It’s autumn in North Carolina, which can only mean three things: spectacular sunlit leaf color, a distinct uptick in latte consumption, and NCAA college sports in full swing.
I get the privilege of working with several Division I college sports programs, most notably my graduate school alma mater: the University of North Carolina at Greensboro. I’ve been feeling the Spartan love this week with lots of outcall sports massages in the athletic training room, and working with these talented young people never fails to keep me on my toes.
The Internet Age has given athletic people vast resources to learn more about sports, nutrition, physiology, training, and therapies. On the whole, I am impressed that the availability of knowledge seems to help my massage clients to be well-informed and discriminating consumers of information. People who participate in sports at a high level view their bodies as tools — their vehicles for recreation and competition. This insight frequently leads them to constantly seek and evaluate information that will improve their performance, health, and experience. It also means they ask practitioners a lot of questions.
It’s easy to view “why?” as a challenge: a threat to authority and credibility. But forcing myself to dig deep into the body of knowledge through the incredibly effective (and sometimes incredibly annoying) Socratic method makes me a better practitioner and helps me build a reputation among my clients that I am a trustworthy source of information. The college students I work with ask questions that often catch me off guard, and the exercise of thinking analytically and critically to construct a thoughtful answer is often a missing ingredient in massage education.
Let’s apply it to a common instruction massage therapists give to clients following a bodywork session: “Be sure to drink plenty of water after your massage.”
The pat answer many of us learn in massage school is “to help flush out metabolic waste.” But what does that mean, and most importantly, is it a rigorous and factual response to the physiologic processes at work?
To be thorough and deductive in crafting an answer, consider all the pertinent facts. Massage therapy has a demonstrable effect on blood and lymphatic circulation, because the mechanical manipulation of soft tissues introduces heat and pressure, which creates a mild inflammatory response. The body’s response to topical heat is rapid dispersal by dilating capillaries in the tissue, which decreases blood pressure because of decreased vascular resistance. To maintain homeostasis, the body responds to the drop in blood pressure by adjusting fluid uptake in the blood stream and changing heart rate to stabilize blood pressure. One important role the circulatory system performs is transportation of the surplus substances of metabolism and energy production and expenditure to the kidneys to be excreted from the body. An example is the process of converting protein into energy: the leftover substances include ammonia, urea, and uric acid, which are toxic if they remain in the body. Massage is not directly shown to release metabolic waste from soft tissues under study conditions, but in consideration of the peripheral responses to massage, appropriate hydration supports homeostatic processes to promote optimal muscle function and recovery. Most importantly: with the exception of a few conditions such as hyponatremia (abnormally low electrolyte dilution), drinking water is an appropriate recommendation for overall health an wellness; the risks are vanishingly small, and the potential benefits are great.
For many clients, this explanation goes in to way too much physiology detail. However, I think as a therapist, it is important to understand the complete picture and to be able to articulate it accessibly and intelligently. It establishes credibility and develops the ability to think critically and scientifically about the therapeutic intention of our work. It also helps me to be better able to talk about the effects and benefits of massage to other medical providers, which has made a huge impact on building my client base and becoming regarded as a skilled practitioner, able to get into a variety of unique opportunities as a massage therapist. For me, it’s simply not enough to regurgitate pat answers; I am voraciously curious and keeping current on research helps me to continuously refine my methods and understanding.
If you are a consumer of massage therapy, I encourage you to ask your therapist questions about what he or she is doing and effects on the body. I think most therapists are like me — we get really excited when clients show an interest in our specialty and we want to share with you information that can positively impact your health, wellness, and understanding of your body. Learning about physiology and anatomy in school was like getting an owner’s manual to my body and I love sharing that feeling of empowerment through knowledge with my clients. I don’t think it’s appropriate to try to test therapists’ knowledge with “trap” questions, but to approach your therapist as a resource to broaden your understanding of health, wellness, and activity. Additionally, most massage therapists maintain an extensive referral network of other allied healthcare professionals, so even if we can’t directly answer your questions, we can almost certainly direct you to another expert who can.
Do you have a burning question about massage therapy, or are you a practitioner who has encountered great questions from your clients? Shout out below!
