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by Greg Morling
The vertebral column was originally designed to act as an arch. Take a look at the monkeys and gorillas who inspect us as we wander the zoo. When we became upright, the spine had to act as a weight – bearing column. Anthropologist from the University of Missouri, Carol Ward (2010), explains that to support our head and balance our weight directly over hip joints and lower limbs, the spine evolved as a series of S curves – a deep forward curve, a lordosis, in the lower back, and a backward curve , or kyphosis, in the upper back.’
This change didn’t happen overnight! It took place at least four million years ago, probably earlier.
This system of S curves is energetically efficient and effective for maintaining our balance and for bipediality. The ‘arch’ became the ‘curved column’ and brought with it associated problems, including a greater possibility of back pain. The pay-off was the ability to see threats from wild predators lurking in tall grass and the capacity to travel further distances with babies, food and other resources in our arms. We were also now able to reach hithero inaccessible fruits.
The lower region of the spinal column suffers from the pressure and oblique forces exerted on its curved structure by our upright posture. These forces are not so intensely present in our ancestral ape friends at the zoo.
There is only one muscle that joins the vertebral column to the legs; the iliopsoas. It is reasonable to assume then that this muscle would be intimately involved with the biomechanical changes that accompanied bipediality and the need for spinal curves.
Nik Bogduk (1997), the leading medical scientist in biomechanical discoveries relating to the iliopsoas provides evidence that iliopsoas, ‘plays only a small role in the action of the spine’, and goes on to discuss how much pressure derives from iliopsoas compression loads on the lumbar disc. These forces, particularly at the lower lumbar area are one major cause of back pain. There is certainly a downside to upright! Bogduk’s work also presents a possible challenge to the long held belief that the major role of the iliopsoas is hip flexion.
Considering that so much more balance is necessary to walk on two legs as opposed to four, stability of the spinal column provided by the iliopsoas could be considered a more important role for this muscle. This is one area that we explore in my practical workshops focused on the iliopsoas.
Tactile procedures aimed at giving these highly stressed iliopsoas connection points a ‘rest’ may lead to a more speedy recovery for an aching back.
I will be asking a friend of mine at the Sydney Taronga Zoo if his simian (monkey) charges have complained of back pain at all. There is a good chance that they have not and are probably ‘lucky monkeys’ unlike us bipeds! who rely so much on the integrity of our iliopsoas to keep us stable and free of the dreaded pain in the back .
References
Ackerman, J. (2006) Carol Ward quoted in ‘The Downside of Upright’ National Geographic July, 2006
Bogduk, N. (1997) Clinical anatomy of the lumbar spine and sacrum, 3rd edition Churchill Livingstone, Edinburgh
Greg Morling
Several years ago I was at dinner in the United States with the Benny Vaughn, the great American sports massage therapist. I reminded him that we had both been speaking at a massage conference in Melbourne in 1998 and he had explained to me that we (massage therapists) all do basically the same thing. Around our table were James Waslaski, Erik Dalton and my friend, Whitney Lowe. They all agreed with Benny’s assessment.
I have reflected on Benny’s words from that time to this article. What do we do as massage therapists and what are the common elements in all our work?
As massage therapists we all touch. This statement may not seem so earth-shattering but the quality of the tactile experience we create for our client may well be the reason why they return to your practice. The communications we transmit through touch constitute the most powerful means of establishing human connection and it is the mother of the senses; the first to come into being and the parent of our eyes, ears, nose and mouth.
We would do well to remember that despite the sometimes myopic focus on the study of musculature in our massage schools and colleges we never touch muscle directly in our careers as therapists.
We affect only superficial muscle but we touch skin.
The more time I spend in the dissection laboratories at the University studying the iliopsoas in situ, the closer I come to understanding the significance of the skin and the role it plays in our success as therapists.
Ashley Montagu wrote in his masterful bestseller, Touching: The Human Significance of the Skin that, ‘on our skin, as on a screen, the gamut of life’s experiences is projected: emotions surge, sorrows penetrate, and beauty finds its depth.’
The surface area of the skin has an enormous number of sensory receptors receiving stimuli to heat, cold, touch, texture, pressure and pain. A piece of skin the size of a thumb nail contains more than 3 million cells, 100 to 400 sweat glands, 50 nerve endings and a metre of blood vessels. It is estimated that there are some 50 receptors per 100 millimetres, a total of 640,000 sensory receptors. Tactile points vary from 7 to 135 per square centimetre. The number of sensory fibres from the skin entering the spinal cord by the posterior roots is well over half a million. This amazing sensory pad, this skin, is what you influence with massaging hands before influencing any muscle.
I would argue that the messages you provide through your touch is as therapeutically important as any friction, stretch or muscle manipulation. We spend lots of our time focused on the biomechanical paradigm but the quality, style and intent of our touch is the thing that matters most and matters first.
Compared to the other senses, touch is very hard to isolate because tactile sensory information enters the nervous system from every single part of the body. As a result, very little research has been done on touch. However, recent studies have attempted to map how the sense of touch works and how a simple stroke of the skin can alter an individual’s health and behaviour.
I am an advocate for both positive intent and quality of touch when you massage.
The function of the skin includes protection, thermoregulation (10% of our blood supply is contained in the skin’s dermis layer), excretion and absorption.
There is not scope in this article to explore in detail the function of the skin but as tactile therapists we need to be aware of the significance of touch and how our intent in therapy and our quality of touch in clinic may well be the thing that leads to more rapid and lasting positive results for our clients.
Benny Vaughn pointed out to me that we all do the same thing. Perhaps he was talking about the issue of touch and not the myriad of techniques and styles we see today. We will certainly explore some of these issues during my workshops in the UK this year.
Article by Natalie Millan
Abstract
After a brief discussion of the task of a therapist, and what involves general public expectation, a professional framework is identified. This paper addresses how risk-management is relevant to the massage therapist within their clinical practice. An at-risk example within the daily work of the therapist is examined and leads to discussion centered on the client/therapist paradigm. It discusses boundary violation and the concept of boundaries relating to behaviour.
The author demonstrates how an ethical frame of reference is the key to assessing risks. The purpose of the paper is to show how the integrity of a massage therapist and their industry cannot afford to ignore risk-management education. The overall goal is to introduce concepts to help therapists work from a professional base as they move forward in a growing industry.
Massage therapy
Diana, an Indian woman aged thirty-five, is a marketing consultant and had been involved in a motor vehicle accident. She chose to visit a massage therapist for assistance with her lower back. The disabling pain had put a distressing halt to her dynamic life, including avid gym training and running.
Diana had spent eight months enduring consistent physiotherapy and slowly rebuilt her exercise lifestyle. She appreciated the first three appointments of remedial massage that helped her maintain her gains. Diana wanted to measure those gains out on her old running track that coming spring!
At the fourth appointment, the therapist briefly discussed how massage is turning into a maintenance treatment, which will use a broader approach. Diana understood this to mean the strokes would not be so painful. At one stage the therapist stopped massage, simply placing hands on Diana’s lower back; making her question what the therapist was doing. When the therapist explained that Reiki would help her, Diana requested ‘No Reiki – just massage’ to be performed so the therapist moved on to broader strokes. More on this later.
Boundaries and space
All therapists who treat human health must maintain boundaries. The massage therapist will be considered the professional in the public eye, as they are the client. It does not matter how interpersonal the role.
Boundaries are imperative when working within the intimate space of a client. Risk-management increases when a client’s private space, (physical, emotional and spiritual energies) have been entered into. The sacred space of human energy is to be treated with the utmost of care and respect as the therapist assists their healing process.
This very outlook is also the therapist’s ally if a client disrespects therapist space and the service they deliver through it. Trust and rapport are imperative for the client. Diligence and astuteness are imperative for the professional, equally for their personal safety.
So why didn’t Diana book a fifth appointment with the massage therapist?
