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INS

2ND QUARTER 2016

INSIDE: DELIVERING PAIN EDUCATION • DERMONEUROMODULATION THOUGHT VIRUSES • GATE CONTROL THEORY • KINESIOLOGY MUSCLE BALANCING • OUTCOME MEASURES – THREE DIMENSIONAL PAIN

ILLUMINATE PAIN

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MNZ MAGAZINE n PG 1

CONTENTS

2 Advertising Rates and Information

3 MNZ Executive, Staff and

Sub-Committees

4 President’s and Executive Reports

REGULAR FEATURES7 Regional Roundup

9 What’s On

29 Reviews

30 Massage Therapy Research Update

– Dr Jo Smith and Dr Donna Smith

32 AGM Information

FEATURES10 Delivering Pain Education – Paul

Lagerman

14 Thought Viruses – David Butler and

Tim Cocks

15 The Missing Link – Bridie Munro

16 Dermoneuromodulation –

Jason Erickson

18 Gate Control Theory – Viatcheslav

Wlassoff

20 Make a difference in clients who

suffer from Traumatic Brain Injury –

Don McCann

22 Facilitate Positive Change –

Kinesiology Muscle Balancing –

Richard P. Rust

24 Outcome Measures: Three

Dimensional Pain – Joanna Tennent

25 Medical Massage – Should they

Stay or Should they Go? – Debbie Roberts

28 Rio 2016 – Pip Charlton

MNZ MAGAZINE Q2 2016CONTENTS

EDITOR’S NOTEMany thanks to the international and local massage community who have so willingly submitted articles on PAIN for this edition.

Please take the time to admire RMT Phillip Silverman’s cover shot of his very own artwork. Phil is off to New York in June on an art scholarship to further investigate his love of the human structures. We wish him well.

Aucklander Physiotherapist Paul Lagerman set the ball rolling by contacting us with his desire to simplify the approach to Pain Education delivery. As he says, we can no longer understand pain as purely a physical sensation, as for several years it has been classified as a sensory and emotional experience. His interest in pain, rehabilitation and communication has sparked a new drive in him, to reach out and collaborate with clinicians inspired to make a difference with sufferers. We thank him for seeing the value in massage therapists.

We encourage massage therapists to try and understand the “Gate Control Theory” versus

Cover Photo and Skull – made by Phillip Silverman, Wellington RMT and Tutor, Delver into the Arts.

Glass blown skull using a mould, made from glass, colour bar and gold leaf.

Background: For almost two decades I have worked in the health and fitness industry, with a key focus on functional anatomy as it relates to posture and movement.

My recent work has focussed on the skull which developed from my interest in portraiture. It has been stated in anthropology that the language spoken and to some extent the emotional history of someone can be

identified within a skull, leading to the idea that a skull could be viewed as a structural narrative of a person’s lived experience via language and emotion; this fascinates me. I have become intrigued by the many traditions including mysticism surrounding this form and the paradox that the skull is both used as a symbol of life and death at the same time. Such meaning far extends the idea of a bony structure or an over-simplified empirical model of the world. I have used the medium of glass largely due to its refractive quality and consequent response to its environment that is true of any living organism.

Find us on MNZ and @Massage_N_Z

the “Thought Virus” concept proposed by David Butler who has recently been in NZ explaining Pain. He has worked alongside the pain guru to many, Lorimer Moseley. His work continues to inspire. Bridie Munro attended these workshops and has reviewed “The Missing Link” for our benefit.

DermoNeuroModulation is presented by American Jason Erickson to enable practitioners to develop novel methods to fit the needs of the moment. This technique offers another informed way of thinking critically and strategically about what we do in manual therapy.

Joanna Tennent writes on Outcome Measures for Pain and questions “if we could more clearly measure the clients experience with the pain, could we get a more 3D version?”

Kinesiology muscle balancing may provide an anchor in the therapeutic relationship that there has been an identifiable change for the client. This is frequently associated with less pain, greater comfort and ease, and increased range of motion. Richard Rust discusses his experiences.

Plenty to read – take your time with a cuppa. Enjoy.

Carol

https://www.facebook.com/mnzsirep?fref=ts

https://twitter.com/Massage_N_Z

MNZ MAGAZINE n PG 2

ADVERTISING INFORMATION

ADVERTISING RATES AND INFORMATION

ARTICLES, CONTRIBUTIONS, RESEARCH, COMMENTS AND IDEAS…

ARTICLE SUBMISSION GUIDELINES

• Word count - Max 1800 words include references

• Font - Arial size 12• Pictures - Maximum 4 photos per

article, send photo originals separate from article, each photo must be at least 1.0MB

• Please use one tab to set indents and avoid using double spacing after fullstops. The magazine team will take care of all formatting.

Editor - Carol Wilson

[email protected]

DISCLAIMER: The information presented and opinions expressed herein are those of the advertisers or authors and do not necessarily represent the views of Massage New Zealand (MNZ). MNZ is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any advertising disseminated on behalf of organisations outside MNZ.

ADVERTISING RATES

Valid from February 2016. All rates are GST inclusive.

MNZ Magazine:

CMT, RMT and Affiliate members receive a 15% discount on magazine advertising.

All adverts are in full colour, semi-gloss.

Casual advertising rates:Full page $290Half page $160Quarter page $90

Package deals (in 4 publications over 12 months):Full page $840Half page $450Quarter page $240Magazine inserts (per insert) $0.75c

MNZ Website:

CMT, RMT and Affiliate members receive a 15% discount on magazine advertising.

All website advertising is placed for 2 months, unless otherwise stated when booking.

Advertising blocks (6 adverts) $280Events/adverts page (one off) $50

MNZ Magazine and Website Annual Bulk Advertising Packages:Packages provide magazine and website coverage. A discount is already included in these prices.

Package 1 includes:Magazine full page advert (x4)Website advertising block (6 ads) $1120

Package 2 includes:Half page advert (x4)Website advertising block (6 ads) $760

Email Advert to MNZ Members:Provides a one–off mass email blast to membership.Members (RMTs, CMTs) $25Non-members + Affiliates $80

SUBMISSION DEADLINES

The MNZ Magazine will be published:

Q3 2016 (deadline end July 2016) Q4 2016 (deadline end Oct 2016)

Q1 2017 (deadline end Jan 2017)Q2 2017 (deadline mid April 2017)

Note: submission dates may be changed or delayed as deemed necessary by the Editor.

The MNZ Magazine link will be emailed out to all members and placed in the members’ only area on the website, with hard copy posted to those members who request it.

Requirements of advertisements:

Advertisements must have good taste, accuracy and truthful information. It is an offence to publish untruthful, misleading or deceptive advertisements. Advertisements for therapeutic goods and devices must conform to New Zealand therapeutic goods law. Only a limited number of advertisements can be accepted. Advertising availability closes once the quota has been filled.

ADVERTISING SPECIFICATIONS

Magazine

All adverts for the magazine are to be sent by email as an ATTACHMENT in WORD or PDF (with a resolution of 300 DPI or more). They will not be accepted if embedded within an email. Please send any multiple pages as separate files, not as one PDF.

Magazine Page Sizes

• Full page is 180mm wide x 250mm high• Half page is 180mm wide x 124mm high• Quarter page is 88mm wide x 120mm

high

Website

All adverts are to be sent by email as an ATTACHMENT in WORD or PDF.

Advertising Blocks only: To be provided as a png, giff or jpeg file. Size 210 x 210 pixels

Email Adverts to Members

Adverts for one-off emails out to members can be either plain text or in html format. We can also send out attachments with your email.Advertising copy must be emailed as an attachment in WORD or PDF. Copy will not be accepted if embedded within an email. Logos can be included if emailed as jpg or png files.

PAYMENT

FULL PAYMENT MUST ACCOMPANY EACH ADVERTISEMENT

Methods of Payment:

• Internet banking to ASB A/c 12-3178-0064216-00

Please include your business name in the ‘reference’ field when making an internet transfer.

• Crossed cheque made payable to Massage New Zealand and sent to PO Box 4131, Hamilton East, Hamilton 3247, when you send in your booking form.

• Credit Card

BOOKING FORM

Please complete an Advertising Booking Form and email the completed form to: [email protected]

EXECUTIVE AND STAFF

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MNZ EXECUTIVE, STAFF AND SUB-COMMITTEESEXECUTIVE COMMITTEE

President Jo Smith [email protected]

Vice-President Deborah Harris [email protected]

Education OfficerDavid McQuillan [email protected]

Research Officer Donna [email protected]

Publicity OfficerSonya Healey [email protected]

Liaison CoordinatorMaria Monet-Facoory: 021 251 7827 [email protected]

STAFFExecutive AdministratorOdette Wood: 027 778 [email protected]

Membership SecretaryCarol Burgess: 0800 367 [email protected]

Treasurer Reina Reilly: [email protected]

NON EXECUTIVE POSTS

Magazine EditorCarol Wilson: 027 281 [email protected]

Upper Nth Island Regional Coordinator Barry Vautier: 021 363 448 [email protected]

Lower Nth Island Regional Coordinator Iselde de Boam: 021 044 [email protected]

South Island Regional CoordinatorUshma Shah [email protected]

Iwi LiaisonPosition Vacant

NZQA LiaisonPosition Vacant

Natural Health Practitioners New Zealand Rep Vicky McMath [email protected]

Education Committee Pip Charlton Cathy Allan Roger Gooch

Publicity CommitteeFrances BellVicky McMath

MNZPO Box 4131Hamilton EastHamilton 3247Phone: 0800 367 669

MNZ MAGAZINE n PG 4

REPORTS

PRESIDENT’S AND EXECUTIVE REPORTS

PRESIDENTKia ora koutou,

After a quick trip to Queenstown for the day yesterday and seeing the beautiful autumn colours, it reminded me just how quickly the year is going and how insanely busy it has been. I need a massage!

I hope your massage therapy worlds have been successful over the first part of 2016 and you are taking care of business as well as yourselves. The MNZ Executive has a number of projects on the boil and Executive members are putting in a lot of work just not in their portfolio areas but contributing to all projects. Odette Wood, our very organised and competent Executive Administrator, has launched herself into her new job with gusto and is keeping us all on track. One current major project includes the website redevelopment which has required contracting a new web designer but we are extremely hopeful to have something up and running by August. Publicity projects are also at the forefront of our thinking – more on that next time.

Last issue we launched the new CPD policy and while it did not take effect for your 2016 membership renewal I hope that as you start involving yourself in CPD activities in this new 2 year cycle (April 2016 to March 2018) you keep a check on what needs to be done and keep records and reflections as you go – it makes it much easier at the end when we need to report on these things.

I hope you enjoy this issue of the MNZ

Magazine. The Magazine team has done another awesome job – and I LOVE the colour. Wrap up warm for winter and enjoy a read.

Nga mihi nui,

Jo Smith

VICE PRESIDENT Hi all,

What a wonderful summer we have had! I hope you are all feeling sunned up and strong going into these colder seasons. The Executive are working towards building a new, better, and more functional website to help us take our MNZ message to the world. This will make it easier to support one another as therapists, provide useful information and resources to members, provide information to our clients about who we are as MNZ registered therapists, and let them know why they should choose us for treatment. A group of us will be involved in re-writing the content of the web pages, I look forward to helping with this project.

My main role as Vice President is to help the organisation deal with complaints about any MNZ members. I will be working with our Executive Administrator to re-work our complaints process, to ensure it is easy to understand and user friendly for clients who

need to make a complaint. In reviewing our complaints process I have found some very useful information on the Health and Disability Commissioner website: http://www.hdc.org.nz/complaints It is useful to remember Right number 10 of the HDC Code of Rights is “The right to complain and have your complaint taken seriously.” Please go to the above HDC website and search ‘complaints management guide for general practice’, for some good tips around how to deal with a complaint in your practice. Please do email me if you would like any support or more information around dealing with complaints.

Best wishes,

Deborah Harris

TREASURER Hi all,

Already the second quarter for 2016, time flies. It is time for me to prepare the accounts for auditing and drop them off at the auditor, and answer the audit control questions. The audit is a requirement as per MNZ constitution to ensure that members’ funds are used appropriately.

The budget for 2016/17 has been prepared but still needs some adjusting to represent and forecast as much as possible the expected income and expenses for this next financial year.

REPORTS

MNZ MAGAZINE n PG 5

This time will also be the time for those therapists who are self-employed, who I believe are the majority of us, to endeavour to get their paperwork sorted and prepared for the annual tax return, which some do by themselves whereas others will pass the bookwork on to an accountant. Please remember if you have any questions regarding your accounts, that I offer advice for free as part of the MNZ mentoring programme.

