safely are? The hours you operate and how www.healthyesteem.com.au answer the question without involving you choose to conduct business will This article aims to introduce ethics any personal reasons. You may choose to transfer over to how your clients abide as a skill set and explain how learning tell me the niceties of the car - the little by your boundaries. The level of integral ethics gives the therapist a professional touches that particularly appealed to and professional conduct will define the edge in terms of risk-management. In you and helped you make your decision. level of an ethical framework a therapist today’s complex, multicultural society it is However, these little touches can still be operates within. Even when outside our essential for Massage Therapists to hold facts about the car. clinic, our objectives and preferences strong skills that address the intangible If I were to ask you what ethical principles when networking with colleagues will be issues that daily confront a therapist in you mainly rely on when working as a an extension of our ethical framework and clinical practice. therapist, your answers suddenly become have an impact on our reputation. What have you done today that makes loaded. This is because they are going to But how easily can you articulate all these you feel good about the work you do be based on context and values. Such a principles as a busy, working therapist? with others? question causes you to reflect on your The key point that develops professional Today’s Massage Therapist has a rich personal values first and then give reasons integrity is the ability to explain and technical skill-set that makes their work for your choice of principle. Justification justify the combination of our hand skills, unique, cultural and valuable. As part of a requires an existing knowledge of the marketing style, business acumen and burgeoning wellbeing industry, Massage topic and confidence in your personal ethics. This, in turn, will send the reassuring Therapy continues to exhibit a strong experiences. To answer this question and powerful message of trust, safety growth rate. Many therapists have become requires an ability to articulate the and competence to our existing and ‘the busy practitioner’. complexity of the topic. established client base. Importantly ethical conduct will also determine the life span The question above asks you - as a To be asked about our position regarding of a therapist’s career. therapist - to reflect on your daily ethics helps us to acknowledge how achievements. It is an ethical technique ethics is a skill to be learnt, refined How to interpret ethics in the client/ to help you rest at the end of the day by and practised, just like our soft tissue therapist relationship remembering the positives and purpose techniques. The modern Massage Overall, the term ethics seems simple of your work. Therapist will recognise the need for enough when managing a business such skills as we intimately work within - it is explained as doing what is right. Ethics is a difficult and vast subject that a multicultural society. The difference The therapist only has to review their is often misrepresented as dry, boring, between the skill sets is that soft tissue association’s Code of Ethics to refresh the didactic and, worse, irrelevant. For this techniques generally produce a tangible principles and guidelines. Simple ethics reason, the complexities of the topic are result (for example, increased range of can be seen in our draping standards, often left unanswered and confusion sets movement) whereas ethical techniques infection control and safety policies. in when ethical dilemmas occur. produce an intangible result (for example, However, there are still many problems to My aim in this brief article is to address professional reputation). be ironed out for any professional working what style of ethics can really help the 1,2 Applied practical ethics can help us gain in a client/therapist paradigm. Massage Therapist in the context of clarity and focus around issues in our clinic It is a special person who chooses to work sustainable and successful clinical practice. that we often mistakenly bracket off as intimately with clients. Many people are strictly business related. familiar with the principle that, when we enjoy the work we do, the clients will 12 september 2008 journal follow and our business will grow. association of massage therapists ltd
As we become busy practitioners we start In this context, it could be argued that to see the importance of knowing how to safety is the key motivation for Massage effectively manage our time. Professional Therapists to learn ethics as a skill. development programs must be relevant The established therapist will often in their focus to be of value to our day. recognise how to reduce risks due to Workshops in ethical theory and principle their knowledge and experience - what are not going to help the busy therapist. worked before will probably work again. However, education in ethical skills that However, many new therapists are includes strategies for risk-management entering the massage industry directly becomes more immediately applicable. from tertiary education and do not have This is particularly evident given that this advantage. Therapists working from research states how many therapists do home clinics are particularly vulnerable. not know how to address at-risk situations Research demonstrates that most within the client / therapist relationship, therapists in private practice are on their professional awareness notwithstanding.3 own with their risks. This is because AMT on Ideally ethics is designed so you can there is not a lot of scope to share risks 4 manage your professional life. Yet the with other practitioners. In this light, Facebook. difficulty seems to lie in the application professional networking takes on an and integration of ethics into everyday added importance. www.facebook.com practice. The clinic is a place where a Conclusion therapist would like to establish a strong The days where ethics relied upon the Log on reputation and rapport whilst at the same therapist’s existing values are no longer Sign up time reduce the risk of awkward situations, with us. The modern day Massage ethical dilemmas, unwanted feelings, Therapist will view ethics as an educated Search for AMT late clients, no-shows, pay discrepancies, skill, as massage moves within a fast- Network with burnout and even knowing you are not growing wellness industry. Working isolated in your work. and living within a multicultural society colleagues So, to improve our understanding on requires the professional to work View photos of our how to better address client / therapist confidently from an ethically sound frame 2008 AGM relationships, we need to take a of reference. The ability to assess and different view: to learn practical ethics maintain strategies in risk-management as a framework for decision-making and will allow Massage Therapists to build knowledge in risk-assessment. Ethics in safety, rapport and an ethical reputation the form of addressing risks is a skill that for themselves and their industry. helps to maintain a solid professional Applied practically, it will also assist the frame of reference to work from regardless Massage Therapist to build a sustainable, of the type of client(s) we may encounter. flourishing business. Ethics as risk-management References 1. Allhoff, F. and Vaidya, A. 2( 005). Business Ethics. According to research conducted by Volume 3. Professional Ethics. London. Standards Australia, information about Sage Publications Ltd. risks in business, professional practice, 2. Australian and New Zealand Risk-management public expectation and personal safety Key Steps. http://www.riskmanagement.com.au sighted 07/07/2008. needs to be continually updated. All 3. Egan, G. (2002).The Skilled Helper. A problem industries require risk-management management and opportunity- development strategies including the massage industry. approach to helping. Ch.15. p261. The The key to managing risks can be in the psychology of hope 7th ed. Brooks/Cole 4. McBride, N and Tunnelcliffe, M. 2( 002). ability to identify what the term ‘at-risk’ Risky Practices. A Counsellor’s guide to risk means, what constitutes a risk and how to management in private practice. Palmyra. W.A. assess risks.2,5 Bayside Books. 5. Millan, N. (2008). Professional Esteem. Australia. We need to make the connection Openbook Howden Design & Print. between risk-management and exploring amt what is ethical behaviour. The term risk essentially means where things can go wrong and what types of hazards compromise public, professional and september 2008 journal 13 personal safety. association of massage therapists ltd
14 september 2008 journal association of massage therapists ltd
Intelligent Hands Sense and Nonsense in Manual Therapy Presented by Philip Latey, Osteopath Discussion, demonstations, supervised practice and training in sidelying techniques Commences: Friday 24th October 2008 from 3pm - 6pm and every Friday thereafter for 4 weeks
Cost: $45.00 per 3hr session Venue: 21 Chandos Street, St Leonards, Sydney 15 CEU Bookings: Please phone (02) 9437 3900 per sessions
Website: www.philiplatey.com.au AMT accredited
september 2008 journal 15 association of massage therapists ltd
