MASSAGE TRAINING AND THE PHYSIOTHERAPY BSc

To identify the mechanical effects This included the movement of fluid (oedema, lymph and blood) and the mobilisation of soft tissue. It covered, very briefly, what happens to skin and subcutaneous tissue, contractile and non contractile tissue, scar tissue, adhesions and contractures when subjected to massage techniques. Indications for massage were as a treatment for pain, oedema, muscle dysfunction and connective tissue abnormality. Each of the indications was discussed in a little more depth so, for example, when discussing pain relief the following were mentioned: dispersal of chemical irritants; alteration of fluid pressures; stretching fibrous tissue; pain gate theory; neural inhibition and the placebo effect.

Under the heading of ‘connective tissue’ cell types, extra cellular matrix and the stress strain curve all got a few minutes. The section on soft tissue mobilisation talked about muscle spindles, facilitated segment theory and collagen cross bridges.

To explain the therapeutic rational This part consisted of a quote from Holey and Cook (1) “Massage is the manipulation of the soft tissues of the body by a trained therapist as a component of a holistic therapeutic intervention.”

To identify contraindications They gave a fairly comprehensive list of both absolute contraindi- cations and precautions that are standard to most massage courses.

To describe the main features and purposes of massage We received information on how and why to apply stroking, effleurage, petrissage and tapotement and the work of Cyriax and Hunter plus Evanteth on specific stretching. The lecture was followed by two practical sessions of two hours each. During this time one instructor taught the basic techniques mentioned above to 22 students, of which only three had any massage experience.

Self-development So six hours in total, four of which were practical. It doesn’t seem a lot, but the university argues that at degree level students are largely responsible for their own learning; the contact hours with the staff are only a signpost towards self development. They issue a recommended reading list including two books Therapeutic Massage by Holey and Cook (1) and Cyriax’s Illustrated Manual of Orthopaedic Medicine (2) and two journal articles, Specific Soft Tissue Mobilisation in the Management of Soft Tissue Dysfunction (3) and The Biology of Scar Formation (4). After that the students are on their own.

The trouble with the self-learning theory is that, in reality, massage is only one part of a much larger syllabus, every part of which has its own, often extensive reading list. Coventry University uses a modular study system. In the first year there are eight modules each of which 150 hours of student study time are expected, although if you want to cover even part of the reading lists it requires much more. The rehabilitation module covers man- ual therapy, electrotherapy and exercise prescription, both in practice and in the wider context of a bio-social-psychological modal that encompasses much of today’s physiotherapy teaching.

As far as the practical application is concerned there is no foun- 10

dation on which to build skills. With a 22-1 ratio and only four hours to cover a wide variety of techniques, each student has had only a few minutes of staff time in which to get feedback on their performance. They can go away and practice, they can try and follow the illustrations in a text book, but that is hardly the same as the hours of supervised practice available on most dedicated massage courses. The degree students are groping in the dark. They don’t have a starting point. They are not practising taught skills and building on their own competence; they are effectively trying to teach themselves and that takes a lot of time including a lot of trial and error.

Students aren’t daft. To get through the work load they prioritise. They work out which subjects seem to be given more time by the university, which ones the staff are more enthusiastic about and which are most likely to come up in an assessment.

Finally,

they talk to their colleagues returning from placements and find out what they will need in the real world. My experience on placement was that, within the NHS, there is little time for massage. In fact, in one outpatient department I was specifically told not to use it, in case the patients liked it and wanted to come back for more.

CONCLUSION So now I understand why so many chartered physiotherapists find it difficult to understand massage. It’s a mind set they have picked up at university. It’s given less study time than ultrasound and short wave and no one is suggesting that newly qualified students are not competent in the use of electrotherapy and need 500 hours study to use it, so why would they believe massage to be any different. They are told that massage is the “manipulation of the soft tissues of the body by a trained therapist” and believe they are a therapist trained in its use to a level commensurate with the amount of massage used in most of the NHS.

Massage was the foundation stone of the formation of the CSP. It might be out of fashion, but I’ve seen enough good effects in my own clients to know that it is of huge therapeutic benefit and the evidence for that is mounting. It’s up to us to spread the word.

THE AUTHOR

Bob Bramah is a member of the Sports Massage Association, a member of the editorial panel of sportEX dynamics, and a final year physiotherapy student at Coventry University.

Note: This article originally appeared in the newsletter of CPMassT, the Chartered Society of Physiotherapy’s specialist interest group of physiotherapists in massage. We would like to thank CPMassT for the permission to reproduce the article in sportEX. For more infor- mation on CPMassT contact Tessa Campbell. Telephone 01962 861000 or email famcam2000@yahoo.co.uk

References: 1. Holey E, Cook E. Therapeutic Massage. Saunders (WB Co Ltd) 1997. ISBN:0702019232 2. Cyriax JH, Cyriax PJ. Illustrated Manual of Orthopaedic Medicine. Butterworth-Heinemann. ISBN:0750632747 3. Hunter G. Specific soft tissue mobilisation in the management of soft tissue dysfunction. Manual Therapy 1998;3(1):2-11 4. Hardy MA. The biology of scar formation. Physical Therapy 1989;69:1014-1024

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