Have a great second quarter and enjoy reading this magazine.

Warm regards,

Reina Reilly

EDUCATION OFFICER Kia ora koutou,

I hope that you have settled into your year, and that everything is progressing as intended. March 31 is the end of the financial year for most people, a good time to reflect on the previous year, and think about your goals for the year ahead. If you’ve never done this, why don’t you try it? What would you like to achieve in 2016/2017? How will you know when you have achieved each goal? What will you do to help you achieve these goals? Make sure that you close the loop by reviewing this at the end of the year.

In the world of massage education, the education committee continues to make progress on our recognition of prior learning (RPL) framework.

Over the past two months a number of members have contacted Massage New Zealand with enquiries about the changes to health and safety legislation. New Zealand’s health and safety legislation has been reviewed because New Zealand doesn’t have a very good work safety record. Our workers are twice as likely to be killed or suffer serious harm on the job when compared to Australia, and six time more likely when compared to the UK! The previous health and safety laws were reviewed, and the new Health and Safety at Work Act came into force on April 4, 2016. I’ve included a brief overview of the impact of this legislative change here. Thanks to those members whose enquiries prompted this.

The major focus of the legislative change seems to be on defining responsibility. Those directing a business, making decisions within a business, working within a business, visitors to and customers of a business all have some responsibility to maintain health and safety under the new act. The new legislation also shifts the focus from monitoring and recording incidents to proactively identifying and managing risks.

We are working on making a more comprehensive package describing these changes and what the implications are for those involved in the massage industry, and will make you aware of this when it is available.

Nga mihi, (Kind regards)

David McQuillanSources:

http://www.business.govt.nz/news/get-ready-for-health-and-safety-law-changeshttp://www.mbie.govt.nz/info-services/employment-skills/workplace-health-and-safety-reformhttp://www.business.govt.nz/worksafe/hswa/mythbusting/business

LIAISON COORDINATOR The Regional Coordinators (RCs) have been busy activating their excellent local continuing professional development (CPD) meetings and supporting others in the development of new peer group support networks. Congratulations to Hamilton MNZ members, who with support from Upper North Island RC Barry Vautier, have launched a new group. Also to Queenstown who are in the process of doing so with support from South Island RC, Ush Shah. Lower North Island RC Iselde de Boom has also been working to successfully attract new members to the Wellington group meetings.

Thanks to all MNZ members who are responding to the call to build your own support peer networks in your local areas. Do remember that non-members are also welcome and encouraged to join the local group meetings. The important link with MNZ is created by liaising with your Regional Coordinators. They are your link through me, to the Executive. The tiered approach makes us all accessible to each other and strengthens the connections that are forged at networking events like regional meetings, conference, CPD workshops and the AGM. Speaking of which, the AGM is coming up, so keep an eye out for details so you can plan to be there. It’s an excellent opportunity to hear what’s happening in MNZ, to have your say, to ask your questions and to meet your MNZ

MNZ MAGAZINE n PG 6

REPORTS

representatives. Let’s also not forget the CPD workshop attached to the AGM and the CPD value of attendance. See you there!

Maria Monet-Facoory

PUBLICITY OFFICERHello everyone. I hope this year has been treating you well so far. Isn’t it amazing how time ticks away so quickly! Thank you to everyone who responded to the official MNZ complaint to the Broadcasting Standards Authority (BSA) (highlighted on our Facebook page), and to our MNZ members for bringing it to our attention.

There has been a lot happening behind the scenes for the last couple of months; MNZ website upgrade, membership benefits analysis, AGM planning, and promotional activity planning. Over the next couple of months, I will be addressing the MNZ Awareness Week campaign, and weighing up the concepts. This will allow us to ascertain which is going to have the most impact in our communities, and so too, for our members. If you have any suggestions or would like to be involved, please don’t hesitate to get in touch. My email is [email protected]

I hope this edition of the MNZ magazine inspires you, and wish you and your

practice a prosperous couple of months until the next update.

Sonya Healey

RESEARCH OFFICER Tena koutou

As the weather starts to cool down in the Deep South, it is time to look forward to winter fires, dusting off our puffer jackets, and planning for a glass or two of mulled wine. While we are not quite in the throes of a winter blast, the cooler weather is always a topic of discussion down here. The Executive has remained working at a frenetic pace with a number of major projects on the go. I look forward to seeing the upcoming new website and media profiling of MNZ, thanks to our hardworking Administrator, Odette and Sonya, our Publicity Officer. The research front has been busy also, searching for research articles on pain that you may be interested in. Please have a look in the research section of this magazine. On the SIT research front I have just completed two research posters that I will present at the Massage Therapy Research Conference in Seattle in May. They represent part of my PhD and report on the survey findings and the Conceptual Model: Stepping towards legitimation of massage therapists. The model profiles the proposed link between Degree-

based education and our Professional Association (Massage New Zealand). These posters will be available for viewing on the New Zealand Massage Therapy Research Centre (NZMTRC) website from around June/July. Stay warm, get a massage, do something nice for yourselves over the cooler months.

Warm regards,

Dr Donna Smith

EXECUTIVE ADMINISTRATORWelcome all to our second issue of MNZ Magazine for 2016. What a year it has been so far! Your Executive Committee has been putting in the long hours on a number of projects. As you will be aware from Q1, there have been changes with continuing professional development (CPD) which now puts our processes and requirements in line with many other health professions. Other work is also happening in the areas of reviewing and updating our recognition of prior learning (RPL) framework, reviewing our complaints process, and creating resources that can guide our members in the business aspects of being a massage therapist, such as how to set up health and safety processes in your clinic. One of the biggest projects, underway at present is our website rebuild. I am very excited to announce that we have just contracted

REPORTS

MNZ MAGAZINE n PG 7

REGIONAL ROUNDUP UPPER NORTH ISLAND The last meeting of the Auckland group was on Monday 7th March. Our topic, Massaging refugees with Post Traumatic Stress Disorder (PTSD) was presented by Barry Vautier and Claire Duggan, body therapists at the Mangere Refugee Centre. Claire went through the science of PTSD and Barry presented some of the research on this topic. They illustrated some of the benefits of massage and PTSD with anecdotal stories. Here’s an excellent article for those wanting to learn about PTSD:

Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108-114.

Dates for 2016 to put in your diary for Auckland meetings:

Venue: 380 Manukau Rd, Epsom, Auckland.

Monday 4th July - Enegrams with Chris Toal.

Tuesday 6th September

Monday 7th November

Monday 5th December - Christmas cheer

Look out for the email reminders.

Please contact me at [email protected] to suggest meeting topic ideas for CPD in 2016, offer to present or suggest presenters. You don’t have to be an expert - just come with your enthusiasm and new members are always welcome.

Our meetings in Auckland run from 7.30 to 9pm. Sometimes we have a cuppa tea and a biscuit (or a beer / wine) and we alternate Mondays and Tuesdays, so people can

at least get to some of the meetings which qualify for CPD hours.

If you can’t get to our Auckland meetings and want local support in the Northern region I’m very happy to support you with ideas and training resources to hold your own meetings. All you have to do is meet with a small group of other members and report on your activities and learning to gain CPD hours. You might discuss client cases, share a technique you have learnt, or discuss some research.

Kind regards

Barry Vautier BHS, RMT, MNZ

LOWER NORTH ISLAND Working with the help of enthusiastic Wellingtonians, there have been some exciting CPD opportunities for local massage therapists over the last few months and there promises to be many more!

In February we were treated to a hands-on introduction to dry needling from Joannes Boele van Hensbroek and Kaz Hagedorn. Participants were amazed with the new experience of working with these tools. Then recently in April, we had a workshop on postural and NMT assessment and realignment strategies presented by Richard Rust of the Wellington School of Massage Therapy. There was a new mix of people attending this workshop including three new Wellington MNZ members, which was exciting. We hope they’ll visit more workshops and networking events in

a new website development company to rebuild our tired and out-dated website. The company we have contracted has a proven track record in building great websites for membership organisations and over the next few months it’s going to be all go as a number of us focus on working with them to produce and deliver a modern, compelling and functional website that will promote MNZ and engage its users – you our valued members, and the general public who are seeking up to date information about massage therapy and looking for massage therapists in their area. It is my goal to have a website that we can be proud of and that will serve our needs in the years to come.

I hope you find lots of useful information in this Q2 issue, “Illuminate Pain”.Whether acute or chronic, muscle or nerve related, somatic or emotional, the impact of pain on the individual can be severe and far-reaching and as massage therapists we are well-placed to be able to have a positive outcome on the effect that pain has on our clients. As I write this report, I have just received my online access to Pain Adelaide 2016 – an annual meeting on chronic pain featuring some of the best researchers and speakers on the topic. I’m looking forward to sitting down with a warm drink and watching the presentations. I encourage you to do your own research and reading on emerging evidence about pain by checking out http://www.bodyinmind.org/ and http://www.noigroup.com, two great sites.

Keep warm and well as we enter into the winter months and I look forward to meeting up with many of you at our AGM taking place in Auckland on 28th August.

Odette Wood

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REPORTS

Wellington as there’s a keen community to get to know here.

Coming up, we are looking forward to the workshop on Sports Taping by Marcus Tidwell at the New Zealand College of Massage on the 27th of June. Also, back by popular demand, a networking breakfast at Cafe Vista on Oriental Parade on the 27th of July.

To wrap up, I would like to put it out there to anyone in the lower north island region, if you have an idea about a get-together in your town, please get in touch with me. Part of my role is to help members organise events and discuss ideas with them. If you don’t need my help – great! Just send me a summary of what you’re doing and I can include a mention in my quarterly report, to let others know what is going on in other parts of the region.

Iselde de BoamMNZ Lower North Island Rep.021 044 8552 Photo and Skull – made by Phillip Silverman,

WHAT’S ON

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WHAT’S ON...

If you have organised or been involved in a MNZ event in your area

we would love to hear from you! Please email your Regional Roundup or What’s On dates to:

[email protected]

DATE WHERE/HOW TO REGISTER

19 June – Feldenkrais for

Massage Therapists

28/29 July – Massage for Cancer

VENUES: NZ College of Massage,

Level 9, 76 Manners St, Wellington

REGISTER: Nelie on [email protected]

Auckland Massage group:

Monday 4th July - Enegrams

Tuesday 6th September

Monday 7th November

Monday 5th December

PRESENTERS: Chris Toal on Enegrams

7.30 - 9pm

CONTACT: Barry Vautier for more info at

[email protected]

Wellington Massage Group:

June 27th – Sports Taping

July 27th – Networking Breakfast,

Vista Cafe

VENUE: NZ College of Massage, Wellington

6 - 7.30pm

PRESENTER: Marcus Tidwell – Sports Taping

CONTACT: Iselde de Boam 021 044 8552

[email protected]

August 28th Sunday

MNZ AGM and Workshop

VENUE: Quality Hotel, Parnell, Auckland

Workshop 9.30 - 1pm

Website launch 2 - 2.30pm

AGM 2.30pm - 4.30pm

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ARTICLES

BRIDGING THE GAP BETWEEN CLINICIANS AND PATIENTS IN DELIVERING PAIN EDUCATIONPaul Lagerman BSc MNZPB MNZPS

INTRODUCTION

The clinical landscape regarding the management of persistent pain has

changed. No longer can we understand pain as purely a physical sensation, as for several years now it has been classified as a sensory and emotional experience1. Yet many clinicians continue to treat pain as an input with the premise that treating the tissues will elicit change. Unfortunately, this often provides only a short term result for sufferers, resulting in feeling better but not actually getting better. Therefore, a contemporary paradigm shift in the understanding of pain from biomedical to biopsychosocial thinking is required. However, this carries many personal and professional challenges for sufferers and clinicians.2

Traditional biomedical approaches assume that pathology and injury cause a deviation from normal function. This may hold some weight in an acute pain presentation but is not true of persistent pain. Where the model falls down is the assumption that the greater the pain an individual experiences, the greater the underlying pathology. If you’ve ever had a paper cut you’ll understand why this model doesn’t fit with contemporary thinking.3 It would assume that treating pain is relatively simple, yet we know from much research that an underlying pathology can resolve but pain continues, and conversely, there can be significant pathology identified on imaging and yet the individual is completely asymptomatic! What’s that about?