The DVD reviews the current research and In fact at times it may look like he is doing DVD Reviews gives references to the leading clinicians little at all! He invites the skeptics to look and researchers in the field. An outline of beyond what is done in their own practice By Tyraus Farrelly the current assessment and treatment and play with what he is showing them. protocols, (emphasising the importance of For those of you who firmly (no pun Assessment and a multidisciplinary approach) and the intended), believe in the more mechanical, Treatment of current medical definition of fibromyalgia direct approaches to soft tissue release, Fibromyalgia are discussed. this DVD won’t be for you. However, if you All known triggers and associated are not familiar with indirect therapies as a conditions, and the neuro-chemical and treatment paradigm then it provides psychosomatic links to fibromyalgia are helpful roadmarkers into various indirect also presented. therapies that are worth exploring. The lecture then moves on to various That said, does the presentation contain all clinical approaches for the manual you need to know about Fibromyalgia and therapist and what Mr Goldstein considers how to treat this perplexing condition? the two primary divisions or categories of Certainly not! However, it does give you a manual treatment - direct and indirect. starting point with valuable resource links He defines both categories and gives and an insight into the various treatment examples of which modalities fit into each methodologies for this condition. category and why. He then provides an It may also open up a whole new world of Supplier: Complementary Health insight into his own specialised approach study and research into the more indirect Seminars to fibromyalgia treatment, which centres methods of manual therapy for those who Presenter: Steven Goldstein around an indirect approach. have not been exposed to these before Format: DVD - All regions, PAL In the practical component, Mr Goldstein and are open to looking beyond their Duration: 2 Hours demonstrates his treatment protocol on current approach. Price: $59.00 (Discounts apply to AMT Members) two volunteers. Though he explains the At a glance: Contact: 03 9481 6724 basis and purpose of each technique, one Excellent quality Producer: Glow Worm problem I had with the presentation was Good value for money Website: www.comphs.com.au that the actual application of certain Notes & resources available on web techniques was often obscured by the Complementary Health Seminars, one of Valuable training aid for any level volunteer’s body or the camera angle AMT s preferred business partners, AMT member used. In my opinion, a better approach supplied a copy of Assessment and Technique application could be would have been a close-up view and Treatment of Fibromyalgia for review. explained better explanation of how to apply each Overall, this is a professionally produced Multiple camera angles would have technique prior to demonstrating the DVD with very good audio and video been useful quality. technique within the sequence protocol. Multiple camera angles may have also Overall Rating The presenter, Steven Goldstein, has been been useful! a clinical massage practitioner since 1986 Recommended viewing! and a massage educator since 1992. He As previously stated, Mr Goldstein’s has taught what he calls Integrative Fascial approach primarily relies on indirect Tyraus Farrelly is a senior level 2 AMT member. He completed the TAFE Associate Diploma of Health Release, a unique blend of direct techniques. His rationale for this is that he is more concerned with the big picture, Science in 1995. He was the head Massage Therapist myofascial and indirect osteopathic for the Illawarra Steelers and the techniques, in the United States and looking more at the direction of St George Illawarra Dragons for 4 years and the head consultant Therapist for the Australian National Australia since 1995. restrictions, than restrictions in individual muscles. His techniques are very gentle Martial Arts team for the World Karate The DVD is broken up into a lecture style, Championships. He has conducted post graduate and subtle but he challenges us to look at theoretical component and a practical workshops privately and for the Illawarra Steelers the systemic effects that these subtle and delivered workshops on Massage for Pain Relief demonstration. The lecture notes are techniques have on the nervous system within a pain management course. He has worked available for download at the with many Physiotherapists, Musculoskeletal and our body and mind. Complementary Health Seminars website Specialists, Chiropractors, Exercise Scientists and For many therapists not familiar with the Sports Physicians within a rehabilitation www.comphs.com.au. My advice would environment and within an elite sports environment. be to download and print these notes more subtle techniques of positional He currently runs a full time clinic in Wollongong, prior to watching the DVD, as the slides are release, concepts of bind and ease and with a focus on sports and occupational injuries. sometimes hard to make out on the DVD. first barrier restrictions, Mr Goldstein’s For comments or suggestions please contact Tyraus approach can look less than effective. at [email protected] 16 september 2008 journal association of massage therapists ltd
Orthopedic Massage He goes on to demonstrate assessment The inclusion of common tests for thoracic for Complicated and treatment of these conditions, outlet such as Roos Stress Test, Wright test Cervical Conditions including his own specialised approach for and Costoclavicular Syndrome Test would treating adhesive capsulitis of the hip. have been helpful. Treatment and stretches to other hip This may seem like harsh criticism but with muscles included the QL, Iliopsoas and the bodies such as WorkCover demanding 6 deep hip rotators. evidence-based assessments to verify the Treatment of cervical conditions focused need for treatment, pre and post on the integrated approach of releasing treatment testing would go a long way shortened, contracted muscle groups and towards validating treatment response. strengthening their weak overstretched Perhaps these areas are covered in another antagonist muscles. A common mistake one of the presenter’s titles, ‘Orthopedic he advises us against is simply treating the Massage for Thoracic Outlet and Frozen painful symptomatic area which is often Shoulder’ but I still believe it could have weak, overstretched and ischaemic. been covered even briefly here. Supplier: Terra Rosa Throughout the presentation Mr Waslaski This criticism also applies to whiplash as Presenter: James Waslaski explains other common mistakes this is also mentioned as a condition Format: DVD - All regions, PAL therapists make in their treatment covered within the DVD. So I guess it’s Duration: 1Hour & 10min approx approach, suggesting alternative methods. mostly a question of truth in advertising! He demonstrates how to assess between Price: $85.00 (Discounts apply to AMT Members) My final criticism is that, while there is a muscle, capsular and bone-on-bone Contact: 0402 059 570 disclaimer at the beginning of the DVD, pathologies through joint end feel and Website: www.terrarosa.com.au neurovascular precautions during some of gives us the tools to treat each condition. Terra Rosa is also one of AMT’s preferred the treatment needs to be emphasised. business partners and has supplied the His treatment approach is methodical and The DVD title alone suggested we are Orthopedic Massage for Complicated precise, showing a range of techniques to working with possible joint, bone or Cervical Conditions DVD for review. isolate and treat many of the deep cervical neurovascular involvements so all relevant muscles and anterior chest muscles for This DVD is professionally produced, with precautions should be mentioned. such conditions as whiplash and thoracic great viewing aids such as the picture-in- Having got that off my chest, this is a great outlet syndrome. Mr Waslaski presents the picture cadaver dissections showing DVD that all therapists would benefit from information in a clear and insightful relevant points of anatomy to back up the viewing. It is clear that Mr Waslaski is a manner. His use of anatomy models and treatment techniques being shown. knowledgeable and experienced educator other demonstration tools really helps to and therapist. He presents a treatment The presenter, James Waslaski, has add to the already detailed instruction he method that I think would revolutionise produced 6 DVDs on sports injuries and gives throughout the DVD. complicated orthopedic conditions. He is the way many therapists approach and Now that I’ve blown the presenter’s an international lecturer running seminars treat upper thoracic and cervical trumpet, here’s the down side. There are a each year in the US, Canada, Ireland, conditions. few things that could have been included Scotland, London, Greece, Australia and in the DVD, especially considering it is At a glance: the Caribbean. barely over an hour in length and the Excellent quality The DVD takes us through a 12-step format allows for much more. Great visual learning aids used protocol covering such things as client throughout Firstly, the DVD is called ‘Orthopedic history, range of motion and muscle Fair value for money Massage for Complicated Cervical testing, various treatment methodologies Valuable training aid for any level Conditions’ and the front cover advertises focused on structural integration, AMT member that this includes thoracic outlet review. culminating in a client home care program Only a little over an hour in duration Yes, it includes some great treatment of stretches and strengthening exercises Could of covered some areas in more techniques for thoracic outlet syndrome. to support the structural integration detail What it doesn’t do, however, is adequately treatments shown. explain what thoracic outlet syndrome is Overall Rating Mr Waslaski starts the treatment protocol or the different causes of this syndrome by demonstrating the importance of such as scalenus anterior syndrome, Highly Recommended viewing! pelvic stabilisation and how this can be a costoclavicular space syndrome, amt major factor in common cervical hyperabduction syndrome or cervical rib entrapment neuropathies. syndrome.