At that fourth session, Diana drifted into a relaxed state; the therapist once again slowed down the massage component and simply rested hands on Diana’s shoulders. This ‘resting’ broke the continuity of rhythmic touch and Diana’s drift. In asking why this was being done, the therapist assured Diana that Reiki is what will help her. Rather than being professionally informed of this incorporated modality, Diana learnt of it haphazardly. First mistake.
When Diana did inadvertently learn of it, she specifically stated she didn’t want Reiki to be performed, because she had booked remedial massage. The therapist minimised this clear request. Second mistake.
To intrude on anyone’s personal space without permission and especially disregarding a client’s request, is rude and violating. Personal space includes spiritual energy to be the most sacred of all the energies. Diana lost complete trust in this therapist, hence no further bookings. Diana made no recommendations despite her opportunity to do so. Harsh?
Discussion
Importantly, the issue?was not Reiki as a modality. Many health workers, to include the author, are advocates for and are the recipients of energy based complementary therapies and their therapeutic benefits4.
It is held in high esteem that improving health and caring for others are a therapist’s underlying values. These values drive professionals to assist their clients quality of living. Having the opportunity to assist a client reach a strengthened pain free goal gives any professional in health their career satisfaction. The issue at hand is the intrusion on a client’s personal space without informed consent or permission.
Therefore the above example shows simple mistakes that demonstrate a therapist’s enthusiasm for her craft but lack of professionalism and respect for simple ethics. It is such acts of omission that open the door for boundaries to become clouded. The risk of stretching the boundary of consented modalities was loss of client and loss of recommendation. If the therapist in question plans to maintain a strong rapport and good reputation they must work from a professional based skill-set.
Risk-management
The aim of the previous example was to demonstrate how direct communication is part of a therapist’s professional framework that protects the client’s energy and their own. Extensive research is continually being updated surrounding risks in business, professional practice, public expectation and personal safety1.
This paper identifies one aspect of risk-management surrounding massage therapists to involve boundary recognition. The need for boundaries is not simply to align to governing ethical requirements; it is to reduce a therapist’s potential for at-risk situations.
Like ethics, the term boundary is still too broad when identifying therapist risk. Boundaries can range from a macro and basic practice-management to the micro interpersonal disciplines surrounding over-identifying with a client, personal and professional integrity. With risk-management therapists can further define and discuss boundaries using risk-context.
Risk-context
The discussed example showed the key problem related to risk-context was the therapist being too enthusiastic to use a technique she associated with. In any given treatment, if this keenness occurs (more than once in Diana’s case); the therapist is not working from an ethical frame of reference, that shouts the principle of competency. Likely, the therapist is working out of eagerness and personal opinion or influence. Enthusiasm can have a downside, that being; it can ignore the use of a client-centered care approach.
Simply stated, risk-context means that you don’t take up every opportunity that presents itself to you just because you can. For the professional working from an ethical frame of reference, it is a given when decision-making to ask yourself ‘what are the risks?’
Let’s put risk-context another way
If a therapist has just completed a post-graduate in a specific technique, chances are they will use that technique at every opportunity. Here we join risk-context with ethics by addressing behaviour. A blind-spot can occur for the therapist when they do not assess the risks and the appropriateness of using their professional skills. If boundaries are ignored, it is considered an unethical behaviour. The professional is to be mindful that risks lead to consequences that lead to negligence.
If blind-spots are occurring in a clinical practice, they show how the involved therapist has found that although reading about principles in ethics is simple, the difficulty lies in their application. Realistically speaking, most therapists in private practice are on their own when dealing with their risks. However, the constructs of isolation, competition, multicultural society, cultural and technical diversity give reasons for massage therapists to work with the commonality of a professional ethical framework6.
The practice of effective risk-management is not a professional instinct; it is a learnt skill that involves respect toward professional power. Even when competency in technical skill is evident, competency in client-based care involves discipline when administering this professional power. Addressing risk-context shows the therapist how the professional weights their personal enthusiasm toward modalities, techniques and opinions with professional appropriateness2.7.
Until now ethics has been stereotyped as boring and authorative, seen to only serve the governing body and/or legal business requirements. Therapist disinterest in ethics is potentially due to the lack of education on how ethics can benefit them. Notably the ability to educate correct and useful strains of ethics has also contributed to therapist complacency, which has been found throughout the helping professions3.
Currently, massage therapists are intuiting a greater need for sound education in ethics, to assist their growing practices and risk-management strategies.
General public expectation
One explanation for the growth of the massage therapist’s practice is their ability to work within complementary therapy and conventional medicine. Many forums have been structured to discuss how to integrate the two disciplines which many massage therapists have attended. Recently one municipality held a forum for the public. It was run by a business networking group. Their forum was on conventional versus complementary treatment and public opinion.
The outcome observed was a strong demand for trusted therapists to be available from local doctors. Albeit one networking group, it typified public expectations strongly calling for well-being integration with an emphasis on whom they can trust.
It showed how the general public hold greater reliance on complementary therapies and use trusted recommendations. This forum also brought to light that currently, the key modality conventional medicine will refer to is massage therapy, making therapists (with a sound and trusted reputation) the high contender for referral from General practitioners.
The downside to increased public demand is generally, therapists do not know how to address the difficult at-risk situations that may occur in their practice5. Yet with greater public expectations on massage therapists, there is greater risk for therapist burnout. This reinforces how an ethical therapist must seek out education that shows how to reduce burnout by monitoring major and minor risks. Such strategies will show that the key to risk-management is regular clinical appraisal and self-reflection.
Looking toward the future
Massage therapists are seeing the results of public education with increased clientele. The public have become educated in personal health and are more scrutinizing in the therapists they will trust. Our younger generations are being taught about well-being within their educational systems, potentially increasing the demand on complementary therapies further.
With the generations to come, both public and professional, the therapist who survives will have built a trusted reputation. They will have overcome a stereotypical mind-set towards ethics3. The modern massage therapist will embrace a professional and ethical framework that shows veracity and integrity toward their profession, toward other professionals, to the public and importantly toward themselves.
To conclude
As therapists we all are vehicles to assist clients in regaining their health, well-being and quality of life. Modality and specialty practised by the therapist notwithstanding. The commonality lies in capturing an opportunity to care for another person and to support them. Such an opportunity is a privilege and a responsibility all professionals providing a health service are to take very seriously. This same seriousness applies when intimately working with clients. Your professional base stems from a solid ethical frame of reference that reduces at-risk concerns, regardless of public expectations and client types. n
References:
- Australian and New Zealand Risk Management Key Steps. www.riskmanagement.com.au sighted 20/6/2008.
- Brody, H. (1992). The healers power. New Haven. Yale University Press.
- Corey, G., Schneider-Corey, M. and Callanan, P. (2007). Issues and Ethics in the helping Professions. 7th ed. Belmont, C.A. Thomson Brooks/Cole.
- Crellin, J., and Ania F. (2002). Professionalism and Ethics in Complementary and Alternative Medicine. Binghamton, NY. The Haworth Integrative Healing Press, an imprint of The Haworth Press, Inc.
- Egan, G. (2002). The Skilled Helper. A problem-management and opportunity-development approach to helping. 7th ed. Brooks/Cole.
- McBride, N., and Tunnelcliffe, M. (2002). Risky Practices. A Counsellor’s guide to risk management in private practice. Palmyra. W.A. Bayside Books.
- Peterson, M.R. (1992). The Professional’s struggle with power. At Personal Risk. New York. W.W. Norton and Company. pp50-71.
Natalie Millan is an advocate for healthy esteem and is the author of Professional Esteem a practical guide to ethics and risk-management; the new series release for 2008. Her second book Professional Esteem – ethical energy is currently in print. Natalie is an educator in communications and ethics and has 20 years experience as a massage therapist. She volunteers her services for the committee of the A.A.M.T and is currently developing workshops for therapists on risk-management. View Natalie’s profile at www.healthyesteem.com.au.
