CE INSTITUTE LLC BLOG

Does anyone know what's pictured here below in this article? Or why that picture would be shown when discussing the root cause of a problem?

That is a water pump that was installed and made available for public service to London's population from over 200 years ago.  Today, it's now walled off with an iron fence, but well preserved as part of London's history.

Do you know why an image like that from London's history is significant to the definition of root cause? It's because 40 years after that pump's installation, there was a significant cholera outbreak in a consolidated area of London; and, only one doctor was able to zero in on the source that created this rapid disease outbreak. That doctor started documenting all of the cholera illnesses and deaths on a map, and found that they circled around one of these types of public London water pumps. 

England's Thames is one of the most popular rivers in the world. It was the lifeblood of England, where settlers could easily move up and down the country, and accept traders and other goods over this easily transportable body of water.  Then the Thames River became England's toilet. Before modern day plumbing was created, toilets were installed along the Thame's where residents relieved themselves, then the Thames would wash the sewage away. That was until the population grew so great, that the Thames became a literal cesspool, and that grisly sewage leaked into London's water supply. One of London's water wells/pumps became particularly contaminated to the point that it was responsible for the severe cholera outbreak of 1864.  Once the infected well was identified and it's pump handle was removed, there was a significant decline in cholera cases.

So what does that have to do with neuromuscular therapy which is also known as NMT? 

Neuromuscular therapy (NMT) attempts to discover the root cause of whatever reason placed a client in front of a practitioner.  Some clients seek massage therapy for back pain, insomnia, ambulatory issues, stress or other medical disorder.  So when a client shows up to the office and receives a general Swedish massage, would they feel better?  Probably? Definitely? We would say or claim almost anyone would feel better after a regular full body massage.  But would a regular body massage provide long lasting relief from headaches? Or back pain?  Or postural issues? The answer is no.  Regular body massage usually provides temporary relief, which is why we have neuromuscular therapy for practitioners who want to dig a little deeper to that root cause of an issue.

We will compare this to London's 1864 cholera outbreak. Could doctors provide laudanum or other medical treatment while a client was dying of cholera to ease their suffering? Sure they could. But would that really help them? Of course not. According to the Mayo Clinic, over 50% of individuals infected with cholera will die if not properly treated with today’s advance in medicine.  It's the same with body massage.  We're providing a temporary relief, but that may not address the root cause or causation of the medical issue for why the client sought treatment in the first place.  We must find the root cause of any issue to provide significant treatment to a client seeking relief.

In neuromuscular therapy, our job is to:

• ask questions
• assess posture
• measure leg lengths to look for anomalies
• visually inspect foot care and wear
• relieve trigger points
• determine if a client has lost range of motion
• elongate shortened soft tissue aka increase range of motion (ROM) with massage therapy, bodywork and stretching techniques 
• much MUCH more....

Neuromuscular therapists are looking for what could be causing the issue where a client is seeking relief.  Sometimes the issue is easy, such as your client is an athlete who just ran a marathon, and all of the strenuous exertion has made them seek pain relief.  If we only had clients that were all as easy as this scenario.

Some of our clients are seeking massage therapy because modern medicine has failed them. They have some type of pain or disorder that several doctors have already missed or dismissed, and the client is still seeking answers, and is now sitting in front of you. Neuromuscular therapists are investigators. Our job is to look for a root cause of whatever the client suffers from, and then:

• provide skillful soft tissue manipulation as needed
• provide recommendations within their scope of practice, such as: your shoulder would probably feel better if you didn't carry that twenty pound purse on it all day
• provide referrals to other medical professionals as needed (i.e. From looking at your feet and then the wear pattern on your shoes, you might benefit from some orthotics. Let’s have you meet with a podiatrist to see what they think, while I simultaneously try to increase your circulation to your lower leg cramps and relax some of soft tissue restrictions.) and much MUCH more....

Here's an example of seeking a root cause with a client who is experiencing headaches with unilateral neck pain.  If you observe them turning their head every time you speak, ask them if they hear better in the ear that they are turning towards you. If yes, refer them to an audiologist for a hearing check.  If their hearing is properly restored, perhaps they'll stop constantly turning their neck to one side which might be causing that unilateral cervical pain with headache. Once you've relieved their trigger points, released soft tissue restrictions, restored range of motion or whatever else is obtainable, you will likely have addressed that client's root cause of their medical problem as well as provided some much needed relief.

When a medical issue such as chronic or worsening headaches with increasing cervical pain is presented to a doctor, they might order tests to rule out a fatal obvious problem such as blood clots. They could order MRIs, cat scans, or other life threatening potential causes, but do you think a doctor takes the time to really evaluate a client today? Most do not have the time to sit and have a meaningful conversation with a client, asking questions and watching or evaluating different soft tissue ailments, or the client’s overall body mechanics in general. That’s where a neuromuscular therapist can help.  It is our job to evaluate the client’s body mechanics and more, to try to get to the root cause of their issue and address it.

