Destinations
Point A to Point B. If you go to whatever navigation app you use on your phone and ask for directions it will ask for a location, and a destination. You can choose between your current location, or whatever point you’d like to start from. It’s quite useful in life to know where you are, where you would like to start from, in what direction you’re traveling, and what your ultimate destination is.
In certain circles we refer to the space in between current location and ultimate destination as a continuum. This is were I am, this is where I’d like to wind up. A very simplified form of a continuum that many massage therapists are familiar with looks like this. Reduce pain and inflammation, restore range of motion, then strengthen. Since strengthening is generally considered outside the scope for most therapists, we focus on our end of the continuum. Reduce or eliminate pain and inflammation and restore range of motion and function.
In strength and conditioning, a common continuum might look like this. Mobility, static stability, dynamic stability then strength. Strength base, power phase, sports specific phase, de-load phase, active recovery phase, rinse and repeat.
As a massage therapist we are not licensed to diagnose. Many of our patients and clients come to us for specific reasons. A large percentage of the time the reason is either acute or chronic pain or a specific condition. This presents some interesting challenges because the nature of pain can often make it difficult and unreliable to diagnose…If we were going to diagnose, which we cant, because it lies outside the boundaries of our legal and ethical scope. So what to do?
Many of us use a variety of tools to ascertain what we suspect to be the cause or issue, and form some sort of plan to treat, but again this can be shaky ground in that, if we are not careful and diligent about the way we not only treat, but the way we represent our treatments, we can be inadvertently diagnosing just the same.
The field of manual therapy encompasses chiropractors, osteopaths, physical therapists, physiotherapists, occupational therapists, athletic trainers and massage therapists. Massage therapist is the entry level into the world of manual manual and the only occupation under the umbrella of manual therapy that does not include diagnosis within it’s scope. Yet massage therapists spend more time actually performing hands-on work than all the other disciplines combined. While the other professions require the learning and execution of many other skills and abilities, the sole concentration of massage as a manual therapy is a focus on hands-on.
Yet the other professions are having a much greater influence on defining manual therapy than the massage therapist. One could argue that we are the step-children, the middle child of the manual therapy industry. We do the bulk of the heavy lifting, yet receive the lowest financial compensation, the least amount of respect and recognition. Worse yet, when someone is looking for the manual therapy “expert”, were are often the last to be consulted.
The conversation around what manual therapy does, how it works and it’s efficacy is being defined largely by individuals in the industry who do little to no actual hands-on. This is alarming. Ida had her recipe. Go do this work, in this way for 5 years and maybe….maybe you’ll start to figure out the body and how it works. Until then….just do the recipe. These days people read studies and watch videos of cadaver dissections and represent themselves as authorities on manual therapy.
What is interesting, is the near isolation that occurs between massage as an industry, and the other forms of manual therapy. While it is not unusual for a massage therapist to specialize in pain or sports/athlete specific modalities, it is exceedingly rare for a massage therapist to operate dually in allied professions. As a massage therapist and strength coach of 25 years I’ve operated in both fields, often in overlapping roles. This has allowed me an unprecedented perspective into the processes and continuums of allied but often divergent fields. Many massage therapists try diligently to establish profession relationships with other medical providers and some are quite successful. However, the majority of the massage industry operates in isolation from allied manual therapy disciplines. As an observation I’ve found allied professionals much more receptive to working with a strength coach than they were a massage therapist.
Origins
If I were to look back on the start of my career I had been first an athlete for several years, then a personal trainer, then a massage therapist. There are many commonalities between being a massage therapist and a fitness professional, but there is one specific commonality I would highlight here. Both exist as service industries. If you visit the website for the bureau for labor statistics you will discover that in terms of national median income and career length for a massage therapist and a personal trainer is not dissimilar to a waiter or waitress. The nature of these industries, their income level and opportunity for longevity tend to attract a more part time work force.
There does exist within the food service industry a very specialized position. The professional waiter. This is a small percentage of the industry in terms of skills and income (someone making over 6 figures) For an individual to make 6 figures in a profession where 85% make less than the national median average in income requires a dedication to personal and professional development uncommon to most in the service industry.
We all make a choice in terms of what end of the industry we want to operate from. I made a decision early on to be at the top of my profession as both a massage therapist and a strength coach. Years ago I stopped calling myself a personal trainer. I make the designation of professional strength coach over personal trainer because I believe that personal training is more indicative of the average person who approaches personal training like waiting tables. More of a part time job than a full time professional career. When I lived in LA the waiter at the IHOP was an actor. Everyone in LA is an actor. When I lived in South Beach everyone was a personal trainer, massage therapist, model or real estate agent.