First, a disclaimer: this post is going to be a self-congratulatory/self-flagellating exercise in navel gazing, although I hope not entirely devoid of insights. If that’s not your thing (and it’s totally cool if it isn’t!), it’s probably best to skip over this one. I promise to get back to bicycle racing soon. Without further delay, I present my latest Soigneur’s Diary entry.
This is a really flippant, privileged, entitled-white-girl-from-the-suburbs thing to say, but rings true: I’m not used to not being good at things.
I’m a little bit on the type-A side in that respect. I tend to pick up new things pretty easily — new sports (with the notable exception of inline skating), artistic pursuits, academic skills, clinical skills, using technology, and so forth. I try to embrace the “see one, do one, teach one” approach to learning and it generally serves me well. I take pride in mastery of processes and making meaningful contributions through my work. I learn best when I can take a methodical approach and clearly see how all the moving pieces fit together.
So it’s absolutely driving me crazy that I’m not a great soigneur already. I feel like I have about 1 out of every 10 days of total competence versus completely screwing up and getting in the way. There are a few things I’m doing very well, like therapeutic massage and first aid management, but it seems like such a small percentage of the job. It’s the part that the director rarely sees, which really shouldn’t matter — performing my job expertly is its own reward and if I’m doing it right, my part should be relatively invisible as athletes recover from racing and heal from injury easily and rapidly. I would never presume to take credit for their achievements, but I am keenly aware that poor clinical reasoning on my part will inevitably impact them negatively.
But that’s the tip of the iceberg; the other 90% of unseen lurking mass is the part that consistently trips me up and makes me feel foolish at best and incompetently negligent at worst. Part of the challenge is the rest of the job should be more or less invisible too: the best soigneurs get noticed by going unnoticed. Everything is immaculately prepared and arranged when it needs to happen without question or hesitation. All the details are managed to make a perfectly smooth big picture. All this is done without the expectation of thanks; at the end of the day, the things that matter are that the riders are cared for, and the rest of the staff is happy and never inconvenienced by a task left incomplete.
I am working so hard to get to that point. I had a long phone conversation with my mentor yesterday, who likened my situation to being thrown into battle on the front lines without basic training. (I have a hard enough time justifying a career in something as “trivial” as sports to my Quaker Meeting; the military metaphor might be enough to get my Friend card revoked!) It does feel a bit like that sometimes, but I think of it more like a counter-terrorism squad: people only notice the superb work they do when they let that one-in-a-million slip through the cracks and horrors ensue. (I’ve been watching Homeland in my spare time before bed; ugh, my Quaker card is definitely in serious jeopardy now). Obviously, forgetting a chair or mislabeling a supply box doesn’t have quite as serious repercussions, but it shows that I’m not performing at the high standards to which I hold myself. I feel like 5 months of doing this job should be enough time to achieve proficiency; I mean, seriously, sure there’s the sports medicine bit, but mostly I wash vans and fill bottles and make sandwiches. How hard can it be?
I’m not a dumb person. I’m comfortable solving calculus-based biomechanics problems, I know all the bones in the human hand and nerves in the brachial plexus, I play half a dozen musical instruments, I got a perfect score on a section of the GRE, I can still recite the first canto of Dante’s Inferno in Italian that I memorized in college (which is probably why I have trouble remembering phone numbers). I’m a serial enthusiast and when I get really excited and into a particular topic, I read everything I can get my hands on to amass a near-encyclopedic knowledge about it (my mom sometimes calls me Cliff Clavin and I don’t think it’s a compliment). Emotional and social intelligence…maybe not so much. I have a hard time fitting in and perceiving social cues. I get so excited about successfully navigating a social interaction when I meet a new person that I invariably immediately forget their name. I don’t have a strong personality, and I think that causes me to come off as aloof, shy, and boring. In reality, I usually just have no idea what to say. I don’t think of myself as particularly cute, funny, or interesting, so I tend to discount and discredit the qualities and contributions I bring to the table. I am less shy than just painfully introverted, and I recharge with alone time and spending one-on-one time with close friends. I expend so much energy trying to be liked that I make myself wholly unlikeable. I’ve come to grips with the realization that I’m kind of weird and have weird interests, but I lack the confidence to fully own my weirdness and instead fall firmly into the awkward zone. I haven’t really found my people, so I make up for my difficulty forming friendships by throwing myself into work and dramatically overthinking everything. It’s pretty exhausting, actually.