Now some might think NMT practitioners will have less clients because they resolve a root cause to the point that a client may no longer need to see them, but that's just not the case. That’s because people love to talk.  When someone shares that a therapist relieved pain that four different doctors couldn't, just get ready for massive referrals and more medical problems to present themselves with new clients at your pain relief establishment!

In today's hands-on therapeutic practices, we want to continue the work that was extraordinarily defined with this example of a cholera outbreak over 200 years ago. We need to get to the root cause or causation of medical problems to really help our clients with a more holistic approach. While most medical practice today is transactional, where one issue is treated which could cause four more issues, we want to be different.  Let's treat the root cause of medical issues with neuromuscular therapy to help our clients even more. 

Would you like to learn more about the practice of neuromuscular therapy?  Have you ever heard of neuromuscular therapy?  Neuromuscular therapy also known as NMT is hands-on soft tissue manipulation that helps properly align and improve function of the human body. While there are additional benefits, some NMT applications include client evaluations and much more.  Here’s and example:

Kyphoscoliosis is a combination of two different medical conditions that create a three-dimensional deformity of the human vertebral spine:

1. Kyphosis is an excessive forward or anterior curvature in the upper thoracic spine.
2. Scoliosis is an excessive lateral or sideways curvature of the spine, which would always affects multiple areas of the spine.

In neuromuscular therapy appointments, clients should complete a written client intake form or health history prior to hands-on bodywork. The client’s goals for their treatment should also be included during this client intake period, with reasonable goals set and mutually agreed.

After a provider has the client’s medical diagnoses in writing, they should then evaluate a client’s posture amongst other evaluation techniques to provide proper hands-on neuromuscular therapy treatment.  Hopefully, if you ever see an individual similar to the one pictured here, they would already have a kyphoscoliosis diagnosis so that a provider could easily communicate with the client about their medical condition. 

When a practitioner is not qualified to create a diagnosis within their licensed scope of practice, then they would not be able to diagnose or tell this individual that they have kyphoscoliosis. Instead, someone such as a massage therapist (LMT), physical therapist assistant (PTA) and others who cannot legally diagnose medical conditions would need to make a medical referral to a doctor for a proper diagnosis, if or when the client is unaware of their medical condition.

Kyphoscoliosis (or any spinal deformity) becomes easier to treat once a medical diagnosis has been made.  While working various spinal deformities are covered in our neuromuscular therapy courses, we are showing this example here for one obvious reason.  Do you see the shoulder bag on this individual’s depressed shoulder?  If you had a kyphoscoliosis client like this, which shoulder would you recommend they carry their shoulder bag?

The answer is this kyphoscoliosis client should be carrying their shoulder bag on their elevated left shoulder. Their left shoulder is elevated while their right shoulder is depressed.  That creates a lateral curvature of spine which is known as scoliosis, and almost always results with uneven shoulders and/or pelvis. Your goal would be to try to even the two sides of the vertebral spine to bring them anatomically level to one another.  So, while hands-on techniques such as myofascial release, trigger point therapy, deep tissue bodywork or massage therapy could help improve a client’s anatomical position, it would be difficult to maintain any improvements if a kyphoscoliosis individual spends their days walking around like this.

This is why it is critical in neuromuscular therapy appointments to review the client’s activities of daily living, workplace ergonomics, everyday lifestyle habits and more.  This can help you determine if they are doing something that could be harmful to their progress after they leave your treatment room.  Then practitioners can address harmful activities to help prevent a client’s continued digression.  Otherwise, a client might not feel that your therapy is effective or helpful when they do not achieve desired results.

Attempting to correct long term spinal deformities is extremely difficult. It is practically impossible to achieve structural improvement in cases such as structural scoliosis.  Functional scoliosis would prove easier to treat. Each individual and spinal deformity would have a different degree of difficulty or possibility.  A client’s activity outside of your treatment is just as important as the therapy provided inside of it.

If a client with a vertebral spinal deformity is in pain, then pain relief would be an obvious treatment goal.  However, treating the root cause of the pain would create longer lasting results which is why in this case here, we would want to try to even the shoulders into normal anatomical position, if or when possible. This could take years without 100% success.  In this individual’s case, we would consider any postural improvement to be a success and continued digression a possible failure.  Keep in mind that it is difficult in neuromuscular therapy treatments to determine when there is failure because the treatment could have slowed or minimized the client’s digression, and it would be hard to tell otherwise.  One indicator of success versus failure would be if a client terminated their neuromuscular therapy and then rapidly digressed worse than what was happening during treatment, then you’d both know your past treatment(s) were quite successful.