So pain is a complex beast, and if the hunt for the ‘off switch’ proves futile, there must be another way. Persistent pain

is at epidemic proportions throughout the Western world, which may allow comparisons to be drawn with other epidemics.4 Historically, epidemics have been contained through education and communication, thus it would make sense to communicate with and educate people in pain.5 However, this is not so simple. It can be difficult for clinicians to translate the findings of pain science into clinical application.

Persistent pain sufferers present to a variety of healthcare professionals looking for the ‘off switch’. Unfortunately, pain is inherently more complex than this, and so it is important to provide a shared understanding of pain that supports the practice of all health professionals that have exposure to those who suffer with persistent pain.

This article aims to briefly outline the biopsychosocial (BPS) model and its

application for the practice-based educator, discuss the use of collaborative learning between clinician and patient, and identify the ongoing issues within persistent pain management in New Zealand healthcare.

THE BIOPSYCHOSOCIAL MODEL

The BPS paradigm has evolved. Originally proposed by George Engel6, it has taken years for the model to become recognised. The BPS model is not a revolutionary concept, but has failed to gain traction until more recent years. The model encompasses three key aspects: the biological (anatomy and physiology, pathophysiology), the psychological (thoughts, emotions and behaviours), and the social (work, culture, relationships). These aspects play a significant role in a person’s pain experiences. However, the model comes with it’s own level of complexity, in that

ARTICLES


it demands the clinician to broaden their scope of knowledge and skills and cross boundaries into other fields that may be perceived as beyond their scope of practice. A study by Synnott et al 7 identified that clinicians may feel underprepared to treat some elements of a BPS nature that contribute to persistent pain problems, and may stigmatise patients who present with these factors. Therefore, a need for more integrated care providing adequate support networks are required to facilitate better models of care. Furthermore, studies have shown that multidisciplinary approaches provide better outcome than a single discipline approach.8

Moreover, a recent systematic review by Kamper et al 9 has shown that, based on the largest collection of trials and participants reviewed to date, there are robust positive effects of multidisciplinary biopsychosocial rehabilitation programs. Patients participating in these programs are more likely to gain small, long term benefits in improved pain and disability compared with usual care or physical treatments.

Therefore, if clinicians wish to advance their knowledge and skills to meet the demands of the BPS model, understanding their role as a practice-based educator would facilitate this learning need.

THE PRACTICE-BASED EDUCATOR AND COLLABORATIVE LEARNING

The practice based educator is traditionally regarded as an experienced work-based practitioner that has a high level of knowledge and skill in their specialist field. The practice-based educator is able to adopt an educational role training others in similar roles, as well as patients.13 Accordingly, we are all practice-based educators. There is (of course), a catch! We all have an innate desire to help people. We are also seen as the professionals. A tenet of practice-based education is to ensure efficient and effective learning. However, this often leads to the educator (clinician) focusing on their own performance and disregarding the needs of learner (patient).14 The educational delivery then becomes didactic and not collaborative, resulting in clinicians feeling proud of their knowledge but the patient walking away confused.

Due to the enormity of the biopsychosocial model and the complexity of pain there is a need for advanced communication skills. This allows clinicians to identify when medical language and metaphors may be confusing or potentially threatening10, 11, and to use language that encourages individuals to engage in a “safe” movement program and/or learn to live well with pain.12

Barker et al10 identify several aspects of the communication exchange process that creates difficulties between clinicians and patients, including:

• Understanding the clinician and medical literature

• The use of jargon and medical models

rather than patient-centered lay models• Patients and clinicians appearing to

define terms differently• Misunderstandings amongst healthcare

professionals that can arise

Therefore, there is a need to shift from medical and scientific terminology to a more simplified language that is understood by the patient. This enables an enhanced collaborative learning dialogue between the clinician and sufferer, therefore facilitating the opportunity to make sense of persistent pain.13

This is vital when we consider the unhelpful role that healthcare professionals often play in both the instigation and perpetuation of downward spirals into disability, anxiety and pain within our local population. Complex terminology and language explaining anatomy and pathoanatomy is usually a main culprit for this, and studies have shown that this is not an effective method for reducing pain and disability. Conversely this may have the opposite effect, increasing fear and perpetuating pain.17, 18

In order to bring about a meaningful change in the way that we think about and explain pain to our patients, we must first focus on the education of clinicians from all backgrounds. Dreeben15 highlights that patient education forms a ‘significant component of modern healthcare’. Yet, Bolton16 argues that ‘educational skills are merely assumed in both practice and research.’

PERSISTENT PAIN IN NEW ZEALAND

We know that persistent pain is a real problem, and many people can’t access help for it. In NZ, one in six adults have ongoing pain.19

There is compelling evidence to show that both patients and clinicians display an outdated and unhelpful understanding of pain. Unfortunately, this knowledge gap is one of the driving forces behind the current epidemic growth of persistent pain in Western societies. This is further compounded by the poor clinical outcomes that conventional, passive interventions so often provide.20

PERSISTANT PAIN IS A REAL PROBLEM – IN NZ, ONE IN SIX ADULTS HAVE ONGOING PAIN.


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Within New Zealand, we routinely see patients who have repeatedly and unsuccessfully used healthcare resources in an attempt to ‘fix’ their pain. Current models of treatment based upon outdated biomedical evidence continue to be a driving force for the perpetuation of persistent pain states.

Long-term sufferers are often unable to make sense of pain and withhold themselves from participating in familial and social pleasures. As a clinician, it is vital to adopt a collaborative and integrated approach to provide a reduction in an individual’s sense of suffering and to facilitate a reconnection with life’s pleasures.

The application of massage therapy has been shown to provide short-term effects for acute, sub-acute and persistent back pain.22 Yet massage is an incredibly personal, social and mindful experience for the pain sufferer. Massage has shown to reduce pain and anxiety in cancer patients 23, ease pain in knee osteoarthritis 24 and low back pain 25. Moreover, massage therapists require a competent knowledge of anatomy and physiology, pathoanatomy and disease processes21. With a solid grounding in the BPS model, and in partnership with other clinicians, massage therapists are in a strong

position to create a shift in focus for the individual that suffers persistent pain.

A PERSONAL NOTE

On a more personal note, during my recent attendance at the San Diego Pain Summit I witnessed the clinical paradigm shift as a living, breathing, entity. The summit was one of the best, unbiased, collaborative and forward thinking conferences that I have attended. It was refreshing to see so many disciplines in attendance, including physiotherapists, chiropractors, osteopaths, occupational therapists, and Feldenkrais practitioners. A large proportion of the audience were massage therapists.

The combination of the summit experience, my interest in pain, rehabilitation and communication has sparked a new drive to reach out and collaborate with clinicians inspired to make a difference with sufferers.

CONCLUSION

Collaborative pain education provides a means for all clinicians to effectively meet the demands of the biopsychosocial model, and more importantly, the needs of persistent pain sufferers. Furthermore, it provides a sense of uniformity for the patient that could otherwise be confused by multiple opinions

and mixed messages regarding the origin and treatment of their pain. A simplified approach to pain education delivery will prevent sufferers from becoming disengaged and provide them with an opportunity to make sense of pain, thus promoting a sense of hope and restoring an internal locus of control. Through understanding an individual’s coping style and educating in a way that is non-threatening, clinicians would be better equipped to respond to and deliver the evolving demands of the biopsychosocial model and contemporary pain science.

Paul Lagerman is an Auckland

based physiotherapist working in

pain management at Active +. He

is an advocate of practice-based

education and collaborative

learning and provides education

courses and seminars in pain

management for all clinical

disciplines.

He is the creator of the naked

physio blog and naked physio

podcast, and the course tutor of

Know Pain NZ. Contact Paul on

[email protected]

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REFERENCES1. Pain Taxonomy (2014).

International Association for the study of Pain. Retrieved from www.iasp.org

2. Stewart, M. (2015). The assumption dilemma: do healthcare professionals have the teaching skills to meet the demands of therapeutic neuroscience education. Pain News. 13. (1).

3. Louw, A, Puentedura, E. (2013). Therapeutic Neuroscience Education. Teaching patients about pain. New York. OPTP Publishing. ISBN 978-0-9857186-4-0.

4. Butler, D.S, Moseley, L. (2003). Explain Pain. Adelaide. Noigroup Publications.

5. Remington P, Brownson R, and Wenger M. (2010). Chronic Disease Epistemology and Control, 3rd edn. Washington, DC: American Public Health Association.

6. Engel, G.L. (1980). The clinical application of the biopsychosocial model. The American journal of psychiatry, 137(5), pp.535–544.

7. Synnott, A., O’Keeffe, M., Bunzil, S., DanKaerts, W., O’Sullivan, P., O’Sullivan, K. (2015). Physiotherapists may stigamtise or feel unprepared to treat people with low back pain and psychsocial factors that influence recovery: a systematic review. Journal of Physiotherapy. 61, 68 - 76

8. O’Keeffe, M et al. (2015). Comparative effectiveness of active interventions for non-specific chronic spinal pain: Physical, behavioural or combined? A systematic review and meta-analysis. Physiotherapy (United Kingdom), 101, pp.eS1131–eS1132.

9. Kamper, S.J. et al. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ (Clinical research ed.), 350(February), p.h444.

10. Barker et al., (2009). Divided by a lack of common language? – a qualitative study exploring the use of language by health professionals treating back pain. BMC Musculoskeletal Disorders. 10:123

11. Greville-Harris, M and Dieppe, P. (2015). Bad is more powerful than good: The nocebo response in medical consultations. The American Journal of Medicine. 128, 126-129

12. Thompson, B.L. (2015). Living well with chronic pain : A classical grounded theory.

13. Cross V, Moore A, Morris J, et al. (2006). The Practice- Based Educator: A Reflective Tool for CPD and Accreditation. Chichester: John Wiley and Sons.

14. Knowles M, Holton E, and Swanson R. (2011). The Adult Learner, 7th edn. Oxford: Butterworth-Heinemann.

15. Dreeben O. (2010). Patient Education in Rehabilitation. Sudbury, MA: Jones and Bartlett.

16. Bolton G. (2010) Reflective Practice: Writing and Professional Development, 3rd edn. London: SAGE.

17. Morr S, Shanti N, Carrer A, Kubeck J, Gerling MC. (2010)Quality of information concerning cervical disc herniation on the internet. Spine J 10:350-4.

18. Greene DL, Appel AJ, Reinert SE, Palumbo MA. (2005). Lumbar disc herniation: evaluation of information on the internet. Spine. 30:826-9.

19. Dominick C, Blyth F, Nicholas M. (2011) Patterns of chronic pain in the New Zealand population. N Z Med J;124(1337)

20. Eccleston, C, Crombez, G. (2007). Worry and chronic pain: A misdirected problem solving model. Pain. 132 (3) 233-236.

21. Degree Course Programme (2016). New Zealand College of Massage. Retrieved from http://www.massagecollege.ac.nz

22. Furlan, A.D. et al., 2008. Massage for low-back pain. Cochrane Database Syst Rev, (4), p.CD001929. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieveanddb=PubMedanddopt=Citationandlist_uids=18843627.

23. Hughes, D. et al., 2008. Massage therapy as a supportive care intervention for children with cancer. Oncology nursing forum, 35(3), pp.431–42. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18467292.

24. Perlman, A.I. et al., 2006. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Archives of internal medicine, 166(22), pp.2533–2538. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieveanddb=PubMedanddopt=Citationandlist_uids=17159021.

25. Netchanok, S. et al., 2012. The effectiveness of Swedish massage and traditional Thai massage in treating chronic low back pain: A review of the literature. Complementary Therapies in Clinical Practice, 18(4), pp.227–234.


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By David Butler and Tim Cocks

UP TO DATE THINKING

The idea that our thoughts can fundamentally alter our pain is

powerful stuff – it’s just about as far away from the out of date notions of ‘pain receptors’ and ‘pain pathways’, as you can get. Like pain, you can’t see a thought, but we know that both pain and thoughts are real and involve complex neuroimmune interactions. If a person says “it hurts”, then no one can say it doesn’t – there is only one witness to the event.

YOU ARE NOT YOUR THOUGHTS

Delving into this territory can be tricky and requires tact, appropriate knowledge, getting a bit philosophical at times – “you are not your thoughts”, and often, the right stories and metaphor. We introduced the notion of ‘thought viruses’ to people experiencing pain, therapists and clinicians in Explain Pain, and it has spread and been picked up around the world now.