This Ezine will replace the printed editions of Mostly Massage Magazine.
In addition to publishing new articles and information we will gradually add the back catalogue of Mostly Massage Magazine articles.
Article by Jason Patten
Virtually every culture throughout history has used some combination of manual therapies, herbal products, water, heat and physical surroundings to create rituals and therapies aimed at achieving health, beauty and rejuvenation. It seems that these practices have now found a melting pot with the emergence of the spa industry (now considered by many to be the ‘spa and wellness’ industry). This industry, which has massage as its core offering, has adopted ‘wellness’ as a new mantra and has become a global phenomenon that is part of a trillion dollar wellness revolution.
It seems that 2008 has seen the wellenss industry come of age with many landmark developments (see table). A report released in May at the Global Spa Summit in New York on the Global Spa Economy(1) suggests that global revenue from spas in 2007 was worth more than US$255 billion globally. Of this massage and other direct spa services accounted for US$48 billion. The report further estimates that in 2007 the wider wellness industry which was worth an additional US$1.1 trillion.
Understanding the Global Spa Industry
While the spa and wellness industry has been growing steadily over the past 2 decades, it has been constrained by a lack of comprehensive information about the industry and the associated business models. The lack of quality information about the wellness industry has been partly addressed by the
release this month of the first comprehensive text on the global spa industry titled “Understanding the Global Spa Industry”(2). This text written by a team of 30 internationally renowned business leaders, practitioners and academics from 10 countries and edited by Prof Marc Cohen from RMIT university and Prof Gerry Bodeker from Oxford University covers everything from the beginnings of the industry through to the size of the market, typologies, marketing, branding and business models to contemporary management practices and social and ethical issues.
This text arose out of a conversation at the first Spa Asia Wellness Summit between the editors where they noted that the spa and wellness industry did not appear on the academic ‘radar’ despite it being a sizable public health phenomenon. It certainly does seem surprising that there could be a $255 billion/year industry that does not have any dedicated texts devoted to it. This is partly due to the fact that spa and wellness is a convergence of many existing industries such as hospitality and tourism, hotel management, natural and complementary medicine, massage, fitness, nutrition, beauty, design, media, and property development, all of which have their own cultures, business models and educational programs. As these existing industries converge they have created the spa and wellness industry which can now be seen to be a unique industry in its own right.
While the lack of quality information about the spa and wellness industry has constrained its growth by making it invisible to investors, policy makers and other potential stakeholders, the industry has also been constrained by a global labour shortage. There simply aren’t enough trained therapists and managers around to cope with the demand and there is a shortage of highly trained people to act as industry leaders. As a consequence there has been a lack of managers who understand the intimate, high-touch nature of the industry and a steady lowering of the educational standards for therapists to enter the industry,. There ahs also been a global competition for therapists and a corresponding movement of workers from developing countries in Asia to the Middle East and other regions that can offer more attractive remuneration packages.
Masters of Wellness
To support the need for high level leaders RMIT University has just launched a new Master of Wellness program (see www.rmit.edu/health-sciences/wellness). This program has been designed to provide graduate students for diverse backgrounds with a holistic overview of wellness and produce highly skilled practitioners and managers who will lead the wellness revolution and contribute to solutions to living ‘well’ on the planet. The Program also aims to positively impacting on students’ personal health and wellbeing and uses cutting edge educational technology and the latest understanding about adult teaching and learning to deliver a fully online program with a global reach.
As the wellness industry is extremely diverse RMIT’s Master of Wellness program is designed to cater for students from a wide variety of educational backgrounds. Thus, rather than restricting entry into the program to students with a health sciences background, the program is open to anyone with an undergraduate bachelor degree or an Advanced Diploma and 3 years industry experience. The program caters for the needs of different students by offering a wide range of electives that include business courses (eligible students can use these to gain credit towards an RMIT Master of Business Administration) as well as courses on ‘Food as Medicine’, “Herbs and Supplements’, ‘Sustainability’, and ‘Integrated Eastern Anatomy’. There are plans to extend the range of electives each year to include other areas such as design, yoga and fitness instruction.
What is Wellness?
The development of a postgraduate Wellness program suggests that wellness is emerging as a new academic discipline. Yet ‘wellness’ is a vague concept that is still evolving. Wellness is a holistic, multidisciplinary concept that includes personal wellbeing, health and happiness, along with sustainability, corporate social responsibility, policy, social justice, environmental responsibility, human security, ethical and spiritual dimensions. As yet, wellness has no rigorously developed definition, theory or philosophy of wellness although a suggested definition is: “Wellness is the multidimensional state of being “well”, where inner and outer worlds are in harmony: a heightened state of consciousness enabling you to be fully present in the moment and respond authentically to any situation from the “ deep inner well of your being ”. Wellness is dynamic and results in a continuous awakening and evolution of consciousness and is the state where you look, feel, perform, and stay “well” and, therefore, experience the greatest fulfilment and enjoyment from life and achieve the greatest longevity.” (3)
Wellness on the World Stage
In addition to the emergence of the global spa industry, wellness appears to be gaining prominence on the world stage. At the World Economic Forum Annual Meeting, in Davos, in January 2008, workplace wellness programs were discussed and the results of a collaboration between the World Economic Forum and the World Health Organisation were released which suggested that workplace wellness programmes are a real yet under-exploited opportunity to tackle the growing world-wide epidemic of chronic disease and presented a call for action to raise employee health on the corporate agenda(4). This coincides with a report from PriceWaterHouseCoopers titled “Working Towards Wellness”(5) that suggests that large multinational corporation are now looking for wellness strategies to implement in their workplaces and the communities in which they operate.
While there are moves towards bringing wellness into the corporate sector, there are also suggestions that a wellness agenda needs to infiltrate the health system. In another report by PriceWaterHouseCoopers titled “Healthcast
2020”(6) it is suggested that current healthcare systems will become inherently unsustainable over the next 15 years and that new systems must emerge that are more consumer focused and directed towards preventive care. These sentiments are echoed in the recent Australia 2020 Summit with the Health Report from the Summit(7) featuring wellness as a major strategy directive for future health policy.
It seems clear that over the next few decades there are many factors that will impact on personal, community and global wellbeing. Changing global demographics along with major societal changes brought about by climate change and technological innovations such as telemedicine and initiatives such as Googlehealth (7) will forever change how humans live and implement wellness strategies. These changes bode well for the future of those in the wellness industry and hopefully for the future of our species.
New Wellness Related Initiatives in 2008
- • Launch of the Master of Wellness program at RMIT University
- • Publication of Understanding the Global Spa Industry
- Release of the Working Towards Wellness report at the World Economic Forum
- Establishment of the National Institute of Complementary Medicine
- Allocation of dedicated funding to Complementary Medicine by the NHMRC
- Establishment of the Australian Massage Research Foundation
- Release of the Australia 2020 Summit report
- Release of the Global Spa Economy Report
- Establishment of the Australian Teachers of Meditation Association n
References
- SRI International (2008), The Global Spa Economy 2007, Global Spa Summit, New York
- Cohen, M. & Bodeker, G. (Eds) (2008) Understanding the Global Spa Industry, Butterworth Heinemann, Oxford
- Cohen, M. (2008) Wellness Spas and Human Evolution; In Cohen, M and Bodeker, G., (Eds) Understanding the Global Spa Industry, Butterworth Heinemann, Oxford (2008)
- See http://www.weforum.org/en/initiatives/Wellness/index.htm
- PriceWaterHouseCoopers (2007) Working Towards Wellness: Accelerating the Prevention of Chronic Disease, World Economic Forum, available at: http://pwchealth.com/cgi-local/hregister.cgi?link _reg/wellness.pdf
- PriceWaterHouseCoopers (2005) HealthCast 2020: Creating a Sustainable Future, available at: www.pwc.com/il/heb/about/svcs/publication/alerts/2HealthCast_2020.pdf
- Good, M,& Roxon N., A long-term national health strategy: The Health Report from the Australia 2020 Summit available at:
http://www.australia2020.gov.au/final_report/index.cfm
- Googlehealth see https://www.google.com/health/p/ also see a 50 min video of Eric Schmidt at a healthcare conference outlining GoogleHealth features available at: http://www.youtube.com/watch?v=dTZKNcx9sBA
Article by Simon Blow
To help initiate the healing process in others, it’s important that our own energy system is flowing smoothly. Exercising of our physical body as well as our internal body and regular meditation practice are important prerequisites to working successfully over the long term in the healing industry.