I’m a worrier. I was in therapy specifically for aviophobia last year, and I realized that air travel was hardly the only time I experienced overwhelming anxiety. The psychologist I worked with appealed to my academic tendencies and gave me an array of articles and chapters to read about how the brain processes threat. Fear is hardwired into the prefrontal cortex “lizard brain” as an important survival tactic. When we receive a sensory stimulus like a sabertooth tiger crouching in the grass, an ancient programmed circuitry fires into action, engaging the sympathetic nervous system to divert all energy to escaping the danger. It is an evolutionary advantage for the brain to perceive a threat where none exists — if we assume that every rustle in the grass is a tiger, we are more likely to survive rather than if we incorrectly identify the rustle in the grass as just the wind when a tiger is ready to pounce. This tendency toward hypervigilance is the reason our species has been able to survive, proliferate, and evolve. It also causes an awful lot of problems in the modern world. When the amygdala receives signals that a threat is present, it floods the blood stream with stress hormones that activate the sympathetic nervous system, stopping metabolic processes and heightening sensory input to prepare the body to face or flee from danger. When a specific, discernable threat is present in the environment (the tiger, to continue the example), the system functions as designed. When there is not a threat readily identifiable, the amygdala looks for other environmental cues that could signal danger, and even cues within the body such as elevated heart rate and respiration. A panic attack is, in essence, crippling fear of fear itself. We then spin “what if” stories that have no actual basis in reality, taking us out of the moment to exist in an imaginary realm of fear and dread. Even though the conscious mind knows it isn’t real, the prefrontal cortex has no way of differentiating and responds to the imagined fear stimulus just as if it were a tangible threat.
My biggest fear is shame, and I am tremendously good at inducing it in a variety of situations. I think this is true for most people, and definitely for me: if I’m given a list of a hundred things I do well and one area in need of improvement, I obsess about the shortcoming and discount all the proficiencies. I dwell on my goof-ups and allow them to overshadow my talents. I walk around like a puppy that’s just been beaten with a newspaper, afraid that my coworkers are going to yell at me the way I am mentally berating myself (usually they don’t, but I live in terror of their disapproval). I parked a van in the wrong place yesterday and I spent the rest of the day in a funk when one of the other staff pointed out my error in an effort to help. It’s an attractive quality, no?
It’s also absurdly unproductive, and I know it is. My guilt and fear that I will never measure up is probably my biggest obstacle to competence. How do I possibly ask others to put their confidence in me, when I lack confidence in my own abilities?
While I was bemoaning my plight to my endlessly indulgent mentor, my mother sent me a TED talk that spoke to the heart of the matter.
In the video, researcher-storyteller Brené Brown explores the link between vulnerability, authenticity, shame, and courage — spoiler alert: she finds that the ability to embrace imperfection and celebrate shortfalls with successes alike is at the core of successfully finding fulfillment in all our relationships and endeavors. Yikes. The very idea makes my throat tight with the first inklings of panic. Wouldn’t putting my vulnerability on display counteract all the effort and energy I put into appearing like a pillar of confidence and strength?
Writing this post to go in the public sphere is my first step toward a healthier exploration of vulnerability. I don’t have to turn into a scared child to accept the fact that I will fail in life, sometimes often, hopefully not too spectacularly, and that’s ok.
My mentor had some great advice that is already helping me to feel more secure about my abilities. His first piece was to stop assuming logical leaps and to be more pedantic about questioning each procedural step. I love this approach; I learn best when I read the directions completely before assembling an appliance, so I have a thorough understanding of the process timeline from start to finish, and a discernable checklist of items that assure the task has been completed correctly. He told me to let go of my concern that people will judge me for insisting on a detailed explanation of mundane things, because an excellent end product at the expense of taking a little more time with the process is better than struggling as I go without a clear vision. The same concept applies to the challenge of dealing with cultural differences that I face with working in Europe — it is always preferable to spend more time hammering out details ahead of time than to assume we’re all on the same page because I don’t want to take up anybody’s time.