When providing neuromuscular therapy, if we learned our client was walking around with a shoulder bag on their depressed shoulder, we would want to immediately suggest to swap the bag onto their elevated left shoulder, or to not carry anything on their uneven shoulders at all.  We would educate the client that hanging weight on their depressed shoulder could create further depression and deformity, and work against shared treatment goals in neuromuscular therapy.  Although we do need to be a bit careful when making these recommendations because of our licensed scope of practice.  If the client wants greater lifestyle direction beyond a few tips, practitioners such as LMTs and non-autonomous nurses and the like should refer the client to the proper professional who can address any lifestyle improvements to be made as part of their licensed scope of practice.  There are specialty practices that can provide this educated direction.

We hope this visual and written explanation helps define what neuromuscular therapy practice could be for you, beyond the hands-on work itself.  To learn more as a licensed healthcare practitioner who is capable of performing evaluations and soft tissue manipulation, please visit and register for our neuromuscular therapy training at:  https://ceinstitute.com/collections/neuromuscular

Trigger point therapy is usually not an appointment by itself.  You rarely see a massage menu that says: Trigger Point Therapy (60 Minutes)

Trigger Point Therapy is commonly used in conjunction with other forms of bodywork including:

• Deep Tissue Work
• Sports Massage
• Prenatal Massage
• Neuromuscular Therapy
• Myofascial Release
• Hot Stone (could burn client)
• Physical & Occupational Therapy

The Mayo Clinic Defines a Trigger Point as:

“Sensitive areas of tight muscle fibers can form in your muscles after injuries or overuse. These sensitive areas are called trigger points. A trigger point in a muscle can cause strain and pain throughout the muscle.”[i]

To learn more, please register for training at: https://ceinstitute.com/collections/trigger-point-therapy

Here's an instructor lesson about what a trigger point is, as defined at our school:

 #tp #triggerpoint #triggerpointtherapy #masseter #intraoral #bodywork #bodyworker #massage #massagetherapist #mt #LMT

 [i] Myofascial pain syndrome, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-causes/syc-20375444, Found online May 6, 2022

Sometimes, when working a corporate onsite chair massage event, a massage therapist will come upon the occasional client with a headache. 

Chair massage is highly portable, and can be easily practiced in almost any office or work setting.

The following is our instructor demonstration of how we would normally treat a headache during chair massage. This particular chair massage routine for headaches includes massage compressions, trigger point therapy application, myofascial release and other bodywork practices and skills.

To learn more, please register for training at: https://ceinstitute.com/collections/chair-massage-event-work

Please keep in mind that we would have completed a thorough client and health history intake process prior to any hands-on work:

#tp #triggerpoint #triggerpointtherapy #bodywork #bodyworker #massage #massagetherapist #mt #LMT #chairmassage #onsitemassage #corporatemassage #painrelief #myofascialrelease #myofascia #myofasciabodywork #generalmassage #neckmassage #scalpmassage #backmassage #massagetherapy #headache #headacherelief 

The following is a Trigger Point Therapy Definition by the American Family of Physicians[i]

We do not agree with this entire definition, but it's a great starting place to learn what a trigger point is:

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.

Sometimes accessing a trigger point can be a little difficult.  When it comes to trigger points mastication, it can be a little more challenging.

To learn more, please register for training at: https://ceinstitute.com/collections/trigger-point-therapy

In this trigger point therapy massage instructor demonstration, we will show you how we teach students to access and treat trigger points intraorally:

#tp #triggerpoint #triggerpointtherapy #masseter #intraoral #bodywork #bodyworker #massage #massagetherapist #mt #LMT

[i] lvarez, David J., and Pamela G. Rockwell. “Trigger Points: Diagnosis and Management.” American Family Physician, 15 Feb. 2002, www.aafp.org/afp/2002/0215/p653.html.

Would you like to achieve more pressure in your massage and bodywork applications without much physical effort?  Perhaps you would like to lean a little longer into a massage stretch?  The choice is yours. And when you make that choice to use your elbows, you should be choosing whether you will use a dull or pointy elbow. 

A pointy elbow is usually applied with your elbow flexed to around 150 degrees, so that your knuckles are facing back towards your head. When you flex your elbow to 150 degrees, you will create a sharp point with your elbow’s olecranon process. We call this a pointy elbow, and sometimes we call it sharpening your tool, because you can use your pointy elbow for massage application. Pointy elbows are also commonly applied in trigger point therapy.

A dull elbow is usually applied with the elbow flexed at around a 90-degree angle. Dull elbows are popular in deeper myofascial techniques. They are also good for general muscle tension relief for for working larger bodily areas, such as the glutes or thoracolumbar fascia, without causing the discomfort a pointy elbow might achieve because it is dull.