In my desire to develop the skills required for me to be a professional and earn the sort of income a full time career provides, I’ve invested heavily and spent years studying and learning. The top 5-10% of any industry requires a different set of skills and abilities. As a strength coach working with interdisciplinary teams of other professionals at an elite level, everything becomes systems. The study of systems has given me a unique vantage point in seeing how different professions go about addressing the same issues and opportunities present for the same group, population or problem.
I never set out with a master plan. Massage therapy and personal training were two areas of interest that I was passionate about. Over the years Ive ran both businesses sometimes together, sometimes separately. I have longstanding clients that I solely train, others that only receive manual therapy, and clients that receive both. I’ve compared the results and there-in lies the true opportunity. I never set out to become a “Hybrid” but in affect that is what I have become. This is where I believe the opportunity exists for massage therapists.
The Hybrid
The way that I practice manual therapy today is much different than the way I practiced manual therapy at the start of my career. In rehab it is common for a physical therapist to deal with the most acute phase post injury or surgery. The insurance industry often dictates the patient be released before they are able to advance much beyond the initial phase of the continuum. Because of that, re-injury rates are quite high as well as chronic pain. Rehab professionals are well aware of this phenomenon. An entire sub-specialty of the industry, post rehab return to sports has been the result.
Over the last decade I have built a reputation and a niche in my community as being a specialist in post physical therapy-return to sports. Not just from a manual therapy perspective, rehab perspective or a performance perspective. I cover the entire continuum. Rehab is a continuum. Training is a continuum. Massage and manual therapy should also be a continuum (more on that in the next article)
Another inevitable by-product of this trend in healthcare and well-care is the advent of the Hybrid. What is a hybrid? For years there have been divided segments of the industry. Orthopedic surgery, physical therapy, chiropractic, massage therapy, etc. that have existed largely independent of each other and often presented as an either or. If chiropractic doesn’t work than physical therapy is an option. If physical therapy doesn’t work there are drugs, or massage or any number of alternatives, that may or may not work.
The challenge is, most of these approaches fail to progress a client or patient across the full spectrum of a continuum. In the A to B analogy, if my goal is to go from location to destination, stopping half way assures that I have arrived. Somewhere, but not my ultimate destination. Taking someone out of pain and restoring a minimum base-line of function is not resilience, optimum function or performance. Its a low bar with little distance to separate the client from the previous state of dysfunction, pain and injury and a rapid return to the starting point. We’ve all seen this and experienced it in our own work, if we care to be honest. We can get someone out of pain temporarily. But it doesn’t last so we become a crutch, with all the physical and emotional baggage that comes along with the care and treatment of chronic pain and injury.
I am a strength coach who has a license to perform manual therapy. This provides interesting opportunities. I am able to perform a broader spectrum of the continuum, in-house. I have also fostered excellent relationships with manual therapists of other disciplines. To be clear, just because I have the skill and license to do hands-on doesn’t mean that I always do it. As my career has progressed, I have fostered relationships with other elite professionals. I refer out more and more. This allows me to be excellent at what I do and not be forced to do things that are not my area of expertise. Just because I am a strength coach and corrective exercise specialist doesn’t mean I always use those skills with every massage client. However, having those skills changes my view of the world and the lens I look through. This is occurring across the entire industry.
The Evolution
Within gym culture you have the meat-head bro-science, GAINZZZZZ types. Then you have the weenie, rehab and corrective exercise physical therapists who suggest if you ever pick up a weight more than 20lbs your spine will explode. Those two populations war back and forth. Two ends of an extreme.
Now youre seeing hybrid physical therapists and sports chiros possessing manual therapy skills and legit strength and conditioning backgrounds that know how to get you out of pain, and then get you big and jacked.
More and more you’re seeing the sports chiropractor with legitimate skills and understanding as a strength coach. The physical therapist who has actually studied hands-on soft tissue work, beyond the basic units required in PT school. Also with legitimate skills as a strength coach. You’re even seeing trainers trying to be massage therapists (more on this in a moment). Everyone is crossing over. What you’re not seeing a whole lot of is massage therapists crossing over. I suggest to you that a key reason for this is a lack of understanding of the opportunities present outside of the massage community.