september 2008 journal 17 association of massage therapists ltd
Workshop Review: Traditional Cupping and Gua-Sha
By Dave Moore
The workshops reviewed here were presented We then examined approved methods of This hammered home that correct, by Bruce Bentley, one of AMT’s accredited cleaning cups and, most importantly, safe hygienic removal and handling of used presenters. Bruce has an encyclopedic work practices particularly in regard to the cups is really important. knowledge of cupping and related use of the flame to reduce the air pressure In each cupping workshop we then techniques which he has acquired during in the cups. Bruce regularly reinforced the went on to discuss conditions for which 30+ years of study. He also wrote his Masters safety message throughout the workshop. cupping was indicated. In the case of thesis on the subject ‘Cupping as Therapeutic Contraindications were discussed in detail, the Western Cupping workshop, one Technology’. He has continued to study followed by what happens during the participant suffering from a heavy cold cupping around the world, visiting many cupping process and what the client can became an enthusiastic and extremely exotic places in Africa, Asia, Europe and the expect to feel. grateful demonstration model as her Middle East, including historic research for The famous cupping marks – the ones symptoms rapidly disappeared after the the famous Wellcome Institute in London that make you look like you’ve lost a treatment! and for Rome University. He has also worked wrestling contest with an octopus - were The various techniques of cupping were closer to home at the AIS in Canberra. another interesting topic. demonstrated and practised. Stationary The two cupping workshops I attended cupping, flash cupping and glide cupping featured Western and Oriental viewpoints were all introduced along with the in separate weekends. In both cases, various sizes of cup and suggested items we commenced with a discussion of that could be used (Pyrex mixing bowls! the history of cupping, looking at some Vegemite jars!), the number of cups which examples from Cave Art, Africa, Egyptian could be applied in one treatment and tombs, mediaeval wood carvings and how to position them. The important Ancient texts. Bruce showed us some of questions of how strongly to apply the his extensive collection of cups, acquired cups and how long to leave them in place from around the planet. He related were also covered. We practised applying wonderful anecdotes - some quite and using the cups with the flame and horrifying - about his experiences studying I guess the octopus won! vacuum-pump variety. cupping all over the world. We discussed the importance of advising The second day of each course was Cupping was popular in Western medicine a client before commencing cupping that dedicated to demonstrations and right from the time of Hippocrates until these marks may result and that they may practise of the application of cups for quite recently. Bruce cited writings by last for a week or more. Bruce explained specific conditions, again from the several of the founding fathers of modern more about the marks, emphasising the Western viewpoint or the Eastern medicine that support the practice. Eastern perspective that they are not traditional medicine viewpoint. These Members of the workshop contributed bruises but manifestations of the stagnant demonstrations and practice sessions to the lively discussion that ensued and blood and Qi being gathered by the were extremely lively, with Bruce spicing shared their knowledge - the group came cups. According to this perspective, the things up with more anecdotes about his from a diverse ethnic background so many more toxins in the body, the more an area travel and studies. We looked at conditions people had childhood stories of cupping will mark. This is why two adjacent cups such as the common cold, cellulite, sports done by Grandma or the lady up the may produce markedly different results. injuries, joint pain and detoxifying just street. It was fascinating to discover that Bruce went on to explain how to ‘read’ the to name a few. In the Eastern workshop cupping is strongly recommended in the colours of the marks and relate them to we also investigated applying cups to Koran. the client’s condition. We were surprised to acupoints on the meridians described Bruce outlined the underlying learn and later observe for ourselves that in TCM. fundamentals of cupping, including the cups can withdraw cold from the body Bruce provided comprehensive course many different types of cups available and and also draw out a cheese-like substance notes for each workshop which contained how to judge the best quality. from the skin which can coat the inside of lots of additional information and reading. the cup. I was pleased to note that we did not suffer the ‘Death by Powerpoint’ mode of 18 september 2008 journal teaching and course notes. association of massage therapists ltd
The Gua-sha workshop was an addendum We looked at specific conditions and to the Eastern Cupping workshop so that indications such as lower back pain, calf we could examine this treatment using cramp and sprained ankle. And I can knowledge gained in the previous 2 days. assure you that it was effective at relieving Gua-sha is an ancient treatment that a chronic neck condition that I have had IEDS appears to date back to the stone age! In for over 20 years! We also examined CLASSIF simple terms it is the scraping of lightly Gua-sha as a preventive treatment to lubricated skin to raise a reddening of the promote wellbeing. skin with darker dots It can be said to be Again, Bruce peppered the day with “Acupuncture without piercing the skin” as relevant anecdotes including one about it stirs up the Qi within the meridians and a very successful Australian greyhound regulates the whole of the meridian. trainer who Gua-Sha-ed his dogs (which We examined the history of the treatment he claimed produced winners!) and then and went on to discuss client preparation went on to use a rather brutal-looking and the importance of informed consent metal device to treat humans! AMT as the treatment also leaves marks that Comprehensive course notes were can last for several days. The important provided for this workshop too, covering a Classifieds areas of hygiene and contraindications wide range of subjects not included in the were emphasised. workshop to encourage further study. A free service for AMT members We learnt how to position a client and To sum up, I had a great time! Bruce www.amt-ltd.org.au how to actually perform Gua-sha, with Bentley has an absolute passion for his a stress on the importance of keeping subject and enjoys sharing his knowledge the client warm both during and after with others. If you are willing to think the treatment. There is a specific order of outside the square and are looking for a treatment, working down from head to treatment to add to your toolbox, I can toe, with a diversion to the arms after the highly recommend Bruce’s presentations. torso has been completed. amt
september 2008 journal 19 association of massage therapists ltd
Rotator Cuff Tendinitis: Four Clinical Perspectives
In this new column, which we hope will I am particularly looking for elevation With internal rotation I am looking for become a regular feature of In Good Hands, or protraction (winging) of the 70-80 degrees without significant motion we invite therapists to discuss and describe scapular along with painful arc and/or of the scapula. If this motion is restricted their treatment protocols for various inappropriate compensatory movements I palpate for and release trigger points in presenting conditions. In this first outing, of the scapular during ROM. I also look the infraspinatus and teres minor of the Paul Doney, Alan Ford, Colin Rossie and for anteriority of the humeral head in the supine patient. Kerry Hage generously share some clinical glenoid fossa, though I re-check this in the Often, when assessing internal and insights and experiences of treating Rotator supine position. external rotation of the glenohumeral Cuff Tendinitis. I treat most rotator cuff problems in joint, it is apparent that the restriction is If you would like to suggest a condition the supine position although I may do occurring at the elbow joint. This is often to be featured here or perhaps contribute to some preparatory massage +/- spinal (but not always) associated with restricted future columns, please email manipulation in the thoracic region. supination of the forearm due to excessive [email protected] with your If the scapula is elevated I concentrate on tone in the pronator and wrist flexor suggestions. releasing upper trapezius and pectoralis muscles. This is common due to the need to pronate for prolonged (often stressful) The majority of times this condition has