He implored me to do one thing at a time. Multitasking is the enemy of process. In science, the most important part of experimentation is the ability to repeat the exact conditions that will achieve a specific end result. Adding too many variables invites error. Accomplish each task completely before moving on to the next, and focus on the task at hand instead of allowing my attention to wander to the next one. Keeping a physical checklist is helpful for me in this area, because it’s one fewer thing to juggle in my mind as I learn a new skill. A slightly slower, more deliberate process is always preferable to hurried neglect.
As I establish processes that achieve satisfactory results, he encouraged me to allow those to become as instinctive as my sports medicine practice has become. He is the only director I have worked with who has actually seen me in action doing sports massage and first aid, and he commented that I am so comfortable in my element that a complex maneuver looks as intuitive and natural as getting out of a chair and walking across a room. I find it a little ironic that I am struggling to make setting out chairs and mixing sports drink as easy a task as performing a physical evaluation for knee pathologies. On the other hand, it’s good to remember that the hard medical part that many soigneurs spend years mastering is already more or less second nature for me.
One piece of advice that struck me at first as a little counter-intuitive was to apologize less. I have always tended to show profuse contrition over even relatively minor offenses, or those that are not even really my fault but I appeared in the wrong place at the wrong time. He told me to quit taking ownership and responsibility for things that are out of my control — not to be an excuse-maker, but also not to saddle myself with the burden of every mishap. Sincerity comes less from expression guilt and more from the actions taken to not let the same mistake happen again, and that’s what’s really meaningful to other people.
He instructed me to let mistakes go immediately. Every time I allow some part of my mind to linger in the past and obsess about a mistake, I am diverting attention from the task at hand and making another mistake more likely. It is always more productive, and often safer, to take a lesson and whisk away the rest. Mistakes in and of themselves have no value — the value comes from learning to approach the situation differently next time for a successful outcome.
Finally, he cautioned me against comparing myself to others. This is a pretty tall order, as I tend to evaluate the world around me through judgment rather than perception. There was a beautiful blonde Australian soigneur here this spring who was also a first-timer, and I was in awe of her skill. She was such a natural at every part of the job, and her extroverted effervescence and gregarious personality endeared her to the rest of the staff quickly in a way I admired and even envied. I have come to realize that she made just as many mistakes as me, but the biggest difference in her approach was her ability to laugh it off and hop right back on the horse. She seemed a lot less stressed than I feel most of the time, and I think her resilience was a huge part of that. I have been racking my brain for ways to develop the same resilience myself; it hadn’t occurred to me that perhaps it already exists within me and was waiting to be tapped.
I cash in another night feeling just a little better about my work today than I did yesterday. I gave a director a bad driving direction today, and I forgot that I had promised a rider to change his wound dressing when another director asked me to make a gas station run for diesel in the van. I didn’t let go quite soon enough on a water bottle feed and the rider knocked it out of my hand. But nobody died. We even won our race. And I am coming to realize that today was a job well done, even if it wasn’t a job done perfectly. And that’s ok.
When I was in 1st grade, I thought dinosaurs were the best. The greatest of course was Triceratops, because of the beast’s striking, instantly recognizable features, and because it had “Sara” in its name (say it out loud). My mom showed me a book with beautiful pictures called Digging Up Tyrannosaurus Rex about the most complete T-Rex fossil ever found (incidentally, by my uncle’s sister in Montana) written by paleontologist Jack Horner. She told me that Dr. Horner had trouble in school because of a reading disability but he became a great scientist anyway. That was it; I wanted to be a paleontologist just like Dr. Horner.
In 2nd grade, I did a book report on the American astronaut Sally Ride. I learned that she was the first American woman to go to space, and I was captivated by the pictures of her with her long hair floating weightlessly like a mermaid underwater. She used the robot arm on the spacecraft to retrieve a satellite, which I thought would be very handy to remotely play with my friends on the playground while I was still in class. That was it; I wanted to be an astronaut just like Sally Ride.