To learn more, please register for professional training at: https://ceinstitute.com/

To read this article at Massage Magazine, please click HERE

#deeptissue #myofascialrelease #triggerpointtherapy #tp #tptherapy #massage #lmt #mt #massagetherapy #therapeuticmassage #deeppressure #massagetherapist

Establishing consistent opening rituals could prove to be beneficial, especially in group practice. Spending one minute or more with anything that feels familiar at the start of any session could feel comforting when an old client quickly reconnects with familiar touch.  Many clients could instantly relax when they recognize what they are feeling and receiving.

In this article, we focused mostly on opening rituals, and added in a few common closing rituals as well. We provided sample and common rituals for the following massage therapy and soft tissue bodywork applications: 

• Abhyanga & Ayurvedic Massage
• Aromatherapy Massage
• Craniosacral Therapy
• Chair Massage
• Cupping Massage
• Deep Tissue Massage
• Geriatric Massage
• Hot Stone Massage
• Ice Massage
• Lomi Lomi Massage
• Manual Lymphatic Drainage
• Myofascial Release
• Neuromuscular Therapy
• Oncology Massage 
• Post-Surgical Bodywork
• Prenatal Massage
• Reflexology
• Reiki
• Sports Event Massage
• Swedish Massage
• Thai Massage
• Trigger Point Therapy

Here is a list of common closing rituals that can be commonly practiced amongst all modalities: 

• Thank the client for their time.
• Express wishful thoughts silently or aloud for the client.
• Apply a hold with static placement of their hands on the client’s body.
• Ask the client to take some deep breaths.
• Perform body brushing techniques.
• Use a towel to remove massage medium from the client’s skin.
• Assist a client off the treatment table with select services or customers.
• Turn up any dim lighting so the client has greater visibility and acclimation back to reality.

Of course, no one has to follow these lists and practitioners can make up their own opening and closing practices as well!  What's most important is allowing your client to feel comfortable and instantly relax in your work area.

To learn more, please register for quality affordable professional training at: https://ceinstitute.com/

You can read this article in full at Massage Magazine by clicking HERE.

 #Abhyanga #Ayurvedic Massage #AromatherapyMassage #CraniosacralTherapy #ChairMassage #CuppingMassage #DeepTissueMassage #GeriatricMassage #HotStoneMassage #IceMassage #ManualLymphaticDrainage #MyofascialRelease #NeuromuscularTherapy #OncologyMassage #Post-SurgicalBodywork #PrenatalMassage #Reflexology #Reiki #SportsMassage #SwedishMassage #ThaiMassage #TriggerPointTherapy #lomilomi

Evidence-based massage practice applies a hands-on researched protocol to a client. The objective is to simulate hands-on applications with methods and protocols found to be beneficial in research or provide therapeutic outcomes, similar to what was achieved in the research study.

Sometimes a researched protocol which show what is not appropriate in massage therapy or bodywork practice.  Studies often exclude subjects with various disqualifications which create various parameters for the student.  Sometimes these exclusions are born from massage contraindications which are important to follow.  from participating due to various constraints or contraindications. This is why the entire study must be read and considered prior to real-time application or practice for evidence-based massage therapy practice.

To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/

To view our evidence-based massage article in full, published @MassageMag, please click HERE!

#swedishmassage #evidencebased #myofascialrelease #triggerpoint #hotstone #hotstonemassage #aromatherapy #aromatherapymasage #sportsmassage #prenatalmassage #oncologymassage #chairmassage #cuppingmassage #avyurvedicmassage #generalmassage #massagetherapy #lmt #mt #massage #lomiloimmassage #mld #manuallymphaticdrainage #lymphaticdrainage #medicalmassage #reflexology 

by Selena Belisle, Founder/Instructor, CE Institute LLC

In evidence-informed and evidence-based practice, therapists are seeing more and more VAS score improvements with massage therapy application.

VAS stands for visual analog scale.  This visual analog scale (VAS) is used for an individual to rate their own pain with numbers ranging between one through ten. VAS was reportedly first used in 1921 by Hayes and Patterson.

While VAS is an easy and commonly used assessment to determine an individual's pain, there is conflicting evidence and debate about the accuracy or validity of the method.

Beyond the debate, massage therapists can use VAS to assess their client's pain both pre and post massage.  Recording any changes in the client's pain from each session will help massage therapists determine which massage therapy methods might provide the most pain relief for a client.

To learn more about massage therapy practice, please click the following website link to find or register for training with us at: https://ceinstitute.com/

#VAS #healthcare #visualanalogscore #healthcarepractices #lmt #massage #massagetherapist #bodywork #bodyworker #massagetherapy #soapnote #recordkeeping #massagerecordkeeping #pain #painassessment #painassessmenttool #assessmenttool