THOUGHT VIRUSES ARE DIMS

Thought viruses can be powerful DIMs (Danger in me neurotags) – and likely to be found across the seven categories, for example:

Things You Hear, See, Smell, Taste and Touch – hearing “you have the back of an 80 year old” or seeing normal, age related changes on x-ray (that remain unexplained and threatening)

Things you Say – “I am riddled with arthritis”

Things you think and believe – “movement is dangerous” or “pain is forever”

Things you do – “I am not bending forwards” is a logical consequence of the thoughts, beliefs and other thought viruses above.

Things happening in your body, such as inflammation.

People in your Life or the Places you go.

KNOWLEDGE CAN BE LIKE A ‘THOUGHT VACCINE’

We’ve made a short clip that we hope therapists will be able to use to introduce the idea of thought viruses (and their ‘vaccines’) to patients. You could watch it in your clinic, have it playing in your waiting room, or perhaps set it as some homework – we know that good education uses multimedia, and hearing new ideas in different ways can help it to ‘stick’ and influence future behaviour.

I can imagine a short introduction that might go something like this,

“We’ve been talking about your pain and your brain over a few sessions now, and I want to introduce you to the idea of ‘thought viruses’ – these are things that we hear, think or say that are scary and threatening – they are nearly always incorrect, but can be powerful enough to maintain or even increase your pain. Let’s watch this short clip and then we can have a chat about it more – maybe you have a few thought viruses that we need to deal with, what do you think?”

https://www.youtube.com/watch?v=7eQpRZxXv2g

From http://www.noigroup.com/

March 2016 – printed with permission

David Butler is an educationalist, maintaining active clinical and research roles. His professional love is devising ways to take the complex ‘gifts’ of neuroscience to students. Clinicians and sufferers in ways that can change their lives.

With Lorimer Moseley, David pioneered the Explain Pain approach in clinical practice and now heads the international Neuro Orthopaedic institute and noigroup.com.

He has taught manual therapy and how to Explain Pain to thousands of clinicians on all continents over the past 25 years. His books, Mobilisation of the Nervous System, The Sensitive Nervous System and the Neurodynamic Techniques Handbook and DVD are regarded as key texts for manual therapists.

THOUGHT VIRUSES

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THE MISSING LINK – REVIEWBy Bridie Munro RMT, BHS (Massage and Neuromuscular)

I felt very fortunate to be living in Wellington in November 2015 when David Butler,

founder of the Neuro Orthopaedic Institute (NOI), from Adelaide ran a two-day pain workshop here on how to explain pain to clients. NOI has an increasing media profile and has produced relatively easily accessible resources on the subjective, complex and frankly beautiful ability of our bodies to create pain.

Accompanying the development of my clinical practice has been a growing interest in understanding pain and the nervous system. One of the most daunting tasks I face is putting together an assessment and treatment plan with a client who is suffering from chronic musculoskeletal pain. Often they have already seen more practitioners than they care to count. They have had scans, tests and an array of remedies and pharmaceuticals however they often seem defeated still experience pain in the same way.

Chronic pain clients when seeking a diagnosis in search of a cure/ understanding/ explanation of their pain are often met with confusing classifications like myofascial pain, fibromyalgia and complex regional pain syndrome. These classifications are relatively non-specific, umbrella terms and may offer clients little hope that they will be pain free one day.

Common goals with clients are based around increasing range of motion, reducing stiffness, changing their sensitivity to touch and of course relaxation. These are all important milestones for clients with chronic musculoskeletal pain, but through my own investigation and then experimentation, I have found only one technique that also empowers, connects and encourages clients that their future might actually hold some kind of real relief- Pain Education.

The ‘Explain Pain’ workshop was informative from start to finish. It reflected my own paradigm shift from finding and treating mechanisms of injury to celebrating neuroimmunology and the clever (albeit sometimes over protective) danger defence mechanism. What follows are some of the key concepts that guide my practice in 2016, months after that course.

So what’s going on up there in our heads?

How come a paper cut hurts so much yet one may find dark bruises on the body with no idea how they came to be there?

The brain decides what signals are harmless and what are noxious by using what the NOI refer to as ‘neurotags’ (Bulter and Moseley, 2014). These can be likened to an orchestra. The orchestra has the ability to play slow and fast, loud and quiet and can get so good at playing one piece of music that it becomes automatic. The brain works in the same way, a neurotag is a specific connection from one neuron to another and as the brain interrupts a signal as noxious the neurotag will get very good at communicating that message, increasing sensitivity and often spreading the message to surrounding neurons causing the pain to increase and or spread.

For varied reasons the brain decides that one is in danger and thus needs protecting. Good. But that spells trouble when pain goes on too long and gets too good at playing its pain song. Remember hurt doesn’t necessarily mean harm, in fact there doesn’t even need to be a mechanism of injury at all to feel pain, if the right stimulus enters the brain it can construct its own pain response based on past experiences and current stressors. This was that ‘ah ha’ moment for me when I could explain to clients why their pain went away when they went away on holiday. Their ‘neurotags’ were firing differently! Phantom limb pain shows us clearly how the brain’s mental map of our bodies can be drastically different from our physical one, as individuals with missing limbs can feel pain in a part of their body that aren’t present in the physical world or how about why an old injury flares up with no specific incident or cause. The brain has just gotten good at playing its pain song.

Pain is a construct of current and past experiences. Pain is subjective. No ones pain will ever be the same as anyone else’s.

How could I expect someone to be pain free when they might not even understand why they are in pain in the first place? Educating a client about the neuroimmunology of pain, helps explain to them why and how chronic musculoskeletal conditions get

so out of hand. Education provides hope and takes away some of the threat of chronic conditions. A systematic review has concluded that there is..

“..compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophisation and physical performance.” (Louw, Diener, Butler, and Puentedura, 2011, p 2041).

The effect of pain education is being investigated currently as a tool for at risk of individuals developing chronic lower pain (Traeger et al, 2014).

No matter what our particular mode of therapy or techniques are, giving power back to the client is a positive first step for client recovery. Understanding how pain works gives individuals an opportunity to appreciate the clever communicating system that their brain uses to keep them safe. This reduces the threat of further injury and gives hope for the future.

In short we are lucky to feel pain.

As said I feel very grateful to have had the opportunity to see David Butler present about pain.

For information on courses and to learn up to date pain rehabilitation programmes visit:http://www.noigroup.com/en/Home http://www.gradedmotorimagery.com/

REFERENCES Bulter, D and Moseley, L. (2014) Explain pain (2nd ed) Adelaide. Noigroup Publication.

Louw, A., Diener, I., Bulter, D., Puentedura, E. (2011) The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041-56.

Traeger AC, Moseley GL, Hübscher M, et al. Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial. BMJ Open 2014;4: e005505. doi:10.1136/ bmjopen-2014-005505


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DERMONEUROMODULATION, STRATEGIC TOUCH FOR PAINBy Jason Erickson, BCTMB, CPT, CES, CAIST, BBA, BA, AA

Massage therapy is a touch-based practice, but it is influenced by much

more than our physical connection. As we interact throughout each session, clients’ bodies give us palpable feedback. If we listen well and communicate effectively, the results of a massage can be extraordinary.

The term “dermoneuromodulation” (DNM) was developed by Diane Jacobs, a Canadian physiotherapist specializing in pain science and the treatment of painful conditions. She was influenced by Dr. Ronald Melzack, who developed the “Neuromatrix” model that is now central to modern pain science, and by physiotherapist Michael Shacklock’s work with the movement of nerves and nerve trunks. In 2007, Diane did a cadaver study that revealed how peripheral cutaneous nerves divide into rami connecting into the underside of skin. This suggested a new conceptual model for all approaches to manual therapy for people in pain:

Dermo (skin) + neuro (nervous system) + modulation (change) = dermoneuromodulation (skin is a medium to interact with the nervous system and effect change).

All manual therapies involve touch, and we’re usually touching skin. DNM focuses on that often-overlooked fact and considers how we can use it more effectively to improve upon what we do. For massage therapists, learning DNM is a paradigm change. It’s not a modality based on a specific set of techniques, but rather a way of thinking more flexibly (and critically) about how to use the techniques we already know. The learner gains an updated knowledge of the nervous system, what causes pain, how to apply that knowledge in hands-on work, and better ways to educate our clients. Instead of

teaching the memorization of techniques, DNM emphasizes clinical reasoning based on neuroscience.

Pain science says that pain and tight muscles are not the enemy, but protective responses of the nervous system. Motor aspects include flinching and muscle “bracing”; the sensory aspects include pain or other discomfort. These may persist long after injury or danger have passed. If the nervous system relaxes, it may abandon these protective responses. This way of thinking encourages gentle approaches to help clients resolve pain, regain function, and feel better. It should be pain-free for client and therapist. It promotes relaxation, informs therapeutic work, and can be applied to all kinds of specific modalities.

From the spinal cord to the skin, nerves pass through small contiguous gaps, or “tunnels” through many tissue layers. These layers move and shift. Where nerves pass from one layer into the next, shear forces may impinge nerves to cause localized ischemia and nociception, often called tunnel syndromes. This may lead to pain, increased muscle tension, and other protective responses.

Moving nerves (neurodynamics) helps restore nerve health and function. Since tunnel syndromes often involve cutaneous nerves (found throughout the skin and subcutis), it should be possible to resolve most musculoskeletal pain by moving nerves attached to skin, i.e., by moving skin into which they are embedded from beneath. This may be done without pressure sufficient to deform or damage the underlying muscle, fascia or other soft tissues. Body positioning, skin stretching/gathering, and gentle movement may resolve discomfort from tunnel syndromes.

HOW DOES THIS WORK?

The skin layer is full of innervation, much of it right at the skin surface. Hilton’s Law states: “The nerve supplying a joint supplies also the muscles that move the joint and the skin covering the articular insertion of those muscles.” (Stedman’s Medical Dictionary). What we do to/with skin indirectly (reflexively) affects motor output.

Mechanoreceptors adapt at different speeds and in different ways. Fast adaptors fire when they detect movement, then shut

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off until new movement restimulates them (e.g. motion detector). Slow adaptors remain turned on, transducing information and firing action potentials into the spinal cord the whole time a stimulus is operating, regardless of whether it moves or doesn’t (e.g., bathroom scales).

KEY IDEA: Use touch strategically. As therapist, give the skin’s mechanoreceptor system as much slow, gentle, and continuous stimulation as possible without adding any more nociceptive input. This may alter the brain’s perception of what is happening in that area of the body and stimulate a downregulation of pain/bracing protective responses. One simple way to do this is with skin stretch.

BASICS OF SKIN STRETCH

When we stretch skin, we are shifting tissue layers, the nerves embedded within them, and stimulating mechanoreceptors. Ruffini corpuscles are slow-adapting mechanoreceptors sensitive to skin stretch; their input to the brain may trigger a positive response: reductions in discomfort and excess muscular contraction.

The basic process:

1. Find a tender point.2. Slowly draw the skin away from the

tender point.3. Multiple stretch vectors may be used as

necessary.

There are at least five known cases of carotid artery dissection resulting from massage of the anterior neck (on/around the sternocleidomastoid). This preventable problem and the proximity of the SCM to the carotid artery has leading massage educator Susan Salvo recommending against the use of vigorous or direct pressure on the belly of the SCM. Instead, she recommends use of methods based on DNM.

ANTERIOR NECK/STERNOCLEIDOMASTOID (SCM)

This area is frequently involved in conditions as varied as headaches, vertigo, jaw pain, whiplash, torticollis, and many more. This example focuses on providing some relief to the superficial cervical plexus, a complex network of cutaneous nerves that determine whether the muscles will be relaxed or tight, and whether the

area feels good, painful, or otherwise.

1. With client supine, gently palpate the anterior neck, particularly along the SCM. The tissues may feel tense, firm, ropey, or otherwise irritated. The client may report pain or other discomfort. Choose a side to treat.

2. Slowly and gently turn the client’s head slightly away from the side you will treat. A few degrees may be enough. The client should not be in any discomfort from the positioning.

3. Locate the landmark, SCM, and lightly place the edge of each hand to either side of it. Gently let the skin of your hands sink in until you feel your skin slightly adhere to theirs.

4. Slowly and incrementally shift your hands in opposite directions along either side of the SCM. The hand on the lateral border of SCM should move the skin towards the clavicle while the hand on the medial border of SCM should draw the skin towards the ear. Pause whenever you have taken up the available slack in the skin.

5. Continue holding this for about two minutes. Feel for softening of the anterior neck/SCM; the client may report changes in sensations. If the tissues are slow to respond, continue for another minute or two. When finished on one side, you may switch sides and repeat this procedure.

