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February 24, 2010

Massage Therapy in the Context of Physical Therapy

All you massage therapists out there can relax. Physical therapy does not want your job. Massage therapy that can be billed by insurance is a very small component of what physical therapists do and it falls under the heading of manual therapy. As far as insurance is concerned, massage therapy ranks about the same is modalities: heat, ice, ultrasound, electric stimulation, etc. Insurance companies look at these modalities and will agree to pay for them so long as physical therapy presents a rationale and intends to wean the patient away from its use.

I'm in my third week of my orthopedic clinical rotation, and I'm finally beginning to see where massage therapy fits into the treatment plan for the patient. Generally, I have found that I incorporate massage therapy into the treatment of the neck and back in adjunct other manual therapies or therapeutic exercise. For example, I used a technique to mobilize the SI joint often as a massage therapist and have found this maneuver useful when working with patients who have low back pain. The use of SI joint mobilization is useful in patients who do not respond to muscle activation techniques to correct pelvic rotation. Indications for this type of intervention include hypermobility/instability of the pelvis or a functionally short leg. The rationale for the maneuver is to align the position of the bones correctly and then strengthen the surrounding muscles in the new position in order to hold the correction.

For neck conditions, I like to use massage to loosen the muscle guarding the neck so that I can more clearly feel the structures underneath them. Then I incorporate up-glides and down-glides of the vertebral facets (something I used to do naturally to increase range of motion in the neck, but didn't know it). Suboccipital release, also referred to as an inhibition technique or distraction, is also a common manual intervention. Interestingly, the VA does not support the use of alternative therapies on their veteran patients unless there is adequate evidence to support their effectiveness as a standard of care. So, no Craniosacral Therapy allowed, but Myofascial Release, which utilizes many of the same maneuvers, has the green light by the VA.

The other difference surrounding massage is the freedom that licensed therapists have to utilize whatever tools are at their disposal to make their clients feel better. They have the luxury of a full 30 minutes or an hour to focus their intention on the relaxation of the muscle structures under their hands. Physical therapy often bills in increments of 15 minutes and that combines massage with other manual therapies. Rather than discarding the skills I have, I must figure out a way to to make my techniques work faster. As we all know, the body cannot be rushed, so I must focus my attention more acutely to the task at hand and hope for the tissues respond accordingly. This will take time and practice. I figure about the time I retire, in 25 years, I should finally be really good at all of this.

Posted by linda at February 24, 2010 5:31 PM

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