SWAT Analysis (strengths/weaknesses/opportunities/threats)
Its been suggested in certain circles that a fitness professional can attend massage school and operate as a quasi-physical therapist. Another disturbing trend we see, happening across the industry is trainers performing unlicensed manual therapy, ie, using guns and foam rollers on their clients. There are well established brands and franchises in the industry like Equinox gyms, Hypervolt and Radroller that are actively encouraging trainers to perform unlicensed massage. They even offer certifications in this. It’s methodical, arrogant and quite deliberate. They believe that because they have an implement in their hand and not actual hands on they are in the clear. How is it these companies see the opportunities and the massage community does not? If there is a story to be told, a position to be taken, as it relates to massage, should’t we be the ones making it?
Recently the question was asked, “are you suggesting massage therapists become personal trainers?” My response is, yes and no. It is a business decision to take on advanced education and acquire new skills that each practitioner must make for themselves. I am of the personal opinion that a massage therapist, with their background in anatomy, physiology, biomechanics, contraindication and ethics is much more qualified to become a personal trainer than a personal trainer is qualified to take a weekend course and start doing hands-on. Trainers dont understand this because they haven’t been trained in scope of practice. Most arent even aware that they have a scope.
The scope of this series is to highlight the trends and opportunities available to the massage therapist. All across the industry professionals are making the decision to diversify and broaden their skills, scope and capability to service a larger part of the continuum. It’s a decision to operate in the top 5-10% of any industry in terms of skills and abilities. Thats what were talking about here. Welcome to the big leagues. A massage therapist needn’t become a personal trainer (unless he or she chooses) but being aware of systems and bio mechanical models of movement that exist as industry standards is critical. Massage therapists are simply not remaining relevant in the context of a larger industry wide conversation. We’re being beaten at our own game. The penalty for that is obscurity and death.
One of my personal mentors, Doctor Charlie Weingroff is a nationally recognized presenter, thought leader and arguably one of the top top ten physical therapists in the world. Also an athletic trainer (coincidence?). Ive heard him say often, that within systems, the foundational principles are universal. The methods are many but the principles are universal. When a professional is operating within the continuum, more and more it becomes difficult to differentiate the physical therapist from the chiro, the personal trainer from the massage therapist. Not to suggest that anyone be operating outside their ethical scope.
The beauty of systems is that there is no need to. Everyone is speaking a common language and delivering their own unique contribution to the continuum. This level of professional cooperation is wholly missing from the massage therapy community. Something Ive also heard Charlie say often. “Most people would rather be right. I just want to win.” Do you want to be right? Or do you want to win? When a team of professionals are committed to winning over egos and who gets credit, the results become exceptional.
What I started to realize as I worked as a strength coach and manual therapist on elite interdisciplinary teams, working with professional athletes was this. At that level its systems. Systems that are available to massage therapists, yet so few massage therapists are even aware of these systems because most massage therapists operate in an isolated corner of the industry, the red-headed cousin if you will, with little interaction with the more mainstream and commercially accepted forms of manual therapy.
I know, I know. A lot of my fellow massage therapists would argue they work with athletes and have referral networks with chiros and physical therapists. But they are still operating as a massage therapist. Operating in isolation and ignorance of industry wide standards of systems and best practices. But when a massage therapist starts studying the same systems, speaking the same language…..well now! That’s when everything shifts.
The Choice
The systems and methodologies I’m referencing are the top 5-10% of physical therapy, chiropractic, occupational therapy. Those professionals have the same decision to make. Am I willing to operate in the top 5-10% of my profession in terms of skills and abilities, or am I satisfied with the status quo? Everyone has an opinion and many certainly have their own pet systems and methodologies. Personally Ive made it my business over the last 2 1/2 decades to identify and study the industries top systems from the fields of strength and conditioning, manual therapy and business. Whats particularly telling is the top 10 % of chiros, physical therapists, athletic trainers, strength coaches are all operating within the same systems. They speak the same language. There is no universal language that exists within the massage community.
These are my experiences. All I can do is share my report of findings and tell you the story. It either resonates with you or it doesn’t. In the end, you decide.
In Part 3 I will discuss the systems, the foundational principles, and the opportunities available for today’s modern manual therapy “Hybrid”.
Coach Don Stanley is a TPI Certified Fitness, Medical, Juniors and Power Certified Professional. FMS, SFMS, CFSC and FRC Certified.