minor. If the scapula is protracted I release periods of time with writing/typing/ presented in the clinic, there has been the serratus anterior muscle. mousing. little if any precipitating incident. I generally treat these in the supine It will be necessary to release these I therefore see the tendinitis as secondary position but I occasionally treat the upper muscles (trigger point/cross fibre friction/ to the primary rotator cuff dysfunction trapezius and levator scapulae muscles in Positional Release) and the radiohumeral and expect the tendinitis and any a seated position using Positional Release joint (manipulation or Positional Release/ associated bursitis to resolve if the primary (Counterstrain) or Myofascial unwinding. Myofascial Release) before being able dysfunction is dealt with. Once these areas are cleared I reassess the to obtain full ROM in external/internal shoulder complex in the supine position. If the onset is associated with an rotation. The elbow is also strongly If the humeral head is sitting anterior identifiable trauma or there are other influenced by the biceps muscle and I will in the glenohumeral joint then I will reasons to suspect trauma from lesser check that there is full range of extension generally treat it with a Positional Release incidents (e.g. very elderly patients or a in the elbow and palpate for trigger points technique. My next step is to assess prior history of trauma) and investigations in one or both bellies of the biceps brachii. have not been performed, I will refer passive abduction of the shoulder. If this is The imbalance in forearm pronation/ the patient to their GP for assessment restricted I will release latissimus dorsi and/ supination can often be the primary (usually x-ray and ultrasound). Also, if the or subscapularis. If the release of these cause of the rotator cuff tendinitis as i patient does not respond well to my initial muscles does not achieve the full range necessitates the inefficient positioning treatment I will refer them for assessment of abduction then I will check the triceps. of the shoulder complex in order to if it has not already been done. If adduction of the arm across the body is restricted I will release supraspinatus. accommodate the distal arm limitations. Please note that the following is a brief This leads to chronic muscle and tendon Once these motions are cleared I will description of an ‘average’ treatment. strain in the shoulder complex. Practitioners need to be observant and abduct the shoulder to 90 degrees and As a chiropractor, I will also look for adaptable and not work to formulas. (with the elbow at 90 degrees) test internal restrictions in the thoracic and cervical Although, for instance, a frozen shoulder and external rotation of the glenohumeral spine that may need adjusting. can be treated with these techniques, joint. I take the position with the supine Occasionally, I need to release lumbar and a lot more observation, adaptation and patient’s fingers pointing to the ceiling as pelvic structures in order to free up the judgement regarding dosage of treatment my neutral reference point. I am looking shoulder. needs to be applied. for 80-90 degrees of external rotation. If it is restricted I release the pectoralis The above treatment would take me In an uncomplicated presentation I will major, either by Positional Release or by about one hour to complete. I might do assess the patient standing, looking at cross fibre friction of the muscle’s origins this at a first appointment but following both static and dynamic posture (ROM) of around its sternal and rib attachments. treatments would be more targeted and the shoulder complex. last for half an hour.
20 september 2008 journal association of massage therapists ltd
Paul Doney is a chiropractor who works Under passive and under active with long consultations using massage, engagement to the pec’s, subscapular, manipulation, Myofascial Release, Positional clavicularis, teres, latissimus dorsi and AMT Release and Craniosacral Therapy. He works biceps was also used prior to MET NEW MEMBERS 2 days a week in a Natural Fertility clinic in stretching for these muscles. Bondi Junction (www.BoostYourHealth.com) To assist in correcting the structural NSW/ACT and 4 days a week in an osteopathic and imbalances I gave strengthening exercises Alisha Barthel, Marija Blazevic, Karin chiropractic clinic in Cremorne for the infrasprinatus, suprasprinatus, Cavanagh, Cuiping Chen, Andrew (www.abodyofwork.com.au). rhomboids and upper trapezius. Clifford, Liam Daniel-Marsh, Andrea Stretching exercises were given for the A Little Unusual But TRUE! Delgado-Rivas, Maria Jose Diaz medial rotators, adductors and pectorals About a year ago a client came into my Gubern, David Dickinson, Karyn as well as the biceps brachia. clinic with acute rotator cuff pain and Maruja Edwards, Elizabeth Evans, almost no lateral rotation of the upper During the course of the treatment I Trisha Feutrill, Michael Fullam-Stone, arm as well as extreme discomfort when again questioned my client on her ‘out of Sebnem Giner, Stephanie Glass, attempting to upward extend the arm. the ordinary’ activities in the past week. Shao Quan Guo, Vanessa Hough, The client had never experienced anything She said that the only non-routine thing Irina Ivankovitch, Sharmaine Jones, of this nature before and was a right she could think of was a concert she had Helen Langham, Carina Lewis, hander, who used a mouse with the right attended. I then asked if she had held Stacey Lloyd-Jones, Rodel Manuel, hand and tended to be very dominant the concert booklet and applauded for Simon Mason, Kylie McArdell, Brent in this arm and hand also. During our an extended period of time - and at this McKee, Cara McLoughlan, Margaret interview phase of the treatment session I point it became apparent we had found McNamara, Con Michael, Angela Mills, asked if there was anything at all that she the source of the problem! Monica Nagy, Johanna Pask, Natash could think of that may have attributed to My client had bought a 20-odd page Percy, Michael Pregley, Chanissara the condition and she said no, nothing out concert booklet, tucked it under her left Ravithanakorn, Bryan Rees, Angela of the ordinary had happened, no increase arm for the entire concert ‘to make sure Rex, Natalie Ricketts, Jacob Robinson, in workload, physical activity, strain or no one would pick it up by mi stake’, and Peter Rotton, Manjula Singh, Kate accident had occurred. throughout the 2-hour event she had Solylo, Luke Storta, Phuoc Chau (John) The compression of the anterior and stood and clapped along with most of Tran, Isileli Tuita medial rotators of the rotator cuff had the songs. In my language that means caused numbness of the entire arm and static holding contraction of the latissimus QLD muscle strain and headache on the left dorsi and teres in particular. Repetitive Avalon Kenzig, Christopher Kershaw, side of the upper shoulder and neck. shortening of the subscapularis, pecs, Christopher Laneulie, Donna Lear, On examination there was an obvious clavicularis, anterior deltoid and biceps Trevor Mitchell, Jacqueline Rule, Ian upper body forward rotation on the brachia was almost certainly a major Shepherd, Ryan Sullivan, Danielle left hand side, dropped left shoulder of contributing factor in this particular case. Visser, Lida Xu approximately 2 cms, and kyphosis more Postural imbalances that had remained SA prominent on the left. subclinical were perhaps rendered clinical Joanna Piekart I began the treatment with range of due to this event. movement and strength testing of the A single 1-hour treatment and exercises TAS major rotator cuff muscles. A distinct lack relieved more than 80% of the presenting Leanne Dolbel of strength in lateral rotation and lateral symptoms within 48 hours. Another 1- VIC elevation was apparent, acute discomfort hour session a week later and all was well. Luke Bonnett, Stacey Dolling, Jenna was felt when moving into these positions There was no need for more treatment Huckell, Jodie Jans, Huey Lam, Sonya and specific restriction was found in both and plenty of referrals from family, friends McCraw, Melissa Milburn, Sarit of these positions. and workmates have followed! Musat, Jay Pearce, Nicole Pitman, My treatment consisted of trigger point Just another average day in the clinic... Cindy Rolands, Wanwimol (Jenny) therapy for the subscapularis, pincer Alan Ford is well known to AMT members Thibodeedej, Breanna Thomas, David palpation of pectoralis minor and major, as a presenter, Journal contributor, active Trantino muscle stripping of both of these muscles member in the ACT region and latterly, WA as well as clavicularis, teres, latissimus dorsi, AMT President. He has a thriving practice in Natasha Darling, Shanaleigh Weiland deltoid and biceps brachia. the Canberra suburb of Kingston.