This is but one example. DNM applies to addressing pain/tension throughout the whole body, and may help practitioners develop novel methods to fit the needs of the moment. However, DNM is not “magic” that miraculously works on everyone; it’s an informed way of thinking critically and strategically about what we do in manual therapy. Clients may need other forms of therapy, so “If in doubt, refer out.”

The concept of dermoneuromodulation informs my work with people suffering from chronic and/or complex pain problems, sports performance concerns, and chronic tension patterns. Educating people helps them manage their concerns and take steps towards improvement. We talk about it during intakes, and during sessions if they wish. Many report a deep sense of relaxation. Most love how quickly pain and tension may dissipate. Athletes are pleased

when their flexibility and strength improve. Clients for whom “regular” massage is contraindicated are happy when there are other approaches that may be safe and effective for them.

Dermoneuromodulation training is a great fit for massage therapists that wish to improve their understanding of pain and tension patterns and conditions. Spa-oriented massage therapists may find DNM to be a profoundly relaxing addition to their skill set, particularly for challenging clients. For those who specialise in “medical”, “orthopaedic”, “sports”, or other massage niche markets, DNM provides a powerful means of leveraging knowledge into real results, even with stubborn cases that previously failed to respond.

Jason Erickson is a Board Certified massage therapist, certified personal trainer, Corrective Exercise Specialist, and certified Active Isolated Stretching Therapist in Eagan, Minnesota, USA. Jason teaches workshops and seminars for massage therapists and personal trainers. He has been part of the San Diego Pain Summit (SDPS), the International Massage Therapy Research Conference (IMTRC), and the AMTA National Conference.

His web site is www.HealthArtes.com, and he can be reached via [email protected]


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GATE CONTROL THEORY AND PAIN MANAGEMENTby Viatcheslav Wlassoff, PhD

Pain perception varies across different individuals according to their mood,

emotional condition and prior experience, even if the pain is caused by similar physical stimuli and results in a similar degree of damage. In 1965, Ronald Melzack and Patrick Wall outlined a scientific theory about psychological influence on pain perception; the ‘gate control theory’.

If not for this theory, pain perception would be still associated with the intensity of the pain stimulus and the degree of damage caused to the affected tissue. But Melzack and Wall made it evident that pain perception is far more complex.

According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through. This theory gives the explanation for why someone finds relief by rubbing or massaging an injured or a painful area.

Though the gate control theory cannot present the complete picture of the central system that underlies pain, it has visualized the mechanism of pain perception in a new dimension and it has paved the way for various pain management strategies.

PERIPHERAL NERVE FIBERS INVOLVED IN TRANSMISSION OF SENSORY SIGNALS

Every organ or part of the human body has its own nerve supply and the nerves carry the electrical impulses generated in

response to various sensations like touch, temperature, pressure and pain. These nerves – that constitute the peripheral nervous system – transmit these impulses to the central nervous system (the brain and spinal cord) so that these impulses are interpreted and perceived as sensations. The peripheral nerves send signals to the dorsal horn of the spinal cord and from there the sensory signals are transmitted to the brain through the spinothalamic tract. Pain is a sensation that alerts a person that a tissue or a particular part of the human body has been injured or damaged.

According to the axonal diameter and the conduction velocity, nerve fibers can be classified into three types – A, B and C. The C fibers are the smallest among all the three types. Among the ‘A’ fibers are four subtypes: A-alpha, A-beta, A-gamma and A-delta. Among the A subtypes, the A-alpha fibers are the largest and the A-delta fibers are the smallest.

The A fibers that are larger than the A-delta fibers, carry sensations like touch, pressure, etc. to the spinal cord. The A-delta fibers and the C fibers carry pain signals to the

spinal cord. A-delta fibers are faster and carry sharp pain signals while the C fibers are slower and carry diffuse pain signals.

When considering the conduction velocity, the A-alpha fibers (the large nerve fibers) have higher conduction velocity when compared to the A-delta fibers and the C fibers (small nerve fibers). When a tissue is injured, the A-delta fibers are activated first, followed by the activation of the C fibers. These fibers tend to carry the pain signals to the spinal cord and then to the brain. But the pain signals are not transmitted simply like that.

WHAT DOES THE GATE CONTROL THEORY SAY?

The gate control theory suggests that the signals encounter ‘nerve gates’ at the level of the spinal cord and they need to get cleared through these gates to reach the brain. Various factors determine how the pain signals should be treated at the neurological gates. They are:

• The intensity of the pain signals• The intensity of the other sensory signals

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(touch, temperature and pressure), if generated at the site of injury

• The message from the brain itself (to send the pain signals or not)

As already mentioned, the nerve fibers, large and small, carrying the sensory signals, end in the dorsal horn of the spinal cord from where the signals are transmitted to the brain. According to the original postulate of Melzack and Wall, the nerve fibers project to the substantia gelatinosa (SG) of the dorsal horn and the first central transmission (T) cells of the spinal cord. The SG consists of inhibitory interneurons that act as the gate and determine which signals should reach the T cells and then go further through the spinothalamic tract to reach the brain.

When the pain signals carried by the small fibers (A-delta and C fibers) are less intense compared to the other non-pain sensory signals like touch, pressure and temperature, the inhibitory neurons prevent the transmission of the pain signals through the T cells. The non-pain signals override the pain signals and thus the pain is not perceived by the brain. When the pain signals are more intense compared to the non-pain signals, the inhibitory neurons are inactivated and the gate is opened. The T cells transmit the pain signals to the spinothalamic tract that carries those signals to the brain. As a result, the neurological gate is influenced by the relative amount of activity in the large and the small nerve fibers.

EMOTIONS AND THOUGHTS DETERMINE THE WAY HOW PAIN IS PERCEIVED

The theory also proposed that the pain signal transmission can be influenced by emotions and thoughts. It is well known that people do not feel a chronic pain or, to be more appropriate, the pain does not disturb them when they concentrate on other activities that interest them. Whereas, people who are anxious or depressed feel intense pain and find it difficult to cope up with it. This is because the brain sends messages through descending fibers that stop, reduce or amplify the transmission of pain signals through the gate, depending on the thoughts and emotions of a person.

GATE CONTROL THEORY IN PAIN MANAGEMENT

The gate control theory has brought about a drastic revolution in the field of pain management. The theory suggested that pain management can be achieved by selectively influencing the larger nerve fibers that carry non-pain stimuli. The theory has also paved way for more research on cognitive and behavioral approaches to achieve pain relief.

One of the tremendous advances in pain management research is the advent of Transcutaneous Electrical Nerve Stimulation (TENS). The gate control theory forms the basis of TENS. In this technique, the selective stimulation of the large diameter nerve fibers carrying non-pain sensory stimuli from a specific region nullifies or reduces the effect of pain signals from the region. TENS is a non-invasive and inexpensive pain management approach that has been widely used for the treatment of chronic and intractable pain that are otherwise non-responsive to analgesics and surgical treatments. TENS is highly advantageous over pain medications in the aspect that it does not have the problem of drug interactions and toxicity.

Many other invasive and non-invasive electrical stimulation techniques have been found to be useful in various chronic pain conditions like arthritic pain, diabetic neuropathy, fibromyalgia, etc. The theory has also been extensively studied in the treatment of chronic back pain and cancer pain. However, favorable results are not attained in some conditions and the long term efficacy of the techniques based on the theory is under question.

Nevertheless, the gate control theory has dramatically revolutionized the field of pain research and it has sown seeds for numerous studies that aim at presenting a pain-free lifestyle to the patients who suffer from chronic pain.

Viatcheslav Wlassoff, PhD, is a scientific and medical consultant with experience in pharmaceutical and genetic research. He has an extensive publication history on various topics related to medical

sciences. He worked at several leading academic institutions around the globe (Cambridge University (UK), University of New South Wales (Australia), National Institute of Genetics (Japan). Dr. Wlassoff runs consulting service specialized on preparation of scientific publications, medical and scientific writing and editing.

REFERENCES

Abram SE (1993). 1992 Bonica Lecture. Advances in chronic pain management since gate control.Regional anesthesia, 18 (2), 66-81 PMID: 8098221

Bishop B (1980). Pain: its physiology and rationale for management. Part III. Consequences of current concepts of pain mechanisms related to pain management. Physical therapy, 60 (1), 24-37 PMID:6243184

Melzack R, and Wall PD (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150 (3699), 971-9 PMID: 5320816

Moayedi M, and Davis KD (2013). Theories of pain: from specificity to gate control. Journal of neurophysiology, 109 (1), 5-12 PMID: 23034364

Nizard J, Raoul S, Nguyen JP, and Lefaucheur JP (2012). Invasive stimulation therapies for the treatment of refractory pain. Discovery medicine, 14 (77), 237-46 PMID: 23114579

Nnoaham KE, and Kumbang J (2008). Transcutaneous electrical nerve stimulation (TENS) for chronic pain. The Cochrane database of systematic reviews (3) PMID: 18646088

Tashani O, and Johnson M (2009). Transcutaneous Electrical Nerve Stimulation (TENS) A Possible Aid for Pain Relief in Developing Countries? The Libyan journal of medicine, 4 (2), 62-5 PMID: 21483510

Printed with permission from

BRAINBLOGGER: NEUROSCIENCE and NEUROLOGY | June 23, 2014


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MAKE A DIFFERENCE IN CLIENTS WHO SUFFER FROM TRAUMATIC BRAIN INJURYBy Don McCann

There are manual cranial therapies for massage therapists that can make a

significant difference for clients who have had brain injuries. Unfortunately, many massage therapists are unaware of the positive effect they can have with their brain injured clients.

Recent medical research has actually verified systems in the brain that were previously unrecognized. There are three that are of significant importance for manual therapy. The first is that they now recognize that the cranial motion exists with a subtle movement of the cranial bones. For years, medical schools have been teaching that the cranial bones do not move. The second was a breakthrough study at the University of Rochester Medical Center that discovered the glymphatic system. (named in recognition of glial cells and how their function is similar to the peripheral lymphatic system - Editor) This discovery was only possible because of advances in technology that allowed them to study living brains.

The glymphatic system is a pressurized system that shadows the blood vessels of the brain and is now recognized as the principle waste removal process for the most sensitive of organs, the human brain. The third was a “stunning” discovery at the University of Virginia that overturns decades of textbook teaching that shows the brain is directly connected to the immune system by lymph vessels previously thought not to exist. While it has always been recognized that there were some lymph vessels in the brain, they were thought to be minimal and not of great significance. The new findings show that the brain has a complex and sophisticated immune system based on this newly discovered and extensive lymph system. Again, this only makes sense as the most sensitive organ of the body would need this.

In the past, when some of the treatable brain injuries occurred, massage therapists were

seldom included in the treatment process. If we look at the systems mentioned above, we can see this was a major oversight by the medical community because, once the danger of further haemorrhage or damage to the brain was no longer an issue, massage therapists trained in specialised cranial techniques could have provided one of the primary forms of treatment. This is a bold statement which I now am going to back up.

First, we will look at what happens to the above mentioned systems when a traumatic brain injury takes place. When the cranial motion is examined after traumatic brain injury, it is dramatically diminished. The injury itself can jam sutures even to the point of causing them to become calcified. In addition, there is soft tissue damage. This can be from the surface layers of fascia

just under the skin through the reciprocal tension membrane where it passes through the sutures, and inside the lining of the cranium into the tentorium that supports and holds the brain. This can dramatically disrupt the cranial motion and block neurological function as this tissue thickens into scar tissue.

In the acute stages of brain injury, a restriction of the cranial motion can cause a backup of fluids in almost any part of the brain. This backup of fluid causes pressure and swelling on the brain and inhibits brain function. Restoring cranial motion allows the systems of the brain to work normally and release the swelling. In addition, restoring the cranial motion can often result in a balancing of the temporal lobes which often dramatically reduces vertigo, and the inability to concentrate.

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CASE STUDY #1

Robin, a 30-year-old real estate agent, had a brain injury from an auto accident. For three months she was unable to drive, had significant headaches, could not concentrate, could not stand bright lights, and was on medication for vertigo. She came for treatment because she also had a cervical flexion/extension soft tissue injury. Using kinesiology to evaluate her cranium, it was revealed that she had minimal cranial motion and almost no cranial motion of the left temporal bone. In addition, the relationship of the occiput/atlas/axis was jammed with no motion. The cranial/structural core distortion release, a complete unwinding of the restrictions of the cranial motion, was applied which restored full motion to the cranium. Additional synchronizing of the temporal bones and a mobilization of C1 were applied. By the time Robin got off the table, she felt her concentration was nearly 100%, her headache that had been present since the injury was gone, the lights in the room were no longer affecting her, and her vertigo had disappeared. Additional sessions further normalized and expanded her cranial motion and also treated the soft tissue injuries in her neck. Within three sessions, Robin felt that her brain injury was healed and that she could return to her real estate practice. This was a very good example of how the restrictions of the cranial motion which also jammed C1, had prevented her brain injury from healing. The timely application of cranial/structural techniques produced rapid and long lasting improvement.