Another book report in the 3rd grade brought to life Robert Ballard’s discovery of the German warship Bismarck. Dr. Ballard is best known for his discovery of the RMS Titanic, although he says that the lack of historical record and the nature of the shipwreck made the Bismarck much more difficult to locate. I read that Dr. Ballard’s tiny submarine, Alvin, fit 3 people in the space of a walk-in closet (I made two of my friends squeeze into a bathroom stall with me to experience this claustrophobia firsthand). I read that the pressure at 15,719 feet below sea level, where the Bismarck was found, was so immense that a styrofoam head would be crushed to the size of a shooter marble (I crushed a lot of styrofoam cups to see how much force it took). I read about how Dr. Ballard gathered evidence about the ship to recreate the battle that led to her sinking, and his observations supported the theory that the German crew had “scuttled” the ship, (a delightful word for an 8-year-old audience) intentionally sabotaging her inner compartments to sink the disabled ship faster and prevent her from being captured by the British navy. Most compellingly, Dr. Ballard had kept the Bismarck’s location a secret so that less scrupulous explorers couldn’t rob artifacts, preserving the shipwreck as a historical site. That sealed the deal: I was absolutely, positively going to be an oceanographer, just like Robert Ballard.
I actually stuck with my marine science enthusiasm for quite a long time, as these things go in the elementary-age demographic. Having to wait until age 12 to get SCUBA certified made my ambitions more difficult to maintain, and my interests drifted to a range of topics — music and the arts, then large animal veterinary medicine, then political speechwriting (that one is a little harder to explain, but I was really into it).
When I was in high school, my mom got really into running. I went to see her run the Women’s Only 5k on a beautiful, crisp October morning, and I was so impressed — there was my mom, lithe and powerful, with an awesome kick finish at the end! Something inspired me to requisition her steel hybrid bike that afternoon and I went out on my first real bike ride, a 4-mile loop near my house with a couple pretty good hills in it. When I got back, I had to lay on the living room floor with the ceiling fan blasting full-force for half an hour before I felt like I could walk. I was not a fit kid.
But the next day, darn it if I didn’t go ride that loop again. Twenty-five minutes to recover this time. Two weeks later, I had ridden every day and had gotten up to 20 miles in one shot! A month later, not knowing any better, I showed up at Paceline Bicycles on Saturday morning, 34-pound steel hybrid in hand, and rode 45 miles with some incredibly indulgent, sweet, helpful cyclists who took it upon themselves to make sure this strange kid on her wholly inappropriate bike didn’t become road kill out there.
My parents made what was, in retrospect, a slightly absurd leap of purchasing a $1200 Cannondale road bike for me for Christmas that year, and the shop let me ride it on the Saturday rides. Three months into cycling, and I was getting inexplicably fast. Chubby 16-year-olds typically do not keep up on 19-mph hilly shop rides, let alone start contesting sprints. This was a big deal for me — I had finally found my “why,” and at the same time a community of people who thought I was pretty cool for doing it.
I am not exaggerating when I say that cycling has changed my life in ways I never thought anything would. It led me to a career I love, deep and fulfilling friendships, a recreational outlet that feeds my soul and fuels my body, and a competitive activity that motivates me. My first date with my long-time boyfriend? A bike ride. It has become one of the most enriching parts of my life.
Earlier this week, I got to go back in time to visit 3rd-grader Sara when I attended a lecture by one of my aforementioned heroes, Dr. Robert Ballard. He is an extraordinary speaker, full of infectious vitality and passion. His vast knowledge from his prestigious career is almost overshadowed by his palpable sense of wonder and reverence for the thrill of discovery and the beauty of the world. Here he is in 2008 giving a talk at a TED conference:
Tell me that watching that didn’t make you want to drop everything and go be an oceanographer too!