All traditions have a system of self maintenance and the basic principles are similar. I personally discovered the Chinese tradition while I was recovering from a major car accident. I suffered over 25 fractures below the hips and multiple fractures to other parts of my body. I sustained severe head injuries and nearly died more than once. I spent 15 weeks in hospital, the first nine in a semi-conscious state. This experience left me to walk a very tough road, but I found inspiration in the obstacles that lay in my path.
I commenced studying Tai Chi in 1987 and found many benefits in this practice, but I was mainly interested in the spiritual aspect and this lead me deeper into the study of Qi (Chi) and Qigong.
Qi, pronounced ‘Chi’, is the foundation for Taoist thinking and Traditional Chinese Medicine (TCM). Taoist Master Hua-Ching Ni, in the book Tao – The Subtle Universal Law and The Integral Way of Life, explains, “Chi is the vital universal energy which composes, permeates and moves everything that exists. Chi may be defined as the ultimate cause and, at the same time, as the ultimate effect. Chi is the ultimate essence of the universe as well as the law of all movement. When Chi conglomerates, it is called matter. When Chi is diffuse, it is called space. When Chi animates form, it is called life. When Chi separates and withdraws from, it is called death. When Chi flows, there is health. When Chi is blocked, there is sickness and disease. Chi embraces all things, circulates through and sustains them. The planets depend on it for their brightness, weather is formed by it, and the seasons are caused by it.” So, it is Chi, or vital energy, that activates and maintains all life. Chi animates all processes of the body: the digestion and assimilation of the food we eat, the inhalation and exhalation of air by the lungs, the circulation of the blood, the dissemination of fluids throughout the body and, finally, the excretion of waste products of the metabolism.”
Qigong, pronounced Chi-Gung, is one of the great treasures of Chinese culture and is one of the components of the holistic system of Traditional Chinese Medicine (TCM). Its origins trace back to the Tangyao period of 4,000 to 5,000 years ago. It was clearly outlined in the book Huangdi Neijing or The Yellow Emperor’s Internal Canon of Chinese Medicine, which originally dates from 2500 BC and was published from 500 BC. These theories of Traditional Chinese Medicine are still used today. Medical books published from the Han Dynasty, 200 BC, show detailed theory and clinical practice of Qigong techniques for treating disease and improving health. Silk scrolls known as the Daoyin Diagrams unearthed in the year 1972 at an archeological dig in Changsha, China show detailed illustrations of Qigong exercises and have been dated to 168 BC. From ancient to modern times, Qigong self healing exercises have been used to help improve people’s quality of life.
Qigong is a relatively new term, used since the early 1900s to describe all the Chinese energy or Qi techniques. Qi or Chi is a term meaning ‘life force energy’ that flows through the energy system or meridians in the body and connect with the energy of the universe. Gong or Gung translates to work, mastery or skill, literally, a way of working with the energy of life. There are three main categories – Martial, Medical and Spiritual.
The art of Qigong consists primarily of meditation, relaxation, physical movement, mind-body integration and breathing exercises. There are thousands of different styles and systems, either done standing, moving, walking, sitting or lying. Tai Chi is one popular style.
For thousands of years, millions of people have benefited from Qigong practice. In Traditional Chinese Medicine, good health is a result of a free-flowing, well-balanced energy system. Ailments both physical and emotional occur when the flow of Qi is blocked or impeded, causing imbalance and dysfunction in the body’s energy system. With regular practice, Qigong helps to cleanse the body of toxins, restore energy, and reduce stress and anxiety, and assists individuals to maintain a healthy and active life.
Qi is a flowing energy and is often compared to water. When water flows through a river system, the environment, plants and animals gain nourishment from this fresh energy supply and will be in good health. When this flow of water becomes blocked or stagnates, the environment around it suffers. I don’t think there is good and bad energy – it’s all just energy. Similarly, after rain, the stagnant water flows again through the network of channels, streams and along the major rivers giving life again to the environment. Our own body is a micro representation of our environment and works similarly to the river system. With the correct approach, we can cultivate and transform the stagnant energy in our body into fresh sustaining energy. This flow of energy or Qi in our body is directly related to our posture and body movements, breath and mental condition. When the mind, body and breath are in harmony, our Qi will also be in harmony. It will flow naturally through the energy channels or meridians of the body and with loving kindness, we as conscious beings are able to let our energy merge with the energy of the universe.
Is Qigong a spiritual practice?
It’s a good question, because the understanding of spirituality is different to all of us. There are many variables that depend on our background and culture, even the type of work we do. But what is clear to me is that through the process of work, or ‘Gong’, we are able to refine our energy or ‘Qi’, clearing the blockages. This calms the emotions and helps us become aware of ourselves as a living spirit in physical form. Then we can express ourselves as a spirit and use our energy or Qi to contribute to the development of the human race.
I haven’t worked it all out – life is an ongoing journey, but I get many ideas and positive feed back from students and the people I meet. I’m not sure if we have original ideas or if, when the heart opens and the Qi flows, we are simply all one.
Simon Blow has been a full time professional teacher (Laoshi) for over 15 years. A near fatal accident at the age of 19 lead Simon to investigate various methods of healing and rejuvenating, a path he has followed for over 25 years. He has received training and certification from Traditional Hospitals and Taoist Monasteries in China and has been given authority to share these techniques. Simon has received World Health Organisation Certification in Medical Qigong clinical practice from the Xiyuan Hospital in Beijing and has been initiated into Dragon Gate Taoism and given the Taoist name of Xin Si, meaning Genuine Wisdom. He is also a Standing Council Member of the World Academic Society of Medical Qigong, Beijing China.
Contact:
Phone +61 2 9716 4696
simon@simonblowqigong.com
www.simonblowqigong.com
Article by Natalie Millan
Abstract
After a brief discussion of the task of a therapist, and what involves general public expectation, a professional framework is identified. This paper addresses how risk-management is relevant to the massage therapist within their clinical practice. An at-risk example within the daily work of the therapist is examined and leads to discussion centered on the client/therapist paradigm. It discusses boundary violation and the concept of boundaries relating to behaviour.
The author demonstrates how an ethical frame of reference is the key to assessing risks. The purpose of the paper is to show how the integrity of a massage therapist and their industry cannot afford to ignore risk-management education. The overall goal is to introduce concepts to help therapists work from a professional base as they move forward in a growing industry.
Massage therapy
Diana, an Indian woman aged thirty-five, is a marketing consultant and had been involved in a motor vehicle accident. She chose to visit a massage therapist for assistance with her lower back. The disabling pain had put a distressing halt to her dynamic life, including avid gym training and running.
Diana had spent eight months enduring consistent physiotherapy and slowly rebuilt her exercise lifestyle. She appreciated the first three appointments of remedial massage that helped her maintain her gains. Diana wanted to measure those gains out on her old running track that coming spring!
At the fourth appointment, the therapist briefly discussed how massage is turning into a maintenance treatment, which will use a broader approach. Diana understood this to mean the strokes would not be so painful. At one stage the therapist stopped massage, simply placing hands on Diana’s lower back; making her question what the therapist was doing. When the therapist explained that Reiki would help her, Diana requested ‘No Reiki – just massage’ to be performed so the therapist moved on to broader strokes. More on this later.