Cranial motion is involved in both the glymphatic and lymphatic systems of the brain. However, each deserves special attention beyond just the restoring of the cranial motion. The glymphatic system is the principle waste removal system for cleansing the brain, and a brain injury damages the glymphatic vessels often collapsing or even breaking them. This is especially obvious when there have been broken blood vessels and hemorrhaging as the glymphatic system shadows the circulatory system. The first symptom of damage to the glymphatic system is swelling. Cerebral spinal fluid and blood will back up or leak out in an area that

is damaged. The second is additional inflammation because waste products of the brain accumulate and cause constant irritation which also results in swelling. The third, and this takes place over time when the glymphatic system has not been restored back to full function, is brain degeneration due to lack of waste removal and a buildup of protein and amyloid beta. This may not be evident for a number of years after the injury, and is a major contributing factor to the early onset of dementia or Alzheimer’s for those who have had multiple concussions.

In an acute brain injury, once danger of haemorrhage and additional damage has passed, treatment of the glymphatic system can dramatically speed up recovery. The glymphatic system pumps along with the cranial motion, but to engage it fully it is necessary to compress it. A specialised cranial/structural technique, the frontal/occipital decompression, will compress this system and then work it in a pumping motion. This may push fluid through collapsed glymphatic vessels and pump accumulations of fluid out of the brain. In addition, this pressurized pumping of the glymphatic system may dramatically increase the removal of waste products and inflammation. This will help to restore the glymphatic system back to full function. Many clients report immediate relief from concussion symptoms.

CASE STUDY #2

Cindy, a college basketball player, had three major concussions in three years and, six months after the third one, hadn’t shown any improvement in her ability to concentrate and attend school. She was also lethargic and had constant headaches. The physicians had said it was just going to take time and there could be some permanent damage.

At Cindy’s first session, the cranial/structural core distortion release was applied to release the restrictions in her cranial motion. After the cranial motion had been restored the frontal/occipital decompression was applied to pump out the excess fluid and waste products and reduce inflammation in her brain. By the time the session was over, Cindy was not as lethargic and was starting to show more interest in her environment.

This technique was applied four more times on a weekly basis with steady progress in her ability to concentrate, memory retention, and energy levels. Her headaches had also disappeared. By her fourth session, Cindy was back in school and able to handle her full load. This was after six months of not being able to read or concentrate enough to go to class. A CAT scan also showed a clearing in the areas that had previously been inflamed and swollen.

The lymphatic system also responds well to compression and decompression and is also treated with the frontal/occipital decompression. Consequently, there are two systems at work when treating inflammation and swelling with the frontal/occipital decompression. Both dramatically help in the recovery from treatable brain injuries.

Another effect of brain injuries, is leaving the client’s brain susceptible to further neurological diseases and degeneration because of the damage to the lymphatic system which is the major component of the brain’s immune system. Restoring the lymphatic system and lymph drainage can prevent the development of other neurological diseases such as MS, ALS and Alzheimers.

As you can see, massage therapists can make a significant and long lasting therapeutic difference when treating clients who have had treatable traumatic brain injuries.

Hopefully, this has expanded your awareness of the exciting possibilities that are available for successfully treating clients who have sustained treatable brain injuries. These techniques are not available through the medical community.

Don McCann, MA, LMT, LMHC, CSETT is the Founder of Structural Energetic Therapy® and a licensed massage therapist in USA.

Printed with permissionMassage TodayMarch, 2016, Vol. 16, Issue 03


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FACILITATE POSITIVE CHANGE – KINESIOLOGY MUSCLE BALANCINGBy Richard P. Rust

Bringing Kinesiology Muscle Testing into clinical practice has significantly

enhanced results with many clients. If you find yourself asking “how can I get better results with this client” or “why does this client come back every session with the same issues” this could be the missing link from your work.

The origin of Muscle Testing Kinesiology was from the work of Kendall and Kendall Muscles: Testing and Function, 1949 (later Kendall, McCreary and Provance) a group of American Physical Therapists (Physiotherapists). This is an excellent text and reference for treatment massage work, NeuroMuscular Therapy, and/or postural work with clients. It was one of the first texts that addressed the skill of specific muscle testing i.e. how to put a client’s limb(s) in very specific positions and apply a testing pressure in a specific direction that maximally activates/isolates specific skeletal muscles (to determine whether they – the muscles – have enough strength integrity to “hold”).

Later in the 1960’s and 1970’s, Doctor of Chiropractic George Goodheart assembled an elite team of “research Chiropractors” to study and refine the process of “muscle testing” and developed a variety of eclectic strategies for “strengthening” or “facilitating” muscles that seemed to be testing “weak” or “unlocking” or “underfacilitated”.

Out of this huge body of research, the system of Applied Kinesiology was born, and is based on the understanding that the “neuromuscular circuitry” of each skeletal muscle shares or is influenced by specific “neurovisceral” (organs and glands) and/or “neuromeridian (acupuncture meridians) circuits. From an Applied Kinesiology perspective, when testing a skeletal

muscle, you are actually simultaneously testing the integrity of that muscle’s related neurovisceral and/or neuromeridian circuitry. For example, if the quadriceps test underfacilitated (“unlocking” or “weak”), chances are there may be some stress in the small intestines (inflammation, dysbiosis, food intolerances etc). By stimulating appropriate reflexes for the small intestine and/or by taking probiotics, any of which may have a balancing effect, the “neuromuscular” circuitry of quadriceps will become more fully facilitated (now testing “locking” or “strong”).

Another example is the psoas muscle – an important postural muscle. If the Psoas tests underfacilitated (“unlocking” or “weak”) rather than prescribing hip flexor type strengthening exercises, the kidneys could be “strengthened” or tonified by drinking more water, or stimulating the kidney acupuncture meridian – this may result in the

psoas muscles now testing fully facilitated (“locking” or “strong” ).

In the system of Kinesiology, the main mechanisms of “strengthening” or “facilitating” any apparently “weak” or “underfacilitated” muscles, is with the use of organ and glandular reflexes that actually stimulate and help bring homeostasis to the organ or gland that is reflexed to that muscle.

The main body reflexes used are:

1. Neurolymphatic Reflexes - developed by Osteopath Dr Frank Chapman in the early 1900’s. These reflexes are located anteriorly in the intercostal spaces; and posteriorly on either side of the spine; and some are located in various aspects of the lower extremity.

2. Neurovascular Reflexes – developed by Terence Bennet D.C. in the 1930’s. Mainly located on various aspects of the head.

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pik.

com

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3. Acupuncture Meridians – 5000 year old system that features as a prominent aspect of Taoism. Practised today as Acupuncture; or a branch of Traditional Chinese Medicine.

4. Foods – that specifically support the function of various organs/glands.

5. Other ways of strengthening muscles/organs/glands include the use of “Healing Energy” directly to organs/glands/chakras.

By stimulating or activating these reflexes, the “congestions” may be dispersed, resulting in optimal functioning of the neuro-physiological circuitry, and in turn, the neuro-muscular circuitry functions more efficiently. This means muscles test and function with greater engagement, strength, and facilitation.

How can this information be useful for massage practitioners (and other complementary health practitioners)?

1. By knowing where the reflexes are for a particular muscle you may be working on, by targeting specific massage techniques to stimulate these reflexes, you not only bring greater integrity to the optimum functioning of that muscle, you also positively affect the health status of the related organ or gland bringing

greater health to the whole person.2. Enhancing your massage work on

problem muscles by facilitating a longer lasting muscle balance (by having simulated and balanced the related organ/gland reflexes).

3. For those who work with Treatment/Postural Massage in your clinic, knowing how to test and strengthen relevant “underfacilitated” (testing “weak”) muscles, can fast-track postural changes for clients – which they frequently notice immediately.

4. Knowing how to test and reflexively strengthen or optimally facilitate muscles, may ensure any proprioceptive re-balancing makes faster and longer lasting postural changes: and faster recovery from injury.

5. By simply understanding which organs, glands, meridians particular muscles are reflexed to, it may be by massaging these muscles with this greater holographic awareness may help to create some facilitation of the neurovisceral and neuromeridian circuitry.

Learning Kinesiology Muscle Testing opens up a whole new and exciting field of understanding and healing that is immediately verifiable for both practitioner and client (a muscle that was previously unlocking, testing weak, now locks solidly – it feels stronger!). This provides a very tangible kinesthetic anchor in the therapeutic relationship that there has been an identifiable change. This is frequently associated with less pain, greater comfort and ease, and increased range of motion. The depth and profoundness of Kinesiology work is in no small part due to it’s strong connection to and use of quantum physics and medical science understanding of the human energy system as a concentrated intersection of quantum morphogenic fields. (Krebs and O’Neill, 2013)

Training would begin with Touch for Health – developed by John Thie D.C. (one of the original research Chiropractors that helped develop Applied Kinesiology). This is a simplified version of applied kinesiology more easily accessible and learned by complementary health practitioners who are not chiropractors.

REFERENCES

Muscles Testing and Function, Kendall and Kendall, 1949: Lippincott Williams and Wilkins

Applied Kinesiology – Synopsis 2nd ed, Walther, David S, DC: Systems DL

An Endocrine Interpretation of Chapman’s Reflexes, Owens, Charles DO, 1937: American Academy of Osteopathy

Energetic Kinesiology, Krebs, Charles PhD and O’Neill, Tania, 2013: Handspring publishing

WHEN TESTING A SKELETAL MUSCLE, YOU ARE ACTUALLY SIMULTANEOUSLY TESTING THE INTEGRITY OF THAT MUSCLE’S RELATED NEUROVISCERAL AND/OR NEUROMERIDIAN CIRCUITRY

Richard P. Rust RMT MNZ

Cert. NLP Master Prac. and Trainer, Dip Adv. Bowen Tech. and Instructor, Touch for Health Kinesiology Prac. and Instructor, Kinergetics Prac. and Instructor, Ortho-Bionomy® Prac. and Instructor, BA, LLB

The Radiant Health Centre, www.radianthealthcentre.co.nz

The Wellington School of Massage Therapy, www.radianthealth.co.nz, [email protected]

Photo: Charles Krebs and Richard Rust

The Living Matrix DVD 2009: Interviews with various academic and independent researchers.


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Joanna Tennent RMT, MNZNZCM Wellington BHS (NMT), Dip HS (Sports Therapy) Course leader

It is regular practice within the provision of massage therapy to utilise a variety of

outcome measures (client subjective feel, movement testing, postural assessment and palpatory findings) as ways to evaluate changes in client experience. An individual’s experience of pain is a common reason for a person to seek out massage therapy initially as a potentially helpful intervention. The following is a brief look at commonly used tools to record client experience under the umbrella of ‘pain’ and to gauge changes post-treatment.

Pain is difficult to objectively quantify due to its inherently subjective and multifaceted nature (Younger, McCure and Mackey, 2009). As reported by an Auckland spinal surgeon in the Listener recently “we do not have a pain scan” (Chisholm, 2016). He was referring to the reluctance to carry out spinal fusions where there are a number of spinal levels showing degenerative changes on MRIs or X-rays as it is “impossible to know where the source of the pain is”.

Massage therapists may rely mainly on self-report measures to determine a client’s experience of pain or tension. There are a number of tools commonly in use clinically and for research purposes. Pain intensity can be a simple baseline measure. ‘How intense is your pain?’ It is verbal, quick and straightforward. A numerical rating scale (NRS) typically scores a rating between 0 and 10 (can be 0 - 100) where 0 registers as no pain and 10 as worst pain imaginable.

A visual analogue scale (VAS) is often used to indicate current pain levels along an (ideally) 10 cm line where the mark is made without written indicators of what each may mean. For some people who find number rating difficult, a verbal rating scale (VRS) can be used where pain descriptors are highlighted.

Recognising that the intensity of pain is just one aspect of the pain experience, there are other tools developed to capture more of the complexity. The McGill Short Form Questionnaire, even though a shortened version, also includes a grading system of both sensory descriptors plus ‘affective’ qualifiers such as ‘ sickening’, ‘fearful’. This begins to gather a fuller picture of the impact or relationship of the pain experience on a person.