After his talk, Dr. Ballard answered questions submitted from the audience beforehand. I really hope someone filmed this and it goes up on YouTube soon, but for now I’m going to try to remember it as best as I can. The moderator spoke, “This question comes from a Guilford alumna, Sara, who did a book report on your discovery of the Bismarck in 3rd grade. Presumably that went well for her and she finished her M.S. in a STEM field earlier this year.” Dr. Ballard gave a thumbs up. Swoon! “Sara asks what advice you have for young minds interested in science, and for the adults who want to encourage them.” Just when it couldn’t get any better, Dr. Ballard gave a beautiful, honest, heartfelt answer. An article in the Greensboro News & Record quoted him as saying, “Work with your kid. Don’t laugh at their passion. No passion is a bad passion. You just need to modify it sometimes.” He spoke of hard work and perseverance, what graduate students know all too well: you really have to want it; if it were easy, everybody would have a PhD. Most importantly, Dr. Ballard spoke about the importance of being supportive of children’s dreams — don’t dismiss them as unrealistic or unimportant or just plain weird, but share in their excitement and provide the support they need to chase their passion. Fan the spark just enough for the flame to ignite and come to life.
Whether or not we are parents, educators in the classroom or a less formal environment, or involved in the sciences and humanities, each of us has a real responsibility to usher in the next great generation of thinkers. We like to berate the kids of today for their “plugged in” attitudes, but the prevalence of technology and fluency in its use that “digital native” kids develop from an incredibly early age will be responsible for the next wave of innovation and advances. This is a big part of why I like working with youth and collegiate sports so much — committed, enthusiastic, hard-working young people engage with challenges in a very different, creative way. It is our responsibility to be open to those ideas and willing to entertain fresh thinking, rather than dismissing it as naive and supplanting it with the same kind of thinking that caused our problems in the first place. We live in a world that paradoxically judges the people who are “too into” their specific enthusiasm, but turns around and praise the Steve Jobs and Bill Gates people whose obsessive determination leads to outrageous wealth and advancement. We need to start redefining success; the first step, for me, is to embrace my passion.
Today, I’m about to get passionate about yard work. Go find your passion, and let me know how it goes!
You may have heard the term “evidence-based practice” bandied about in relation to a broad range of disciplines, from medical practice to education to social psychology. Although the term was coined in 1992, the idea has been around for much longer, emphasizing a synthesis of rigorous peer-reviewed research, clinical observation and expertise, and interpretation of anecdotal and intuitive information through the scientific method. Evidenced-based practice has quickly gained traction among the medical community and has helped to improve patient care and practitioner credibility through establishing standards of practice and reliable sources of information.
Evidence-based practice (EBP) was a new concept to me when I started graduate school, which in retrospect is actually a little alarming. I immediately saw the potential to apply EBP to my massage therapy, and found it a little hard to believe that this wasn’t being already routinely taught and reinforced in massage schools. The school I attended has an excellent reputation and I believe that I got a high-quality foundation in massage therapy. However, the two days of class (out of an entire year) that we spent on reading and evaluating peer-reviewed journal articles were sorely inadequate (and the information on how to evaluate the impact of studies was cursory at best). I don’t think everyone needs to have taken graduate-level research methods and statistical analysis to be a great massage practitioner and consumer of information, but the disconnect I see between empiricism and practice in my profession troubles me.
I feel like massage therapy, as a discipline, is at the same crossroads that chiropractic medicine was 15 or 20 years ago. Chiropractors faced a conflict between highly educated, skilled practitioners whose methods were informed by keeping up with current research and their own expertise built upon observation over years of practice, and practitioners with dubious credentials who peddled quackery and “cures” on par with the snake oil salesmen of yesteryear. Chiropractors managed to change and improve standards of practice and the educational gateways to certification and licensure, bringing the profession as a whole into a more credible light in the medical community.The key to this paradigm shift was attention to the existing body of empirical evidence and constantly questioning tradition, asking “is there a more effective way to do this” than simply accepting that the current methodology is best because it’s the way it has always been done.
I routinely hear massage therapists insist that massage helps to flush lactic acid from the body to reduce the onset of muscle soreness. While this was an accepted explanation of mechanism 30 years ago, advances in muscle physiology now suggest that lactic acid uptake occurs rapidly following intense efforts and physiologists agree that lactate buildup is not responsible for delayed onset muscle soreness (although the exact mechanism remains unclear). The research has progressed to offer new answers and better understanding because we continue to question why and how. Keeping up with current empirical evidence and developments is an essential part of EBP – otherwise, our practices stagnate and we end up reinventing the wheel with each iteration from teacher to student. (On a side note, a slightly devious confession: I actually like using the lactic acid uptake question as a litmus test for massage therapists to see if they are keeping up with the literature or just parroting what they learned in school. It’s surprisingly revealing.)