Boundaries and space
All therapists who treat human health must maintain boundaries. The massage therapist will be considered the professional in the public eye, as they are the client. It does not matter how interpersonal the role.
Boundaries are imperative when working within the intimate space of a client. Risk-management increases when a client’s private space, (physical, emotional and spiritual energies) have been entered into. The sacred space of human energy is to be treated with the utmost of care and respect as the therapist assists their healing process.
This very outlook is also the therapist’s ally if a client disrespects therapist space and the service they deliver through it. Trust and rapport are imperative for the client. Diligence and astuteness are imperative for the professional, equally for their personal safety.
So why didn’t Diana book a fifth appointment with the massage therapist?
At that fourth session, Diana drifted into a relaxed state; the therapist once again slowed down the massage component and simply rested hands on Diana’s shoulders. This ‘resting’ broke the continuity of rhythmic touch and Diana’s drift. In asking why this was being done, the therapist assured Diana that Reiki is what will help her. Rather than being professionally informed of this incorporated modality, Diana learnt of it haphazardly. First mistake.
When Diana did inadvertently learn of it, she specifically stated she didn’t want Reiki to be performed, because she had booked remedial massage. The therapist minimised this clear request. Second mistake.
To intrude on anyone’s personal space without permission and especially disregarding a client’s request, is rude and violating. Personal space includes spiritual energy to be the most sacred of all the energies. Diana lost complete trust in this therapist, hence no further bookings. Diana made no recommendations despite her opportunity to do so. Harsh?
Discussion
Importantly, the issue?was not Reiki as a modality. Many health workers, to include the author, are advocates for and are the recipients of energy based complementary therapies and their therapeutic benefits4.
It is held in high esteem that improving health and caring for others are a therapist’s underlying values. These values drive professionals to assist their clients quality of living. Having the opportunity to assist a client reach a strengthened pain free goal gives any professional in health their career satisfaction. The issue at hand is the intrusion on a client’s personal space without informed consent or permission.
Therefore the above example shows simple mistakes that demonstrate a therapist’s enthusiasm for her craft but lack of professionalism and respect for simple ethics. It is such acts of omission that open the door for boundaries to become clouded. The risk of stretching the boundary of consented modalities was loss of client and loss of recommendation. If the therapist in question plans to maintain a strong rapport and good reputation they must work from a professional based skill-set.
Risk-management
The aim of the previous example was to demonstrate how direct communication is part of a therapist’s professional framework that protects the client’s energy and their own. Extensive research is continually being updated surrounding risks in business, professional practice, public expectation and personal safety1.
This paper identifies one aspect of risk-management surrounding massage therapists to involve boundary recognition. The need for boundaries is not simply to align to governing ethical requirements; it is to reduce a therapist’s potential for at-risk situations.
Like ethics, the term boundary is still too broad when identifying therapist risk. Boundaries can range from a macro and basic practice-management to the micro interpersonal disciplines surrounding over-identifying with a client, personal and professional integrity. With risk-management therapists can further define and discuss boundaries using risk-context.
Risk-context
The discussed example showed the key problem related to risk-context was the therapist being too enthusiastic to use a technique she associated with. In any given treatment, if this keenness occurs (more than once in Diana’s case); the therapist is not working from an ethical frame of reference, that shouts the principle of competency. Likely, the therapist is working out of eagerness and personal opinion or influence. Enthusiasm can have a downside, that being; it can ignore the use of a client-centered care approach.
Simply stated, risk-context means that you don’t take up every opportunity that presents itself to you just because you can. For the professional working from an ethical frame of reference, it is a given when decision-making to ask yourself ‘what are the risks?’
Let’s put risk-context another way
If a therapist has just completed a post-graduate in a specific technique, chances are they will use that technique at every opportunity. Here we join risk-context with ethics by addressing behaviour. A blind-spot can occur for the therapist when they do not assess the risks and the appropriateness of using their professional skills. If boundaries are ignored, it is considered an unethical behaviour. The professional is to be mindful that risks lead to consequences that lead to negligence.
If blind-spots are occurring in a clinical practice, they show how the involved therapist has found that although reading about principles in ethics is simple, the difficulty lies in their application. Realistically speaking, most therapists in private practice are on their own when dealing with their risks. However, the constructs of isolation, competition, multicultural society, cultural and technical diversity give reasons for massage therapists to work with the commonality of a professional ethical framework6.
The practice of effective risk-management is not a professional instinct; it is a learnt skill that involves respect toward professional power. Even when competency in technical skill is evident, competency in client-based care involves discipline when administering this professional power. Addressing risk-context shows the therapist how the professional weights their personal enthusiasm toward modalities, techniques and opinions with professional appropriateness2.7.
Until now ethics has been stereotyped as boring and authorative, seen to only serve the governing body and/or legal business requirements. Therapist disinterest in ethics is potentially due to the lack of education on how ethics can benefit them. Notably the ability to educate correct and useful strains of ethics has also contributed to therapist complacency, which has been found throughout the helping professions3.
Currently, massage therapists are intuiting a greater need for sound education in ethics, to assist their growing practices and risk-management strategies.
General public expectation
One explanation for the growth of the massage therapist’s practice is their ability to work within complementary therapy and conventional medicine. Many forums have been structured to discuss how to integrate the two disciplines which many massage therapists have attended. Recently one municipality held a forum for the public. It was run by a business networking group. Their forum was on conventional versus complementary treatment and public opinion.
The outcome observed was a strong demand for trusted therapists to be available from local doctors. Albeit one networking group, it typified public expectations strongly calling for well-being integration with an emphasis on whom they can trust.
It showed how the general public hold greater reliance on complementary therapies and use trusted recommendations. This forum also brought to light that currently, the key modality conventional medicine will refer to is massage therapy, making therapists (with a sound and trusted reputation) the high contender for referral from General practitioners.
The downside to increased public demand is generally, therapists do not know how to address the difficult at-risk situations that may occur in their practice5. Yet with greater public expectations on massage therapists, there is greater risk for therapist burnout. This reinforces how an ethical therapist must seek out education that shows how to reduce burnout by monitoring major and minor risks. Such strategies will show that the key to risk-management is regular clinical appraisal and self-reflection.
Looking toward the future
Massage therapists are seeing the results of public education with increased clientele. The public have become educated in personal health and are more scrutinizing in the therapists they will trust. Our younger generations are being taught about well-being within their educational systems, potentially increasing the demand on complementary therapies further.
With the generations to come, both public and professional, the therapist who survives will have built a trusted reputation. They will have overcome a stereotypical mind-set towards ethics3. The modern massage therapist will embrace a professional and ethical framework that shows veracity and integrity toward their profession, toward other professionals, to the public and importantly toward themselves.
To conclude
As therapists we all are vehicles to assist clients in regaining their health, well-being and quality of life. Modality and specialty practised by the therapist notwithstanding. The commonality lies in capturing an opportunity to care for another person and to support them. Such an opportunity is a privilege and a responsibility all professionals providing a health service are to take very seriously. This same seriousness applies when intimately working with clients. Your professional base stems from a solid ethical frame of reference that reduces at-risk concerns, regardless of public expectations and client types.
References:
- Australian and New Zealand Risk Management Key Steps. www.riskmanagement.com.au sighted 20/6/2008.
- Brody, H. (1992). The healers power. New Haven. Yale University Press.
- Corey, G., Schneider-Corey, M. and Callanan, P. (2007). Issues and Ethics in the helping Professions. 7th ed. Belmont, C.A. Thomson Brooks/Cole.
- Crellin, J., and Ania F. (2002). Professionalism and Ethics in Complementary and Alternative Medicine. Binghamton, NY. The Haworth Integrative Healing Press, an imprint of The Haworth Press, Inc.