september 2008 journal 21 association of massage therapists ltd
Rotator Cuff Tendinitis: Four Clinical Perspectives (continued)
Clients with shoulder conditions often self Two tests that indicate general dysfunction Often, when we’re training as Massage diagnose and report having either frozen in the rotator cuff complex are the Drop Therapists, we are taught to view the shoulder or “rotator cuff”, as though that Arm test (also known as Codman’s test) musculoskeletal system as the 4356- 650 in itself is the name of a disorder! Often and the Abrasion Sign1,2. (approx)7 separate skeletal muscles that GPs tell their patient that is what they have Many structures in the glenohumeral area act in specific ways on the joints. From without even looking at them. can create pain (bursa, ligaments, nerves the structural integration perspective All joints are a compromise of stability etc). With a client presenting with rotator descended from Dr Rolf’s work, an inverse versus mobility. In the case of the cuff tendonitis or tendonosis, I would take view can be taken – that there is one fascial shoulder, the requirement for mobility a history, consider differential diagnoses continuity, muscles being spacers within 8 has the upper hand (excuse the pun). and refer them to their medical practitioner the fascia . The functioning of the shoulder requires for further testing if I sensed any red flags, Communicating openly with the client it to be a highly mobile structure, had any doubts or felt further investigation and sensing from the dialogue what especially at the Glenohumeral Joint or information was required. they expect from the treatment and (GHJ). The four muscles of the rotator Proceeding with treatment, initially I would what will produce the best results given cuff (Supraspinatus, Infraspinatus, Teres observe the client’s pain free active ROM those expectations basically determines Minor and Subscapularis) attempt to give then gently take them through passive the direction I take (more ‘fix-it’ or more it greater stability. They enclose the joint ROM testing. I’d emphasise the need to integrative). As a conscientious practitioner, capsule, their tendon fibres often blending do active ROM gently and would perform I would always do the best for my client by with the joint capsule, acting as soft tissue the passive ROM within their limit. The utilising every technique in my therapeutic stabilisers for the GHJ. The highly mobile last thing l’d want is to further tear an toolbox that seems appropriate for them. nature of the shoulder means they are already damaged tendon. For the same What follows are descriptions of possible readily susceptible to injury. reason, any resisted testing should be methods of treatment, however, nothing Tendinitis is an acute inflammation, done gently- if at all - with the emphasis is intended as rigid or prescriptive. One often a partial tear of the tendon. on monitoring muscle function rather than should be responsive to the client as they Tendinosis is a more chronic manifestation, opposing it. Avoid any extreme stretching present. I fiercely hate the concept of being disorganised and chaotic scar tissue with rotator cuff tendonitis. I would also formulas when applied to the body. As within the tendon, the result of poorly avoid treatment techniques that involve an an ex-chef I much prefer the metaphor healed past injury and poorly formed element of stretching, such as MET, CRAC of a recipe that is adaptable to the collagen. In extreme cases, tendons can be or PNF. In the more chronic tendinosis circumstances at hand. quite calcific. scenario or in subacute tendinitis, these Much of what follows is from a fix-it techniques could perhaps be used with perspective, as I feel Paul Doney has Physiology and assessment appropriate care and caution. In partial or quite thoroughly addressed the wholistic Supraspinatus acts to initiate abduction. complete tears they should be avoided perspective. Infraspinatus and Teres Minor act altogether. to externally rotate the humerus. Remedial Treatment Perspective Subscapularis internally rotates the After the initial health screen, questioning, In the acute phase, the treatment is humerus. As noted earlier, all four muscles ROM and special tests, I would then protection, rest, ice, compression and stabilise the humeral head in the glenoid observe the client’s total posture, noting elevation. Send the client to their doctor fossa, both in static posture as the arms any left / right differences in the shoulder for testing. girdles and anything unusual in their hang by the side and dynamically during In the subacute phase, the aim of the thorax and torso that may be contributing gait and in using the upper limb for treatment is to decrease swelling, then to their presentation. activities such as reaching, eating and work to bunch tissue into the area of injury bringing objects toward us. I have two approaches to working to encourage collagen cross linkages and The movements available at the GHJ are with clients. One I term ‘fix - it’, where scar formation. I‘m working primarily with the local flexion/extension, abduction/adduction In the chronic phase, or if you are seeing phenomena that clients present with on and internal/external rotation. I would test the client for the first time, determine what that day. The other is a more integrative all these to determine how the function is rotator cuff muscles are involved. Palpate approach, looking at the body globally affected. Apley’s scratch test in its various the myofascia to get a more discriminating and seeing local dysfunctions as part of stages covers all of these movements. sense of its condition, and to confirm or that person’s totality - an approach heavily refute your observations. influenced by my training in Rolfing® Structural Integration2,3,4. 22 september 2008 journal association of massage therapists ltd
Deactivate any obvious, palpable trigger After working transverse, work along the Infraspinatus points that are present, then continue line of pull of the structure with the intent Infraspinatus rarely exhibits tendinitis, and deepen the palpation so that you are of aligning the freshly redamaged tissue. except as a result of impact injury. working the myofascia, using both the Fibrinogen, the precursor to creating However, this muscle often has trigger gentle Barnes style myofascial release and collagen fibres, realigns appropriately if points and the kind of chronic, fibrotic the more direct myofascial techniques encouraged in this way11,12. I would be change associated with constant low-level popularly associated with Rolfing9,10. This more circumspect with acute tendinitis stresses. This results from its stabilising latter could take two forms, either ‘spots’ and wait for the healing process to be role - when other rotator cuff muscles are or ‘stripes’. ‘Spots’ involves palpating then under way before attempting transverse damaged it becomes over-active. holding one spot that feels restricted until friction work. The two places on the To work supraspinatus, I have the client the tissue changes texture and tension. tendon most prone to damage are the prone, GHJ abducted 90º and forearm ‘Stripes’ involves sinking into and then myotendinous junction (where the dangling over the edge of the table following a line of restriction within the muscles cease within the connective (in more precise anatomical