Teaching Pathology from the Ruth Werner President, Massage Therapy Foundation

1. Teaching Pathology from the • Ruth Werner • President, Massage Therapy Foundation • Author, A Massage Therapist’s Guide to Pathology • Recipient, 2005 Teacher of the Year Award • Wernerworkshops@ruthwerner.com

2. Why Develop Curriculum on Pathology? • Required by… • COMTA, other accrediting agencies • Some state licensing boards • NCBTMB

3. Why Teach Pathology? • Public Safety: Why do people get massage? • AMTA 2012 Massage Profession Research Report says of the 18% of US adults who got massage in 2011… • 44% for medical reasons • 30% for stress • 12% for “pampering”

4. Why Get Massage?, cont. • So… about 74% for health and/or wellness • 37.9 million people had a massage in 2011 • 170,500,000 sessions delivered • (about 4.5 sessions per person)

5. Massage Locations

6. More Massage Locations 1% each (about 400,000) in… • Workplace • Student clinic • Hospital • Alternative therapy clinic

7. Massage Therapy in Policy • ACA mandates a place for integrative medicine for health and wellness • NCCAM • Recognizes massage as part of integrative medicine • Requires that IM licensed providers be research-literate • It is our job to prepare MTs to be ready to take part in this new/ continuing reality

8. So… • About 400,000 people get massage in a student clinic (under our care) each year • Massage is being used as health care more than as self-indulgence– including in spa and resort settings • … Are we educating students to be health care providers?

9. What Goes in a Pathology Curriculum? • Understanding what issues impact choices for bodywork and safety • Critical thinking: the answer is always“it depends”; our students must determine what it depends on • Palpatory and visual signs of caution • Medications (new field, under-studied) • Skills to get more information (research literacy!)

10. Finding More Information • Print resources about MT and Pathology: • Werner • Salvo • Premkumar • Wible, Persad (MT and pharmacology)

11. Finding More Information • Electronic Resources About MT and Pathology • In general look for .gov, .edu rather than .com • Beware of advertisements hiding as good information • Wikipedia can be a good starting place, but not a good ending place • Medscape.com, emedicine.com • Mayo.com • NIH.gov • Subheads for type of condition • CDC.gov • Scholar.google.com: edits out most commercial sites

12. Finding More Information • Trade Journals • Massage Therapy Journal • Massage and Bodywork • Massage Magazine • Massage Today • They all have columns on pathology and research, with the added benefit that they are more current than textbooks and written by MTs

14. Beyond Objectives– all the way to IMPACT critical thinking Weigh risks and benefits to make choices for a safe and effective session and treatment strategy: Communication Be able to have an informed conversation with the client and his/her health care team: • Which systems are affected • What is the prognosis • What are common treatment options • Where does massage fit/ what does the research say?

15. Troubleshooting Pathology Classes What doesn’t work: • It feels dark and hopeless • It doesn’t seem pertinent • It’s just a big information dump • It’s too technical • It’s too personal • It’s too hard to fit in between courses– after A&P, before student clinic… • Taught by multiple people • Taught by non-MTs, who have no sense of context • It’s too hard to discern what to cover and what to let go

16. How Do We Teach Pathology Well? • Pathology teachers need to… • Focus as much (or more) on the body’s capacity for healing as we do on the process of illness– this frames a context for bodywork as a therapeutic intervention, working to create an environment conducive to positive change • Discuss people who live with conditions with respect and appreciation • (Humor has a place here too) • Instill the fact that life is an open-book test • NO ONE can remember it all (including the teacher) • Plus which, information changes • That’s why you need to be able to look stuff up! • Remember what it felt like to be overwhelmed with information

17. In the Delivery • Review pertinent A&P (this is building the house of cards) • Discuss what happens when certain cards (functions) are removed (interrupted)

18. For Each Topic… • Cover at least: • Definition • Etiology (briefly!) • Signs and symptoms • Conclude from that information: • Massage benefits • Massage risks • How to maximize benefits, minimize risks

19. In the Best of All Possible Worlds Add… What does the research say about massage and ___?

20. This gets us to… critical thinking Weigh risks and benefits to make choices for a safe and effective session and treatment strategy: Communication Be able to have an informed conversation with the client and his/her health care team: • Which systems are affected • What is the prognosis • What are common treatment options • Where does massage fit/ what does the research say?

21. Herpes Simplex • Viral infection leading to painful blisters on the skin • Oral, genital, other • Type 1 v. Type 2: no longer a significant issue • Incidence • Who knows? • Genital herpes: 60%? • Oral herpes: 80%?

22. Herpes Simplex, cont. • Primary and recurrent herpes • Virus is never expelled • Communicability: • Virus is stable on surfaces outside a host • Can spread from one part of the body to another • Can spread during prodromic stage

23. Herpes Simplex, cont. • Types of herpes: • Oral • Genital • Whitlow • Gladiatorum • Others • Signs and symptoms • Tingly, itchy during prodromic stage • Painful blisters on a red base • Scabbing after acute phase (less contagious)

28. Herpes Simplex, cont. • Complications: • Secondary infection • Increased risk of contracting, spreading HIV/AIDS • Vaginally delivered babies • Treatment: • Antivirals to shorten episode (not prevent) • Research: • Nothing on humans with herpes about massage therapy

29. Herpes Simplex, cont. • Massage? • Risks? (How to eliminate them?) • Benefits? (How to maximize them?) • Reschedule during outbreaks, prodromic stage • Avoid hands? • Isolate linens if exposed • Be careful of spreading from therapist to client!

31. Strategizing Classroom Content • Prioritize: • Discuss the most common conditions • Cardiovascular disease • Arterial side: hypertension, atherosclerosis, etc • Venous side: DVT, PE • Types of cancer • Skin, lung, colorectal, breast, prostate • Regional issues • WNV, Lyme, etc…

32. Prioritizing, continued • Discuss the conditions most influenced by touch • Contagious conditions • (especially of the skin– demystify these!) • Public health issues • HIV/AIDS, hepatitis, TB… • Fluid management diseases • Kidney and liver dysfunction • Diabetes • Musculoskeletal conditions • Coordinate with other courses

33. Use Lots of Tools! • The emphasis is on interaction with the material • Draw pictures • Use videos • Invite visitors • Assign projects

34. You can’t cover everything so… • Empower students to get their own information; they should be able to provide the basic things you cover in class • Homework has a place here too… ensure that students are interacting with content NOT covered in class time.

35. Student Projects in Pathology • Focus on critical thinking and communication skills • Assign a research paper • on a student’s choice of topic • on your choice of topic • (beware of plagiarism– it is a difficult issue) • Assign a spoken presentation • Warning: students are not teachers. These can be boring to sit through, and may turn off the rest of the class • Interview someone who lives with a condition • This can also spill over into a research literacy project: • Find an article on the topic (or you can provide one) • Critique it • Describe how to apply findings in practice

36. Thank You!