Other developed tools attempt to explore more fully how pain and dysfunction can interfere and interact specifically with different areas of life. For example, the QuickDASH (Disabilities of the Arm, Shoulder and Hand Score) explores the impact of a regional problem on regular daily activity; social, work as well as specific tasks, using a knife, making a bed, putting on a jacket (Institute for Work and Health, n.d.).

One can really only imagine the difference if pain were able to be measured more objectively. Diploma level Massage training in New Zealand promotes the use of range of movement testing - physical performance tests (ROM). Pain is one component of movement, ‘fear of pain’ and ‘pain avoidance’ as an influence on movement patterning cannot be disregarded. So to use a ROM as an objective measurement again is fraught with challenge. There is not a clear correlation between self-reported pain intensity and performance scores even though the temptation may be there to presume there is.

Other objective markers such as skin conduction and heart rate measures have been explored but there is insufficient correlation to the experience of pain - as yet any biomarkers of pain intensity are under ongoing investigation. The more recent appreciation of the significance of the central neurological component of pain, as more than a transfer of nociceptor input, has led to more focus on the brain.

Neuroimaging attempts have revealed that rather than a ‘pain centre’ there is a broader ‘pain neuromatrix’ (Melzack, 2001) reflecting more of the emotional, situational and attentional factors that play into the pain experience. These endeavours are not yet advanced enough to say ‘we have a pain scan’. (Sartor- Katzenschlager, 2014)

We may not be actively involved in clinical research however we may require reminders of the complex and multidimensional aspects of the pain experience, especially when dealing with chronic pain. More careful attention to our use of outcome measures may encourage more interest than just a singular numerical measure of pain. A simple sensory component such as intensity and quality of pain may offer a rather two dimensional picture of a client’s pain. What is the person’s relationship to the pain? What do they feel about it? What do they think about it? These questions may move the appreciation of the client experience more into a 3D version.

REFERENCESChisholm, D. (2016, April 30). Cutting through the evidence. New Zealand Listener. 12-19

Institute for Work and Health. (n.d.) The Dash outcome measure: About the QuickDash

Retrieved from http://www.dash.iwh.on.ca/about-quickdash

Melzack, R. (2001) Pain and the Neuromatrix in the Brain. Journal of Dental Education 65(12), 1378-1382.

Sartor-Katzenschlager, S. (2014). Pain and neuroplasticity. Revista Médica Clínica Las Condes, 29 (4): 699-706

Younger, J., McCue, R., and Mackey, S. (2009). Pain Outcomes: A Brief Review of Instruments and Techniques. Current Pain and Headache Reports, 13(1), 39–43

OUTCOME MEASURES: THREE DIMENSIONAL PAIN

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SHOULD THEY STAY OR SHOULD THEY GO?By Debbie Roberts, LMT

No, I’m not talking about that song from The Clash. Let me begin by telling you

that the client we will discuss had too many correlating tests and symptoms to stay. Based on this client, we will be taking a look at vertebral artery stenosis or insufficiency and the risk factors of treatment.

We will discuss some of the signs and symptoms that just might make you want to play this tune in your head when a medical massage type of client comes walking in your door. More clients and more doctors are recognizing the words medical massage. Although that is great, it certainly comes with an entire set of specialized expertise that doesn’t necessarily mean a strong sense of palpatory skills.

Should you treat or should you delay treatment or should you not treat at all is the biggest question for a therapist that states they do medical massage or any specialty massage that has the goal of relieving pain. It is truly imperative that the client get a full medical clearance in order for you to safely perform medical massage that would include stretching, soft tissue manipulation, isometrics, or traction, if necessary.

In talking with another colleague of mine, we both agreed that the longer we have been in the massage therapy profession the less anxious we are to jump right in performing manual therapy without first knowing the complete history of the client and making sure the doctor knows the type of therapy the client is about to receive. There are a ton of unusual circumstances that seem to seek out our help these days. And the client situation we are going to talk about in this article was no different.

She had been referred to me by a friend. Over the phone, she stated she was having

left neck pain and occasional headaches that weren’t getting any better with either physical therapy or chiropractic care. She had hopes that a medical massage might help. Sounds simple, doesn’t it? Maybe soft tissue issues with the scalenes, trapezius muscles, or the SCM? When she presented with her reports and history, and I performed a cervical assessment, it became alarmingly complicated. So much so, I didn’t treat, I wrote a report for her general physician, neurologist, and chiropractor asking them to make sure she could receive medical massage therapy with light traction.

Here is what set this all in motion. Her reports raised significant concern for manual therapy without medical clearance and this is only the impression of the report, not the whole report.

First, there were spinal biomechanical alterations noted in the C spine. Second, intercalary bone formation at C3,4,5,6 disc levels. Third, posterior osteophytes formation is suspected at the C6 disc level. Fourth, spondylosis, unconvertebral arthrosis and

facet arthrosis in the cervical spine more prominent at the C6 level. Fifth, osteopenia advanced for her age. And sixth, the neural arch of C1 seemed incomplete.

Her lumbar report stated that they saw atherosclerotic calcific plaguing present within the abdominal aorta. It also stated she had baastrups kissing stenosis of the lumbar spine. Spondylosis and arthrosis at the lower thoracic and lumbar spine most prominent at L3. Also, spinal biomechanical alterations noted.

Red Flags: The calcific plaguing can be happening in any artery and the aortic artery has a branch to the left vertebral artery.

DEFINITIONS YOU NEED TO KNOW

Intercalary bones are common discal ossifications that are usually triangular in morphology, found in the anterior annular fibers of an intervertebral disc, and are thought to be degenerative in aetiology.


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QUESTION – HOW MANY RED FLAGS SHOULD YOU IGNORE? ANSWER, NONE

Osteophytes, commonly referred to as bone spurs or parrot beak, are bony projections that form along joint margins. They should not be confused with enthesophytes, which are bony projections that form at the attachment of a tendon or ligament.

Unconvertebral arthrosis is a term used to describe a specific form of osteoarthritis affecting the unconvertebral joints, more commonly known as the Luschka’s joints, located along the cervical vertebra.

Facet arthrosis is a term used to describe how the joint cartilage deteriorates – and joints depend on this cartilage to stay lithe and mobile.

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

Osteopenia refers to bone density that is lower than normal peak density but not low enough to be classified as osteoporosis. Bone density is a measurement of how dense and strong the bones are.

Baastrups syndrome (also referred to as kissing spines) results from adjacent spinous processes in the lumbar spine rubbing against each other and resulting in hypertrophy and sclerosis with focal midline pain and tenderness relieved by flexion and aggravated by extension.

According to an article written by the American Heart Association, abdominal aortic calcification deposits, detected by lateral lumbar radiograms, are a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality.

WHY I SAID NO

First, I asked the question why physical therapy hadn’t helped. Physical therapy was able to relieve her headaches but not the left sided neck pain.

Red Flag: Left neck pain since July and it is now January. Why?

Second, she relayed she had been having vertigo for the past two months that had not been discussed with any of her three medical professionals, only the physical therapist. She had an incident during physical therapy and the physical therapist performed a maneuver that helped. However, she experienced nausea and vomiting for about four hours that evening. She also stated that the vertigo could happen at rest and/or always seemed to happen when she turned her head to the right.

Red Flags: Only one out of four of her medical team knows she is experiencing vertigo and this needs medical clearance. The vertigo could be brought on at rest. The vertigo also happens when her neck is turned to the right. Is she impinging a nerve, artery or vertebrae? And why nausea and vomiting after the physical therapist relieved the vertigo?

Third, she says she feels like her head is fuzzy all the time and she can’t think.

Red Flag: Just ask the question why? Why is there less blood supply going to the brain?

Maybe she has a subluxation. These are questions for her neurologist or chiropractor.

Fourth, she is describing auras without headaches. Like she can see or experience a big circle sometimes.

Red Flag: Experiencing auras without headache is typically a vascular migraine symptom followed by a headache. This is another question for her neurologist.

OBJECTIVE FINDINGS

She is standing with her whole body rotating to the left. From the frontal view, her head is tilted more to the left. Her left eye looked more strained than her right eye. When I asked her to cover her left eye, her vision was more blurred on the right. When I asked her to cover her right eye, her vision remained clear. Flexion of the cervical spine was without pain or discomfort. However, extension of the cervical spine made her dizzy and gave her a sensation of an attack of vertigo. There was discomfort on the left side of the neck when side bending to the right. She had more cervical ROM looking to the right than she did looking to the left and there was pain on rotation to the left. Slight palpation of the right occiput and suboccipital muscles made her feel like she could experience vertigo and it was exquisitely painful.

Red Flag: Left eye strain and the difference in vision when covered. Extension of the cervical spine just slightly made her dizzy, too close to a positive vertebral artery test.

Here is the question of the day: Does she have the potential of vertebral artery insufficiency or stenosis? And how many red flags should you ignore? Answer, none. She needs medical clearance.

Let’s look at the signs and symptoms of vertebral artery stenosis or vertebrobasilar insufficiency. First, what is vertebrobasilar insufficiency? The vertebrobasilar arterial system is located at the back of your brain and includes the vertebral and basilar arteries. These arteries supply blood, oxygen, and nutrients to vital brain structures, such as your brain stem, occipital lobes, and cerebellum. A condition

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called atherosclerosis (which she has) can reduce or stop blood flow through the vertebrobasilar system. Arthrosclerosis is a hardening and blockage of the arteries. It happens when plaque that’s made up of cholesterol and calcium builds up in your arteries. The buildup of plaque narrows your arteries and reduces blood flow. Plaque can completely block your artery over time, preventing blood from reaching your vital organs. This can occur in any artery in your body. When it occurs in the arteries of your vertebrobasilar system, it reduces blood flow to structure in the back of your brain.

The symptoms of vertebrobasilar insufficiency vary depending on the severity of the condition. Some symptoms may last for a few minutes, and some may become

permanent.Sypmtoms might include:

• Loss of vision in one or both eyes.• Double vision.• Numbness and tingling in the hands or

feet.• Nausea or vomiting.• Dizziness (vertigo).• Slurred speech.• Changes in mental status, including

confusion.• Sudden, severe weakness throughout

your body, which is called drop attack.• Loss of balance and coordination.

CONCLUSION

She took the report to her chiropractor and he performed a more extensive test for vertebral artery insufficiency. At this time,

he didn’t believe she had this, but during the exam he did say to her, “no wonder you are having all these symptoms as you are incredibly subluxated at C2 and C3.” I got the call after her adjustment and she said it is amazing how clear she felt, with less pain and thanking me for taking the time to do the report. She is also taking the report to her neurologist. There may be more medical tests necessary to clear her for medical massage. Moral of the story: Trust your insight before applying your hands.

Printed with permission from Massage Today

April, 2016, Vol. 16, Issue 04

MNZ Call For RemitsMassage New Zealand is now calling for remits to be tabled at the Annual General

Meeting to be held in Auckland on Sunday 28th August 2016.

Remits must be received by 19th June, 2016.If you would like to request a change to the Constitution

please submit your request as outlined below, including a rationale.

Remit: That Clause (give clause number) of the Constitution be amended to read as follows:

“Give your suggested new wording for the clause”.

Rationale: Give the reason you feel the existing Clause needs changing and the reason your suggested new clause will be an improvement.

If you are posting a remit please send it to:

Executive AdministratorMassage New Zealand

PO Box 4131Hamilton East 3247

HAMILTON


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RIO 2016By Pip Charlton RMT

The 2016 Rio Olympic Games start on Friday 5th August and it is expected

that the New Zealand Olympic team will be the biggest ever. The New Zealand Health Team comprising of doctors and physiotherapists.will also include three RMT massage therapists; Annette O’Connor (Tauranga), Clint Knox (Akl) and Hans Lutters (Chch), with Yvette Latta (Dunedin RMT) as reserve. All three were part of the Health team to the last Commonwealth Games in Glasgow.

It is possible that several sports will take their own therapists to meet the needs of their athletes during competition, but details of these personnel have not yet been confirmed.

The commitment for the therapists is close to a month away from New Zealand, with time spent setting up the health rooms in the New Zealand accommodation apartment prior to athletes settling into the village. The clinic opens when the first athletes come into the village (around seven

days before the games start) and goes through to closing of the games themselves. A period spanning 2.5 weeks.

It is a very busy time for all of the Health Team with some long hours, but particularly for the massage therapists with the energy expenditure of their work. We wish them all well and look forward to hearing about their endeavours when they return.