terms, the myofascia, again sensing changes in tissue) and the tenoperiosteal junction humerus is also partially internally rotated texture and tension, similar to cold butter where the tendon fibres insert into the and elbow flexed 90O). Trigger points are warming and giving way. One could use periosteum of the bone. almost always present so I deactivate a variety of options as tools: the whole All the techniques described above could them first. Then work, initially lightly with fingers, the whole palm, the finger pads, be applied to the supraspinatus with the the finger pads, along the fibres from the the thenar eminence, the heel of the hand, client seated or side lying. The ‘U’ formed by medial scapula border to the insertion in one or two fingers, the knuckles (either the clavicle and spine of scapula is a good the humerus. Have the client extend and the proximal or the medial phalanges), spot to access the supraspinatus tendon, flex the elbow joint as you pass along the the thumb pad, the distal phalanx of the especially its myotendinous junction. The muscle. You can gradually increase the thumb, and reinforced fingers. tenoperiosteal junction of supraspinatus depth of your work each pass and ask the Supraspinatus is on the humeral head. To access it in client to increase the internal rotation of Supraspinatus is the most commonly torn order to apply transverse frictions, have the humerus as they raise their forearm. rotator cuff muscle. It initiates abduction the client side lying, involved side up, and Please note that increased depth does not and assists the middle deltoid in all passively extend the humerus. This moves necessarily equate with greater pressure, abduction. However, it is nowhere near the humeral head forward of the acromion more a case of gently exploring and as strong as the middle deltoid. When in allowing access to the tendon. exploiting any opening that the tissue allows. With their elbow flexed, the client dysfunction, it can be active even with the Subscapularis can also internally and externally rotate the arm just hanging by the side. The Painful If subscapularis requires work, I follow a humerus in an ever-increasing range as Arc will be positive in the 85º -110º range, similar protocol but with the client supine. you work on them. but I find this test moderately useless as it Work the posterior aspect of the axilla, could also indicate other things, such as on the anterior surface of the scapula Teres Minor subacromial bursitis, calcium deposits etc. (just antero-medial to the lateral border When treating Teres Minor, I have the client A positive Empty Can Test is an indicator of the scapula). Commence by applying side lying, arm abducted so that the upper of a supraspinatus tear. Various a discriminating palpation, identifying arm rests on the side of the head. If the impingement tests (such as the Neer and the condition of the tissue, deactivate client’s ROM doesn’t allow this, have it rest 1 the Hawkins–Kennedy) also indicate trigger points if present, and continue on the table in front of them. Apply the supraspinatus involvement. that discriminating palpation to work on same protocols as before, working along Initially, I would primarily target the belly of the totality of the myofascia using the the muscle from origin to insertion. the muscle, continuing carefully into the myofascial methods outlined above. In my clinical experience, it is rarely a player tendon. View the tendon as a continuation Have the client’s elbow flexed 90º and GHJ in rotator cuff tendinitis but feels good to of the fascia past where the muscle fibres abducted 90º and externally rotated to be worked. Damage is most likely in those finish: once the myofascia has been allow greater access to the muscle. who overdo weight training.13 suitably addressed start working the Ask for movement, getting them to abduct Other considerations tendon more specifically. further by reaching away with their fingers From a global perspective, I would look at In chronic or calcific tendinitis and and then move back to 90º with their the position of the scapula and the forces tendinosis, tendon damage and reduced elbow leading the way. The subscapularis operating on it. Pectoralis minor, serratus function is present but without the tendon is on the lesser tubercle of the anterior, the rhomboids, coracobrachialis, inflammatory process to initiate the repair. humerus. When working it, be sure that it is levator scapulae and the trapezius all Transverse frictions to the tendon induce what you are on. influence scapula position directly. controlled damage, re initiating the If it moves in elbow flexion it is the Consider the myofascial sling created by inflammatory response and renewing long head of biceps brachii (a common the rhomboids and serratus anterior: the the ability for repair. It also encourages mistake). Superiorly it attaches to the GHJ scapula can be viewed as a ‘sesamoid’ bone increased vascularity in otherwise articular capsule, so again I emphasis the within this sling. vascularly undersupplied tissue. palpate / discriminate aspect of this work. september 2008 journal 23 association of massage therapists ltd
Don’t overlook pec minor: it affects scapula 6. Gregor, R.J. ‘The structure & function of There are a number of modalities a position and in my clinical experience skeletal muscle’ in Rasch, P.J. “Kinesiology & Myotherapist may employ to help with the Applied Anatomy” Lea & Febiger 7th edition, is usually a major player in clients with 1989 deactivation of myofascial trigger points. rotator cuff tendinitis. Pectoralis major and 7. Tabners Medical Dictionary These include Deep Tissue Massage and latissimus dorsi also affect scapula position 8. Myers, T. “Anatomy Trains: Myofascial Trigger Point Therapy, Myofascial indirectly. Omohyoid and sub clavius can Meridians for Manual Therapists” Churchill Dry Needling, Cupping and active/passive be big players. Livingstone 2001 stretch and release techniques. When 9. Smith, J. “Structural Bodywork” Churchill The function of biceps brachii and Livingstone 2005 treating any presenting condition, the attendant muscles coracobrachialis, 10. Stanborough, M. “Direct Release Myofascial Myotherapist will discuss the pros and cons brachialis and supinator, can affect Technique” Churchill Livingstone 2004 of each treatment mode with the client glenohumeral function. An obvious 11. Cantu, R. & Grodin, A. J. “Myofascial and a treatment plan will be initiated. suspect is the middle deltoid: its function is Manipulation” Aspen Publishers 1992 12. Various articles in Findley, T. W. & Schleip, R. It is important that the client is comfortable intimately tied to supraspinatus. “Fascia Research” Elsevier 2007 with the proposed treatment plan – you Also, thoracic rotations are a major 13. Simons, D. G., Travell, J.G. & Simons, L. S. do not want to cause any undue stress in consideration in glenohumeral function. “Myofascial Pain and Dysfunction: The Trigger an already uncomfortable and/or painful Point Manual Volume 1 upper Half of Body” In scoliosis, for example, one scapula will Williams & Wilkins 2nd Edition 1999 situation. Although Dry Needling may be be protracted, the other retracted; one feared initially, it is an excellent treatment in internal rotation, one external. Thus A Myotherapy Perspective method because there is usually little to the forces operating on each