- Egan, G. (2002). The Skilled Helper. A problem-management and opportunity-development approach to helping. 7th ed. Brooks/Cole.
- McBride, N., and Tunnelcliffe, M. (2002). Risky Practices. A Counsellor’s guide to risk management in private practice. Palmyra. W.A. Bayside Books.
- Peterson, M.R. (1992). The Professional’s struggle with power. At Personal Risk. New York. W.W. Norton and Company. pp50-71.
Natalie Millan is an advocate for healthy esteem and is the author of Professional Esteem a practical guide to ethics and risk-management; the new series release for 2008. Her second book Professional Esteem – ethical energy is currently in print. Natalie is an educator in communications and ethics and has 20 years experience as a massage therapist. She volunteers her services for the committee of the A.A.M.T and is currently developing workshops for therapists on risk-management. View Natalie’s profile at
www.healthyesteem.com.au.
Article by Bruce Stark
In the massage and bodywork field we have spent a great deal of time studying – anatomy, Physiology, massage techniques, treatment protocols and assessment skills. But interestingly, “what” we know from our training can actually get in the way of our client’s healing process. Specifically, if we work with an intention for a specific outcome with our client we may indeed miss the very self-regulating responses which are part of the healing and balancing processes which we want to promote.
In somatic work we maintain the fundamental philosophy that the body has a self-regulating and self-balancing capacity and that our role as therapist or practitioner is to facilitate the ability of the body to access and utilise these regulating resources. When we follow a linear way of thinking we are no
longer observing our clients from a holistic perspective. We can easily miss the myriad ways in which the client is responding to the work – and in fact, there will always be a great deal more happening for them than we will ever know as the practitioner. By allowing ourselves as practitioners to get “fixed” in a mindset that there is a specific protocol for addressing specific physical problems without paying attention to how the client responds we can easily impose onto our clients our assumptions about what should be happening in the session and we are no longer “responding” to them.
An simple example would be a client with a frozen shoulder. Depending on the bodywork modality we use and the training we have had we will naturally utilise the techniques and thought processes which we have learned to address the client’s pain patterns and to increase the range of motion in the joint. And often we will incorporate techniques which have demonstrated their usefulness for us in the past. Usually these techniques will be effective in releasing the muscular pain and tension and for increasing ease of movement. But sometimes we may find that there isn’t as much change or that the client’s body doesn’t seem to be as responsive. We may work “harder” in an effort to get the shoulder to release. But might we actually be interfering with a healing process? Or perhaps we may continually try to work harder to get a change or release to happen without noticing that some other issue may be presenting itself?
The reality is that in order to support long-term change and healing we need to work with the regulating processes of our clients’ bodies and these processes may not follow a linear progression. Somatically, we are always striving for an embodied connection since the sense of presence and “holding” is integral to the experience of change and balance. If we try to “fix” our clients we interrupt the emergence of the healing mechanisms that we are trying to engage. We cannot fix our clients – ever. What we can do is provide the environment and the support for our clients to achieve their own healing. When we allow the understanding to emerge we facilitate the healing holistically. When the changes are coherent within the client’s body, recovery occurs more quickly, there is greater proprioceptive awareness, and the client is less likely to injure themselves in the future.
Article by Whitney Lowe
As a sizeable portion of the population in this country ages, it is important for health care practitioners to have a greater awareness of various diseases and conditions that are increasingly common in an older age group. One such condition is a connective tissue disorder that affects the palmar fascia of the hand, called Dupuytren’s contracture. This condition was originally named for Baron Guillaume Dupuytren in the 1830’s, although there is an indication that other physicians had actually described this clinical pathology a number of years earlier. 4 This disease is most common in Caucasians and especially those of Celtic descent. For that reason, it has sometimes been called the Viking disease.2, 3
Description of Pathology
The primary structure that is involved with Dupuytren’s contracture is the palmar fascia (see Figure 1). The fibers of the palmar fascia are arranged in different directions. However, it appears that the longitudinally-oriented fibers (ones parallel with the long tendons in the hand) are the ones most affected in this condition. The palmar fascia is strongly tethered to the skin and underlying bone, unlike most of the sub-cutaneous fascia in other regions of the body. This tethering is to increase the strength of the fascia against tensile stresses between the skin, fascia, and bones that would have a tendency to pull the fascia free from its attachments. The reason the skin and fascia in this region are so susceptible to this kind of problem is that significant tensile stresses occur on the soft tissues of the palm when grasping objects with strong force. These forces are significantly higher in the palm than in other areas of the body.5
Dupuytren’s contracture begins with a shortening and fibrosing of the fibers in the palmar fascia. Again, it is primarily the longitudinal palmar fascia fibers that will be affected. The pathological process that starts the contracture is still unclear. However, it appears that the process begins with a proliferation of fibroblasts in the palmar fascia, producing new collagen that forms into nodules and fibrous restrictions.
There are several different types of collagen in the body. Type 1 collagen is most prevalent in tendons, ligaments, and superficial fascia. Type 3 collagen is present in high concentrations in scar tissue. The fibrous nodules and collagen binding that occurs in Dupuytren’s contracture is predominantly Type 3 collagen, which may be one of the reasons it is so difficult to elongate.
As the collagen binding progresses, the fascia will further contract and draw the digits of the hand into a fixed flexion deformity (see Figure 2). The metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the 4th and 5th digits are the ones most commonly affected.
There appears to be a strong genetic predisposition to development of Dupuytren’s contracture. It is an autosomal dominant gene, and as mentioned earlier, it is most common in people who are of northern European descent. While the condition does not appear to be directly related to traumatic incidents in the hand or forearm, there is some indication that an inciting disease or event may cause the genetically-predisposed person to fully develop the condition.
There are several other common factors in the symptom picture of people with Dupuytren’s. It is about seven to 15 times more common in men than in women.4 It is also most common for people in their 40s or 50s. The incidence of this pathology increases with smoking, alcoholism, diabetes mellitus, epilepsy or other convulsive disorders. The reason that it is more prevalent in this group is not well understood.
Assessment
Information in the client history will be imperative in identifying any of the various risk factors mentioned above. If the condition is in the early stages, there may be some fibrous nodules that are palpable in the palm region, especially over the 4th and 5th digits. In many cases the skin will pucker a bit in the region over the fibrous nodules. The surface of the palm is also likely to be tender to palpation.
If the condition is in an early stage, there will probably be some limitation to active as well as passive extension in the digits; the full flexion deformity, however, will not be evident. In later stages, the flexion deformity will be much more pronounced and the hand will appear more like the image in Figure 2.
There are no specific diagnostic tests that validate Dupuytren’s contracture, and a physician will generally diagnose this condition based on clinical findings and relevant information from the medical history. However, it is also important to distinguish this condition from other hand and finger pathologies that may have similar symptoms. Trigger finger (stenosing tenosynovitis) is likely to have movement system restrictions and pain patterns that are similar to those in Dupuytren’s contracture. However, in this condition you can usually force the digit into full extension, even if the action is a bit painful. The palmar nodules are usually not prevalent in stenosing tenosynovitis.
Treatment
If a client has developed a more advanced stage of Dupuytren’s contracture, it may be difficult to achieve beneficial effects with massage treatment. However, in the early stages, massage and other forms of soft tissue manipulation are far more likely to be helpful.5 The greatest benefit will come from techniques that emphasize longitudinal tensile stress loads on the palmar fascia. Techniques such as deep longitudinal stripping, myofascial approaches, and very active regular stretching will be particularly helpful.
This condition involves the development of fibrous restrictions in the soft tissue. As a result, it is important to find a treatment strategy that will address these restrictions appropriately. The restricted connective tissue needs to be elongated, a process that will develop most effectively with frequent applications of tensile stress to the palmar fascia. The most effective means of accomplishing this is to teach the client an aggressive plan of self-stretching so the tissues can have the greatest opportunity to reduce the fibrous binding. Stretching the fingers and wrist in hyperextension (see Figure 3) is the motion that you want to emphasize most.