REVIEW


TEDX ADELAIDE Lorimer Moseley

Australia’s Lorimer Moseley, Professor of Clinical Neurosciences and tireless pain researcher – presents a TED talk about a snake bite and pain neurology.

A must-watch for anyone with chronic pain, and the professionals who care for them.

https://www.youtube.com/watch?v=gwd-wLdIHjs

For more on Lorimer Moseleys work read:

Reconceptualising Pain According to Modern Pain Science

G. Lorimer Moseley

Oxford Centre for fMRI of the Brain, Department of Physiology, Anatomy and Genetics, Oxford University, Oxford, UK

ABSTRACT

This paper argues that the biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a

reconceptualisation of what pain actually is, and how it serves our livelihood. There are four key points:

(i) that pain does not provide a measure of the state of the tissues

(ii) that pain is modulated by many factors from across somatic, psychological and social domains

(iii) that the relationship between pain and the state of the tissues becomes less predictable as pain persists

(iv) that pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger

These issues raise conceptual and clinical implications, which are discussed with particular relevance to persistent pain. Finally, this conceptualisation is used as a framework for one approach to understanding complex regional pain syndrome.

http://www.bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/

ANATOMY TRAINS 3RD EDITION EBOOKThomas W. Myers

Churchill Livingstone, Elsevier

ebook 2016

$73.00 USD

You’ve been asking for it and now it’s here! Anatomy Trains 3rd Edition is now available as an eBook. Now you can take this holistic anatomy ‘encyclopaedia’ with you - conveniently digitised onto your favourite device, which gives you several advantages:

1: It’s an interactive electronic environment2: You get powerful search functionality3: Highlight useful passages, make notes,

and easily create presentations

The 3rd edition is fully updated and user-friendly. It includes new fascial research findings relevant to trainers and manual therapists, an expanded section on how the trains function in gait, and the new ‘Ipsilateral Functional Line’.

Retrieved fromAnatomy Trains facebook

REVIEWS


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MASSAGE THERAPY RESEARCH UPDATE

Welcome to the second issue of ‘Massage Therapy Research Update’

for 2016. For this issue, we have selected four articles related to pain in three different contexts: cancer pain, post-race recovery pain, and postoperative pain. All four articles support the role of massage therapy in managing pain and continue to build on the body of evidence in this regard. Thank you to the Southern Institute of Technology Bachelor of Therapeutic and Sports Massage programme for sponsoring this ‘Update’.

Kind Regards

Donna Smith PhD and Jo Smith PhDhttps://www.sit.ac.nz/nzmtrc

META-ANALYSIS OF MASSAGE THERAPY ON CANCER PAIN

Reference: Lee, S. H., Kim, J. Y., Yeo, S., Kim, S. H., and Lim, S. (2015). Meta-analysis of massage therapy on cancer pain. Integrative Cancer Therapies, 14(4), 297-304.

Link: http://ict.sagepub.com/content/14/4/297.full.pdf+html

Abstract/Summary

Cancer pain is the most common complaint among patients with cancer. Conventional treatment does not always relieve cancer

pain satisfactorily. Therefore, many patients with cancer have turned to complementary therapies to help them with their physical, emotional, and spiritual well-being. Massage therapy is increasingly used for symptom relief in patients with cancer. The current study aimed to investigate by meta-analysis the effects of massage therapy for cancer patients experiencing pain. Nine electronic databases were systematically searched for studies published through August 2013 in English, Chinese, and Korean. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) and Cochrane risk-of-bias scales. Twelve studies, including 559 participants, were used in the meta-analysis. In 9 high quality studies based on the PEDro scale (standardized mean difference, −1.24; 95% confidence interval, −1.72 to −0.75), we observed reduction in cancer pain after massage. Massage therapy significantly reduced cancer pain compared with no massage treatment or conventional care (standardized mean difference, −1.25; 95% confidence interval, −1.63 to −0.87). Our results indicate that massage is effective for the relief of cancer pain, especially for surgery-related pain. Among the various types of massage, foot reflexology appeared to be more effective than body or aroma massage. Our meta-analysis indicated a beneficial effect of massage for relief of cancer pain. Further well-designed, large studies with longer follow-up periods are needed to be able to draw firmer

conclusions regarding the effectiveness.

Comment: This study reports that massage therapy is significantly effective in relieving cancer pain, and builds on the systematic review of massage therapy for cancer palliation conducted in 2008. The interventions of the 12 included studies reported here involved body massage (7), foot reflexology (4) and aroma massage (1). Control interventions included conventional care but no massage treatment. The authors made a couple of recommendations worth noting:

First, use standard assessment scales that estimate pain intensity on a scale of 0 to 10 (with 0 indicating no pain and 10 indicating the worst pain patients have known). This standardisation would help when comparing study findings – a point worth thinking about when we design studies. Second, they recommend no-massage treatment or conventional care as the optional control-group setting, however they also suggest an option of including Sham Reiki as a control in future studies.

MASSAGE THERAPY DECREASES PAIN AND PERCEIVED FATIGUE AFTER LONG-DISTANCE IRONMAN TRIATHLON: A RANDOMIZED TRIAL

Reference: Nunes, G. S., Bender, P. U., de Menezes, F. S., Yamashitafuji, I., Vargas, V. Z., and Wageck, B. (2016). Massage therapy decreases pain and perceived fatigue after long-distance Ironman triathlon:

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a randomised trial. Journal of Physiotherapy, 62(2), 83-87.

Link: http://www.sciencedirect.com/science/article/pii/S1836955316000187

Abstract/Summary

Question: Can massage therapy reduce pain and perceived fatigue in the quadriceps of athletes after a long-distance triathlon race (Ironman)?

Design: Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors.

Participants: Seventy-four triathlon athletes who completed an entire Ironman triathlon race and whose main complaint was pain in the anterior portion of the thigh.

Intervention: The experimental group received massage to the quadriceps, which was aimed at recovery after competition, and the control group rested in sitting.

Outcome measures: The outcomes were pain and perceived fatigue, which were reported using a visual analogue scale, and pressure pain threshold at three points over the quadriceps muscle, which was assessed using digital pressure algometry.

Results: The experimental group had significantly lower scores than the control group on the visual analogue scale for pain (MD –7 mm, 95% CI –13 to –1) and for perceived fatigue (MD –15 mm, 95% CI –21 to –9). There were no significant between-group differences for the pressure pain threshold at any of the assessment points.

Conclusion: Massage therapy was more effective than no intervention on the post-race recovery from pain and perceived fatigue in long-distance triathlon athletes.

Comment: This is an easy to read study that again builds on the expanding literature support for the effectiveness of massage therapy for pain management. The study was based in Brazil and focused on pain reduction in the anterior quadriceps of male athletes who had just completed a 226 km ironman event. The massage intervention on the anterior thigh was 7 minutes long,

was outlined, but did not include rationale for strokes selected. It is also unclear who conducted the massage intervention; it may have been a physiotherapist. It could be worthwhile to build on this study from a massage therapist’s perspective. Dosage effects could also be further investigated.

EFFECT OF MASSAGE THERAPY ON PAIN, ANXIETY, RELAXATION, AND TENSION AFTER COLORECTAL SURGERY: A RANDOMIZED STUDY

Reference: Dreyer, N. E., Cutshall, S. M., Huebner, M., Foss, D. M., Lovely, J. K., Bauer, B. A., and Cima, R. R. (2015). Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study. Complementary Therapies in Clinical Practice, 21(3), 154-159.

Link: http://www.sciencedirect.com/science/article/pii/S174438811500050X

Abstract/Summary

The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients’ perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting.

Comment: This study took place in a large Midwestern medical center (USA). Integrative massage was provided by a certified massage therapist on postoperative days 2 and 3. The therapist also had 15

years’ experience working in a hospital setting. As the authors note “given the critical needs of many patients during the postoperative period, this level of experience was critical in assuring both the optimal efficacy and safety of the intervention” (p. 158). What was exciting to see was that “since the completion of this study, massage therapy has been made available to all patients at the medical center. It is now a valued part of the standard offerings to address pain and anxiety”. We wonder what we need to do as a professional body to help steer MNZ massage therapists to be able to engage in this type of massage therapy intervention. Research such as this may help, as may generating some NZ data. Engaging with other health professionals such as nurses and working in multidisciplinary research teams could also be beneficial.

A second study also points to research being done by other health professionals on the benefits of massage therapy (hand massage by nurses in this case) for postoperative pain. As a pilot study, it too “supports potential benefits of hand massage for intensive care unit postoperative pain management . . . this low-cost nonpharmacologic intervention can be safely administered” (p. 354).

Reference: Boitor, M., Martorella, G., Arbour, C., Michaud, C., and Gélinas, C. (2015). Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial. Pain Management Nursing, 16(3), 354-366.

Link: http://www.sciencedirect.com/science/article/pii/S1524904214001453


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We are pleased to announce preliminary details of the AGM

to be held in Auckland. The AGM and associated workshop is FREE to all MNZ members attending both sessions. This year we have a very interesting workshop on using a “whole person” approach in massage therapy - something important for all massage therapists to learn about. Please mark your calendars!

Please keep an eye out for more information about the AGM that we will be sending out. Booking details will be sent out shortly.

Date and Time: Sunday 28th August, 9.30am-4.30pmVenue and Location: Quality Hotel, Parnell, AucklandWorkshop: Developing a ‘whole person’ approach in massage therapy.Presenter: Brian Broom.

CPD POINTS/HOURS

Attending the workshop and AGM will give you 15 CPD points (10 hands-on and 5 non-hands on), or 6 CPD hours.

Members who attend the workshop only will receive 10 hands-on CPD points, or 3.5 CPD hours.

SCHEDULE

9.30am-1.00pm – Workshop1.00pm-2.00pm – Lunch break2.00pm-2.30pm – Website launch2.30pm-4.30pm – Annual General Meeting

WORKSHOP SUMMARY

The workshop will begin with a warm-up introductory talk which will include

pertinent case material and create a ‘whole person’ conceptual framework for the day’s discussions. Pre-prepared and spontaneous clinical situations from the audience will give rise to interactive whole group discussions, small group breakout sessions to focus up questions and reactions, theoretical teaching around the questions and participant reactions, gradual and safe handling of anxieties that may arise for participants, and skills teaching around what you do when you don’t know what to do etc. In this way the workshop will be participant-centred as much as possible.

PRESENTER BIO

Brian Broom is a senior physician in Clinical Immunology at Auckland City Hospital, and Adjunct Professor in the Department of Psychotherapy at AUT University, Auckland, New Zealand.

Dr Broom trained in medicine at the University of Otago. As a Medical Research Council (NZ) Training Fellow he studied in Birmingham, London, and Montreal, returning in 1976 to the Christchurch School of Medicine to set up the Department of Clinical Immunology. In 1981 he diverged into psychiatry, ultimately becoming a psychotherapist, and in 1987 set up a multidisciplinary centre in Christchurch, oriented to whole person care, in which he personally combined medical and psychotherapy practices. He is now nationally and internationally recognised for his whole person approach to all physical disorders and presentations, for modelling and teaching the advantages of multifactorial, multidimensional perspectives, and for showing clinicians, whatever their discipline, how they can expand their

clinical approach to be more effective. He has specific experience working with massage therapists.

He has written three books, for health professionals, addressing the role of mindfactors in physical illness, and developed a post-graduate Masters programme at AUT University, (re)training all kinds of clinician to be whole person-oriented in their ordinary day-to-day clinical practices. In 2015 he was finalist for Senior New Zealander of the Year in recognition of this work.

ACCOMMODATION

MNZ has negotiated a room rate of $143 incl. gst per night for a King Standard room (can be 2 single beds). Book directly with the Quality Hotel, Parnell.

Quote reference 2573583. All bookings are subject to availability at the time of booking.

Ph: 09 303 3789W: www.theparnell.co.nz

REGISTRATION

To register for the AGM and workshop, please contact:

Odette Wood, Executive [email protected] 778 2954

Closing date for registrations: 15th July, 2016

For any enquiries, please contact the Executive Administrator [email protected]

2016 MNZ ANNUAL GENERAL MEETING

CONFERENCES


2017February 7 - 14

3rd Annual San Diego

Pain Summit

San Diego, CA

Meet the speakers here: http://sandiegopainsummit.com/

Feldenkrais for Massage TherapistsSunday 19th June4 hour day$105

Massage for CancerThursday 28th July + Friday 29th July6 hour days$245

www.massagecollege.ac.nz - CE CoursesContact Nelie: [email protected] | 04 385 8400

CE Courses at NZCM

®

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