shoulder When treating any condition using no pain associated with it. This is preferable complex will be different, which can Myotherapy, it is important to take into to deep tissue or trigger point therapy as either create or aggravate already existing account the extent of influence of the this can be quite uncomfortable, especially tendinitis. particular injury or dysfunction, not only when chronic dysfunction is present. within the immediately effected muscles Don’t forget the fascia, especially the clavi- As a Myotherapist, my primary aim is to and connective tissue but also within the pectoral fascia. Work around the clavicle deactivate any offending trigger points surrounding muscles and tissues. In the can be helpful. Compensation is another in the rotator cuff to restore correct case of rotator cuff injury, it can sometimes factor: avoiding using the involved side will movement, balance, strength and flexibility be difficult to determine which particular lead to overuse of the other side and the to the muscle or muscle groups affected. muscle is truly at the root of the problem. same condition manifesting. Also, trigger This may be accompanied by stretching points from the rotator cuff muscles can Myotherapy is a discipline with a and corrective exercises for the client to do refer into the wrist and lead to a mistaken foundation firmly based upon the at home to maintain shoulder health. carpal tunnel diagnosis treatment of myofascial trigger points. In terms of Rotator Cuff injury, there are a There are primary trigger points and Colin Rossie has over 20 years experience number of muscles that can be affected as a bodyworker, originally as a Shiatsu secondary or satellite trigger points and in turn when one muscle becomes practitioner and later a Remedial and these may be active or latent. When a dysfunctional. A Myotherapist should treat Sports Massage Therapist, before becoming trigger point is active it causes pain upon not only the offending shoulder but the a Certified Rolfer® and Rolf® Movement rest and during activity, as well as muscle asymptomatic one as well: practitioner. His work is firmly grounded weakness and a decrease in flexibility of although the non-injured shoulder is in a sound knowledge of anatomy and the effected muscle. not currently causing pain, there is a physiology and western science, and an A latent trigger point is one that does reasonable expectation that latent trigger awareness of and exploratory approach not cause pain upon rest but may be points will be present due to the increased to kinaesthetics. painful under active strain or applied use of the asymptomatic side as a pressure like during a treatment. Latent References compensatory measure. 1. Magee, D. J. “Orthopedic Physical Assessment” trigger points will also cause weakness Saunders, 3rd edition 1997 and decreased flexibility in a muscle that Similarly, there should be some time spent 2. Petty, N. & Moore, A. “Neuromusculoskeletal may result in poor balance of muscular treating the muscles of the chest and Examination & Assessment” Churchill groups and a reduction in the coordination neck, as well as postural assessment and Livingstone 1998 correction if needed. 3. Sise, B. “The Rolfing Experience” Hohm of said muscular groups upon activity/ Press 2005 performance. I would commence the session by 4. Maupin, E. “A Dynamic Relation To Gravity, A primary trigger point is considered testing the different ranges of motion Volume 1: The Elements of Structural at the shoulder and the strength of Integration” Maupin, self published, ‘ground zero’ in terms of muscle most recent edition 2006 dysfunction. This is because trigger points, each movement. This should help to clarify 5. Maupin, E. “A Dynamic Relation To Gravity, particularly active ones, will refer pain to which muscles are involved. In the first Volume 2: The Ten Sessions of Structural other muscles which may cause secondary treatment, I would address trigger points in Integration.” Maupin, self published, most all four rotator cuff muscles, as well as the recent edition 2006 or satellite trigger points to become active and therefore painful and dysfunctional. trapezius, rhomboids, levator scapulae and triceps (particularly at the long head). 24 september 2008 journal association of massage therapists ltd
Take home advice would be heat (for post treatment soreness) and gentle movement through all ranges if there is no pain. Ice for inflammation at the attachments or a reasons you combination of heat and ice alternately in 5-minute blocks for \30 minutes total. should attend Follow up treatment one week later would this year’s address the rotator cuff muscles again and additional muscles from the first treatment, Annual Conference taking into account improvement in ROM, strength and reduction in active trigger 10 points. I would add work to the pecs, lats 1 It’s the simplest way to maintain your CEU average. Attend two and scalenes. days and you meet your annual requirement. Attend 3 days and we’ll roll forward 50 points so you’re half way towards achieving In the third treatment, I would again note next year’s quota! any increases in flexibility, strength and It’s fully tax deductible … the conference, the plane ticket, the decreases in pain; applying more focus 2 accommodation, the gossip, the innuendo, the bad hairdos, the to trouble areas. It may be appropriate to wardrobe malfunctions. introduce some stronger stretching and gentle strengthening exercises at this 3 We’ve assembled a crack team of presenters including Jeff Murray, stage. Michelle Yaffe, John Bragg, Karen Lucas and organisational psychologist, Rhonda Andrews. The aim now is to lengthen the time between treatments and empower 4 It’s in Melbourne, spiritual home of the intimate bar, the tram, the very, very large ball of colourful yarn and the arty soundtrack. the client to maintain the condition But seriously, think culture and architecture, music and food, themselves, with the guidance of the refinement and class. And Jeff Kennett hasn’t been the Premier for Myotherapist. Regular maintenance a long time now. treatments may be appropriate. 5 It’s our 19th and that’s a prime number. We won’t get another one It is difficult to predict how long it will of those until our 23rd. take for rotator cuff injury to heal as there are various, complex factors involved. 6 You’ll have an entire weekend to be energised by your colleagues and share the company of likeminded professionals. These include how long the client has been suffering the condition (is it acute 7 We promise there’ll be no nude interpretive dance. There’s a signed or chronic?); what caused the injury in affidavit to that effect. the first place (if it is an overuse injury, is it 8 There will, however, be dancing on Saturday night. Vast, meaty possible to modify the offending activity?); chunks of it, as far as the eye can see and the hips can swivel. And whether the client is willing to do at-home for those of you with dietary requirements, the dancing will be maintenance; and if there are any outside green and leafy and free of preservative 220. factors contributing to the injury (for 9 You’ll go back to your clinic re-energised and inspired. You’ll example, stress or nutritional concerns). remember why you became a Massage Therapist in the first place. The list goes on … And you’ll wonder why you didn’t get to last year’s conference.