There is some indication that myofascial trigger points in the palmaris longus or other forearm muscles may contribute to either pain or movement restrictions that may exacerbate the fibrous restriction process.6 Therefore, when treating this problem, be sure not to ignore the forearm muscles and any other soft-tissues of the upper extremity that might also be contributing to further tension in the palmar fascia.
Other similar conservative treatment approaches may be used in physical or occupation therapy to address this condition. Yet, in many cases these conservative approaches will not be sufficient to halt or reduce the degree of fibrous restriction that has occurred in the soft-tissue. As a result, surgery is often performed to reduce the restrictions of the fascia and restore proper range of motion in the hand.
Surgical treatment will most often include procedures such as a fasciotomy, involving a longitudinal incision following the course of the hand and finger tendons in order to free up any restriction between the fascia and its adjacent tissues. In other cases, a fasciectomy may be performed. This is a procedure in which a portion of the palmar fascia may be resected or removed in order to enhance mobility. This mobility can be further enhanced by a surgical incision called a Z-plasty. In this procedure the incision looks like a zig-zag (see Figure 4). Due to the disruptive nature of this procedure, there can be a long period of post-surgical healing. However, mobility is restored for most people who have this surgical procedure performed.
There may be some alternatives to the surgical procedure in advanced cases of contracture. Initial trials indicate that injection of collagenase (an enzyme that can encourage the breakdown of collagen) can be beneficial in reducing the fibrosity of Dupuytren’s. However, further clinical trials are necessary to validate this theory.1
As a massage practitioner with significant palpation skills, you are in a position to identify this condition in its early stages. If the progressive connective tissue adhesion can be addressed early on, it is likely you can prevent it from becoming a much more serious problem. If the condition has progressed further and surgery has become necessary, you may still be able to make a significant contribution in the post-surgical phase. For example, the Z-plasty procedure runs the risk of scar tissue developing after the surgery. When sufficient time has passed, soft-tissue mobilization can be helpful to encourage free movement between the skin and adjacent fascia.
References
- Badalamente, M. A. and L. C. Hurst. Enzyme injection as nonsurgical treatment of Dupuytren’s disease. J Hand Surg [Am]. 25:629-636., 2000.
- Elliot, D. The early history of Dupuytren’s disease. Hand Clin. 15:1-19, v., 1999.
- Finsen, V., H. Dalen, and J. Nesheim. The prevalence of Dupuytren’s disease among 2 different ethnic groups in northern Norway. J Hand Surg [Am]. 27:115-117., 2002.
- Lee, S. Dupuytren Contracture. Available at: www.emedicine.com Accessed 6-14-2003, 2003.
- Rattray, F. and L. Ludwig. Clinical Massage Therapy: Understanding, Assessing and Treating over 70 Conditions. Toronto: Talus Incorporated, 2000
- Simons, D., J. Travell, and L. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Baltimore: Williams and Wilkins, 1999
Article by Kim Knight
Chi Nei Tsang is one of the most profound therapeutic massage forms found in classical Chinese and Thai Medicine. Chi Nei Tsang practitioners assist those they work with in maintaining their health through tissue and organ massage and wind release techniques. It is essentially a facilitated form of self-care since the highest form of its practice is teaching people to maintain their health and optimize their energy. The final goal is to allow people to set themselves free physically, mentally, emotionally and spiritually”.
What is Chi Nei Tsang?
Chi Nei Tsang (CNT) is the ‘physical branch’ of the Universal Healing Tao, a practical system of self-development that enables individuals to complete the harmonious evolution of their physical, mental and spiritual bodies. Chi Nei Tsang translates literally as ‘The energy and information of the guts’ which when put into practice and phrased more politely becomes ‘Internal Organs Energy Transformation’.
CNT works to train our internal organs to work more efficiently. Rather than working on the muscular or skeletal structures, it focuses on the vital organs and fascia, helping to unwind tension from the navel outwards and purify the cells of physical and emotional toxins.
Where does it come from?
Master Mantak Chia, the founder of the Universal Healing Tao, learnt the ancient art of Chi Nei Tsang from a traditional Thai healer called Dr Mui. Master Chia was intrigued by how working on the abdomen seemed to profoundly heal so many ailments, many of them located in other areas of the body.
In the Forward to Gilles Marin’s book “Chi Nei Tsang – Healing from Within” Chia describes how “My uncle had a debilitating pain behind his shoulder blade that sent him from doctor to doctor without hope of ever getting better. He was finally told that the only thing conventional medicine could do for him was exploratory surgery without any guarantee of improvement. Friends told me about Dr Mui, a traditional healer who was performing miracles using a form of traditional Chinese and Thai healing massage. He was the last member of a long lineage of healers who had virtually disappeared after the Chinese cultural revolution.
Dr Mui made my uncle lie on his back and started to poke around his navel with one finger for a long time even though my uncle kept repeating to him that it was his shoulder that was in pain. After an hour the old man asked my uncle to stand up and move around. My uncle stood up and an astonished look came upon his face: the pain in his shoulder blade was greatly relieved.
I was very impressed and immediately asked him to teach me his technique. He answered that it was not possible, that ‘it takes too long to learn’ and that he could offer very little instruction other than showing the fact that it works. Nevertheless I begged to assist him with his long line of patients. Day after day for the next three years, until his death, I helped him with domestic chores and patients: I witnessed miraculous healing experiences. I saw countless cases of suffering cured before my eyes. Some people came in wheelchairs to get treatment and would come out pushing their own wheelchairs.
Dr Mui never gave any explanations. Sometimes he took my hand and let me feel a lump or a tension that needed to be worked on. He showed me some of his drawings of the meridian system, the flow of blood and chi, and the nerve pathways. I even went to Chulakongkorn University Hospital in Bangkok to study gross anatomy through dissecting cadavers and only after years of dedicated practice was I able to understand the principles of this form of healing”
How is Chi Nei Tsang different from massage?
Although to the untrained eye Chi Nei Tsang may look like massage, technically it is not massage at all. As befits its translation, it is ‘Internal Organs Energy Transformation’. There are also differences in its delivery:
Firstly, CNT cannot be applied with any muscular force. Because we are working on the abdomen, which is a highly sensitive area, any sense of force felt by the client will result in their body psychologically shutting off with muscular tension. On a psychological level, muscles play a protective role in the body. So, in order to make a connection, on both a physical and emotional level, the practitioner needs to use Chi instead of muscle, and this takes training.
So one of the first lessons in learning CNT is ‘No Chi, No Chi Nei Tsang’ . CNT uses principles of Kung-Fu and Tai Chi Chuan and practitioners are trained in Chi Kung, which translates as ‘Energy Management’. CNT can therefore be described as “applied Chi Kung”. The ability of the practitioner to use Chi rather than muscle means that (a) the client feels safe, (which is a number one prerequisite for healing) and (b) the techniques care applied safely.
One of the benefits of the use Chi Kung during treatments is the high level of energetic protection it affords both client and practitioner. Practitioners become very conscious of both their own and their clients’ energy flows, and learn how to prevent themselves from absorbing any discordant energies that inevitably start to release during treatments. This also helps to prevent energetic burnout. The bonus of learning these techniques is that they can be applied to any healing modality.
Chi Kung techniques such as Bone Packing and Fusion also give practitioners the ability to simultaneously refine their own Chi whilst giving treatments. Through the principle of entrainment, this also encourages the client’s body to transform any negative Chi within themselves.
What are the benefits of CNT?