Kerry has been a Myotherapist for 4 years. 10 Have we mentioned that you’ll achieve your annual CEU She treats at 2 prominent multidisciplinary requirement in one, compact weekend? We thought that was clinics in Victoria’s southeast and believes worth repeating … that client education is as important as comprehensive multifaceted treatment. Look forward to seeing you during the last weekend in October. amt The AMT Conference Committee
september 2008 journal 25 Health Fund Status Health Funds and Societies CRITERIA AMT has negotiated provider status on behalf of members with the Health Funds listed. All funds Commonwealth Bank Health Society These funds recognise all AMT practitioner require a minimum of $1 million Manchester Unity levels. insurance, first aid and EUC s. If you are up-to-date with these, there ACA Health Benefits Fund (ARHG) is no need to apply individually Australian Regional Health Group to each health fund: your name Cessnock & District Health Benefits Fund (ARHG) will be forwarded for automatic CUA formerly Credicare (ARHG) endorsement as a provider. Defence Health (ARHG) Druids Friendly Society (ARHG) However, you will need to apply GMHBA (ARHG) directly to Medibank Private and Health Care Insurance (ARHG) HBF. Medibank registration forms Health Insurance Fund of WA (ARHG) are available for download in the Health Partners (ARHG) Health Fund section of our website. LaTrobe Health Services (ARHG) To register with HBF call Lysaght Peoplecare (ARHG) ARHG recognises all AMT practitioner levels. They require you to use their provider number. 08 9265 6125. Mildura District Hospital Fund (ARHG) This number is AW0XXXXM, where the X’s are Navy Health (ARHG) your 4-digit AMT membership number. OneMedi Fund (ARHG) To be eligible to remain on Phoenix Health (ARHG) the above Health Fund lists Police Health Fund (ARHG) Queensland Country Health (ARHG) you must: Railway & Transport Health (ARHG) 1. Be financial and have a Reserve Bank Health Society Ltd (ARHG) commitment to ongoing St Luke’s Health (ARHG) education (ie: an average of Teachers Federation Health (ARHG) 100 CEUs per year) Teachers Union Health (ARHG) 2. Provide your clients with a Transport Health (ARHG) Westfund (ARHG) formal receipt, either computer generated, or with rubber stamp or address label clearly Australian Health Management Group Australian Unity indicating practitioner’s name, Government Employees Health Fund (AHMG) These funds recognise Senior Level One or AMT member number (eg: AMT Grand United Friendly Society Two members. HCF require new providers to 1-1234), practice address (no HCF fax your name, practice address and association name to 02 9279 3549. PO Box numbers) and phone NIB number. Client’s name, date of Victorian WorkCover Authority treatment, nature of treatment (ie: Remedial Massage), and MBF These funds recognise members with the particular health fund provider NRMA HLT 50302 Diploma of Remedial Massage. number may be handwritten. SGIC (MBF Alliances) You must send a signed consent form to AMT. 3. Provide AMT Head Office with SGIO (MBF Alliances) Existing Senior Level One and Two providers remain eligible. a practice address (or business address for mobile practitioners; Medibank Private recognises Senior Level One, no PO Boxes) - failure to supply and Two members. They require you to apply these details to us will result in directly to them. You will need to your name being removed from send them a certified copy of your membership health fund listings. Medibank Private certificate and fill out their application HBF form which can be downloaded from the 4. Notify AMT HO of all relevant AMT website. practice addresses. HBF requires you to apply directly. To register call 08 9265 6125. Please check the AMT website for further ANZ Health Insurance (HBA) information on specific Cardmember Health Insurance Plan (HBA) Health Fund requirements: CSR Health Plan (HBA) HBA (formerly AXA) HBA require a nationally-recognised, diploma www.amt-ltd.org.au level qualification from a Registered Training HealthCover Direct (HBA) Organisation. Existing Senior Level One and Two Mutual Community (HBA) HBA providers remain eligible. Overseas Student Health Cover (HBA) St George Protect (HBA) VSP Health Scheme (HBA) 26 september 2008 journal Calendar of Events Courses accredited by AMT attract 5 CEUs per hour. Courses not accredited by AMT attract 1 CEU per hour. Please check dates and venues of workshops (using the contact numbers listed below)
September 2008 CCEUEUss 6-7 Dorn Spinal Therapy. Presented by Barbara Simon. Sydney. Ph: 02 9918 8057 70 12-14 Onsen Technique Volume III ( Cervical and upper Thoracic regions). Presented by Jeff Murray. Tweed Heads. Phone: 07 5599 2514 105 13-14 Muscle Energy Technique. Presented by Paula Nutting. Melbourne. Ph: 03 9481 6724 70 21 Hunter Branch Meeting. Merewether. Ph: 02 4952 8546 15 27-28 Dorn Spinal Therapy. Presented by Barbara Simon. Townsville. Ph: 02 9918 8057 70 30 Illawarra Branch Meeting. Corrimal Community Centre. Ph: 02 4283 8942 15
October 2008 CEUs 11-12 Western Cupping. Presented by Bruce Bentley. Melbourne. Ph: 03 9576 1787 70 18 Mid North Coast Branch Meeting. Port Macquarie. Ph: 02 6584 6661 15 19 ACT Branch Meeting. Fyshwick. Ph: 0480 238 274 15 24-26 AMT 19th Annual Conference. Melbourne, Victoria. Ph: 02 9517 9925 100 25-26 Trigger Point Workshop. Presented by Stuart Hinds. Melbourne. Ph: 03 9481 6724 70 26 Business Workshop. Presented by David Sheehan. Melbourne. Ph: 03 9481 6724 35 26-27 Traditional Thai Massage. Presented by Bruce Bentley. Melbourne. Ph: 03 9576 1787 70 28 Illawarra Branch Meeting. Corrimal Community Centre. Ph: 02 4283 8942 15
November 2008 CEUs 1-2 Tricks of the Trade. Presented by Jeff Murray. Tweed Heads. Ph: 07 5599 2514 70 1-2 Scoliosis - Treatment Protocols & Perspectives Influenced by the Rolfing Paradigm. Presented by Colin Rossie. Perth. Ph: 02 9517 9925 70 8 Business Workshop. Presented by David Sheehan. Melbourne. Ph: 03 9481 6724 35 8-9 Trigger Point Workshop. Presented by Stuart Hinds. Brisbane. Ph: 03 9481 6724 70 8-9 Corporate Seated Massage. Presented by Ron Saleh. Sydney. Ph: 0416 086 426 70 15-16 Chi Acupressure Workshop. Presented by Master Zhang Hao. Sydney. Ph: 02 9899 9823 70 15-16 Ortho-bionomy. Presented by Bruce Stark. Melbourne. Ph: 03 9481 6724 35 15-16 Dorn Spinal Therapy. Presented by Barbara Simon. Perth. Ph: 02 9918 8057 70 16 Hunter Branch Meeting. Merewether. Ph: 02 4952 8546 15 20-24 Neurostructural Integration. Presented by Ron Phelan. Ocean Grove, Victoria. Ph: 0419 380 443 175 20 Mackay Branch Meeting. Mt Pleasant. Ph: 07 4942 8481 15 22-23 Assessment Skills. Presented by Steve Jones. Brisbane. Ph: 03 9481 6724 70 22-23 glide Cupping. Presented by David Sheehan. Melbourne. Ph: 03 9481 6724 70 22-23 Ortho-Bionomy Fundamentals. Presented by Anthony Swan. Canberra. Ph: 0412 286 385 70 25 Illawarra Branch Meeting. Corrimal Community Centre. End of Year Function. Ph: 02 4283 8942 15 29-30 Trigger Point Workshop. Presented by Stuart Hinds. Brisbane. Ph: 03 9481 6724 70 29-30 Manual Lymphatic Drainage. Presented by Michelle Yaffe. Brisbane. Ph: 03 9481 6724 70
December 2008 CEUs 4-8 Neurostructural Integration. Presented by Ron Phelan. Sydney. Ph: 0419 380 443 175 6-7 Manual Lymphatic Drainage. Presented by Michelle Yaffe. Brisbane. Ph: 03 9481 6724 70 6-7 Muscle Energy Technique. Presented by Paula Nutting. Melbourne. Ph: 03 9481 6724 70 16 ACT Branch Meeting. Fyshwick. Ph: 0480 238 274 15 20 Mid North Coast Branch Meeting. Port Macquarie. Ph: 02 6584 6661 15
Please view the Calendar of Events on the AMT website for the complete 2008 listing: www.amt-ltd.org.au september 2008 journal 27