Chi Nei Tsang is used for many different reasons. Firstly it detoxifies: CNT manipulations help relieve the body of excess stagnation, improving elimination and stimulating the lymphatic and the circulatory systems. CNT also strengthens the immune system and resistance to disease. In doing so, it augments other health care modalities with optimal results. For example, clients using CNT before and after surgery recover better and faster.
Secondly, CNT helps restructure and strengthen the body: Because it addresses the visceral structures and positioning of internal organs, CNT stimulates them to work better and also helps correct the postural problems resulting from visceral imbalances. It releases deep-seated tensions and restores vitality. CNT has been helpful with chronic pains such as back, neck and shoulder pains and problems related to misalignment of the feet, legs and pelvis. Thirdly, CNT helps people become more aware of their emotional life: All of our unprocessed emotional life is stored in our digestive system waiting to be addressed. Poor emotional digestion is also one of the main reasons for ill health. CNT facilitates the unfolding of emotions and the clarification of our emotional life. This makes it possible for us to evolve and grow in the direction of our better self. CNT has also been successfully used in combination with psychotherapy.
Lastly, CNT teaches us to know ourselves better: The CNT philosophy is that we are all responsible for our own health and that true healing can only come from within. Both practitioner and clients learn how to improve breathing, because breath is the bridge between all levels of awareness. Not many people realize that we breathe according to how we don’t want to feel. By becoming aware of our breath we make a connection to those parts of ourselves that we have been hiding from, integrating them so that we move towards wholeness.
What specific techniques make CNT different from other massage techniques?
Unlike some massage which uses indirect methods to contact the internal organs, CNT massages the vital organs directly. There are a number of techniques which address specific organs, such as the stomach, spleen, pancreas, duodenum, small intestine, large intestine, kidneys, liver and gallbladder.
In addition, CNT works on what are known as ‘sick winds’ in the body. Remembering that all the elemental forces of nature are contained within our body as well as without, there is a tendency for energy to become stuck. According to Master Chia “Trapped wind is heavy, gray and sick, like a damp room with no ventilation. Using Chi Nei Tsang is akin to opening the right windows to let the stagnant wind go out and assist in re-establishing a healthy flow of vital energy”.
It is not within the scope of this article to describe the techniques, as they need to be taught in a proper learning environment to ensure maximum safety. And again, as stated above, the ability to work with Chi is of paramount importance when implementing any of the techniques.
Do I use it alone or can I incorporate it into my current practice?
Chi Nei Tsang can be used by itself or with other modalities. On the one hand it is a stand-alone practice, and an hour and a half session passes surprisingly quickly for both client and practitioner, even without exhausting all the many techniques. However, Chi Nei Tsang has also proven to complement a multitude of therapies including Reflexology, Osteopathy, Psychology, Reiki, Shiatsu and Swedish Massage.
Why is it important to massage the abdominal area?
According to Taoist philosophy, ’our organs are the source of life and death’. Taoist sages observed that humans often develop energy blockages in their internal organs which then form knots and tangles in the abdomen. These obstructions occur at the center of the body’s vital functions and constrict the flow of Chi (energy) or life-force. The negative emotions of fear, anger, anxiety, depression and worry are said to damage the organs the most.
The navel area also plays a key role in the body. It is referred to as ‘the original scar’ because this is where the fetus first connected to the mother in the womb. Both nutrition and waste travel through the umbilical cord, and due to body-memory toxins have a tendency to accumulate in this area.
The abdomen is also our energetic centre, or core: the Tan Tien or ‘Elixir Field’. This is our Chi battery, where we can store energy. If this area is blocked with physical and emotional toxins, it will not be able to do its job properly. Always in search of an outlet, any negative emotions and toxic energies create a perpetual cycle of negativity and stress, and if they cannot find an outlet, will build up in the organs and then move into the abdomen and navel area. The abdomen can process some of this energy, but more often it cannot keep up with the flow. Thus the energetic center of the body becomes congested and ultimately disconnected from the rest of the body.
The internal organs also provide the physical lines of force which hold the body together and give it structure. The vital organs are also said to contain the Spiritual Essences of a human being, which is probably one of the reasons why the ancient Egyptians took so much care in preserving them after death. Of course, physical pain can also be caused by overwork, stress, accidents, surgery, drugs, toxins, poor food, and bad posture.
Whatever the cause, (remembering that energy can never be destroyed – only transformed), by working on the abdomen we can release blocked Chi on both a physical and emotional level. It can then be moved to the Tan Tien for transformation by the abdominal (second) brain or to the colon where we can take what is useful and eliminate the rest.
What conditions can it help?
Before answering this question, it is important to note that Chi Nei Tsang addresses first and foremost the person in the body, rather any condition they may be manifesting. This is because you are everywhere in our body: If your liver is hurting, it is you in your liver that is hurting.
Thus it can be said that CNT can help any condition if a person is willing to make a connection with whatever they have been disconnected from in their body. That being said, CNT has been found to be particularly useful in relieving many physical symptoms such as intestinal blockages, fibroids, cysts, knots, lumps, scar tissue, headaches, menstrual cramps, poor blood circulation, back pain, infertility, impotence, frozen shoulder and many other problems.
On a mental / emotional level, one of its key strengths is in switching the body from a sympathetic (stress) to parasympathetic (relaxed) response. Not only does this feel good to the client, it is important to remember that in order for the body to heal, it needs to be in parasympathetic mode. So one of the most beneficial aspects of a Chi Nei Tsang treatment is to bring the client into a place of deep relaxation so that their body’s own wisdom can send Chi to wherever it is needed for healing.
Why are there so few practitioners?
According to Gilles Marin, Director of the Chi Nei Tsang Institute USA, when asked why there are so few CNT practitioners, he replied “It’s not easy. It takes a lot of discipline. It’s not trying to fix anything. A true holistic approach is something not many people do. You have to understand health, life and the forces of nature. It took a lot of training and work on myself. If I improve, my work improves. I do Chi Kung every day. I learn more by practicing year after year. Chi Nei Tsang is applying meditation on a physical level.”
It was only when I read this quote that I realized, even after years of study, how true this statement is. Anyone can learn the techniques taught in a Chi Nei Tsang class, but the ability to deliver superlative treatments really comes from the Chi Kung practices that one does for oneself. This also applies to clients. Part of a CNT treatment is to be given Chi Kung homework, such as self abdominal massage, breathing practice and inner organs meditations. The difference in improvement between clients who do and don’t do the homework is quite noticeable.
In conclusion, Chi Nei Tsang allows one to release and unwind tensions that are manifesting as pain in many areas of the body. It does this by connecting directly with any unprocessed emotional charges and physical toxins stored in the cells, by working at a fascial level with lines of tension that can be traced back to the navel, and by working to release trapped winds. Simultaneously, through breath awareness and gentle touch, CNT helps one to become aware of what has previously been in the unconscious, paving the way for personal growth, inner transformation and good health. n
References
- Master Mantak Chia, “Chi Nei Tsang II – Chasing the Winds” North Star Trust 2000 p xii
- Marin Gilles, “Chi Nei Tsang – Healing from Within”, North Atlantic Books 1999
- Gilles Marin during a seminar
- Bone Packing: packing the bones with Chi. Fusion: transforming negative energy into purified Chi which is then used to nourish the organs and tissue.
- Master Mantak Chia, “Chi Nei Tsang II – Chasing the Winds” North Star Trust 2000 p xiii
Kim Knight is a Chi Nei Tsang practitioner and Universal Tao Instructor in Auckland, New Zealand. She is the founder of Tao Workshops and CNT Retreats NZ and teaches introductory workshops in New Zealand and Australia. She also hosts Senior Tao Instructors from overseas. Her teacher, Gilles Marin, Director and Founder of the Chi Nei Tsang Institute USA will be in New Zealand September 2008 to teach The Fusion Meditation practice,
Chi Nei Tsang and Space and Boundaries/Sexual Chi Kung.
See www.taoworkshops.co.nz for more details
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