Perhaps EBP’s greatest strength is the emphasis on blending old with new, looking to history and tradition as well as the latest empirical research and clinical evidence to offer the best possible clinical reasoning. I often hear things like “massage wouldn’t have been around for thousands of years if it didn’t work,” and I think there is merit to this argument. At the same time, it is essential to use all the modern tools at our disposal to question tradition; otherwise, people might still be saying the same thing about antiquated practices like bloodletting that have been discontinued, having been disproved by scientific inquiry. By testing traditional wisdom through carefully designed experimentation, we can confirm methods that promote beneficial effect and eliminate those that may be ineffectual or even harmful.
What I hope for you to take away is an appreciation for the rigorous questioning of information. Assess the reliability of your sources and note where they agree or diverge. Seek a multitude of resources and opinions, and ask meaningful questions about why we do what we do. Be confident in your convictions but always ready to entertain questions and defend them honestly and with awareness of all factors, even when they are in conflict. Don’t settle for “this is the way we do things,” but challenge the norms – at the very worst, you will confirm the veracity of your claims, and at best you will be armed with new knowledge to improve upon your methods and reach toward excellence. This is the very basis for growth in everything we do, and it is an absolute win-win. My charge to you is to challenge something small every day, and keep digging tenaciously until your curiosity is satisfied.
I’d like to kick off this blog by sharing some about one of my favorite things that I get to do in my job: teaching the massage lecture and lab unit for UNCG’s Master’s of Athletic Training education program treatment modalities course.
I’ve been teaching the class for the past 3 years, 2 of which while I was a Sports Medicine master’s student myself. Most people know athletic trainers from watching sports on TV, as the windbreaker-and-khakis-clad medical staff rush onto the field from the sidelines and tend to injured players. The bulk of athletic training, however, occurs behind the scenes in high school, college, professional, and industrial settings. Athletes put their health and well-being in their trainers’ hands, and these dedicated professionals address every need: the treatment, prevention, and rehabilitation of injuries, optimized fitness training to increase athletic ability, monitoring and recommending nutrition habits, and even the athletes’ psychological mindsets.
I’m not an athletic trainer — I am a licensed sports massage therapist — but I took a variety of athletic training courses in graduate school and I came to deeply appreciate athletic trainers’ unique skills and responsibilities. I’m lucky to use this nuanced understanding to help aspiring athletic trainers think differently about the fundamentals of their treatment protocols.
I won’t deny that it’s hard to come into a classroom full of allied healthcare professionals as a massage therapist and expect them to immediately accept what I have to say, so this year I started with a video from TED. We only watched the first 2 minutes or so, but the whole thing is very worthwhile.
Dr. Verghese’s powerful argument for the role of touch and ritual in medicine is a great jumping-off point for my case for the reemerging emphasis on manual therapies in athletic training. The research on sports massage is finally catching up to the millennia-old evidence-based practice of hands-on techniques to promote recovery and treat injuries. A seminal paper from last year by Crane, et al. demonstrated physiological changes at the cellular level in tissue that received massage following an exhaustive workout that were not present in the untouched limb — the cells showed signs of hormone activity promoting cellular repair, immune changes, decreased inflammation, and formation of new healthy mitochondrial tissue. Dozens of other studies are showing promising results that echo one main point: in many cases, massage improves recovery, but in absolutely no cases have studies found that it can cause harm. Very few treatments can boast such positive results.
Mechanical manipulation of sore or damaged tissue can help tight or circulation-impaired tissue to regain its original resting length and balance. Carefully applied neuromuscular pressure can decrease pain symptoms and ease myofascial trigger points. Massage can slow the atrophy of tissue that must be immobilized due to injury, and increase lymph and blood circulation to supply nutrition to healing tissues. The science supporting sports massage makes its potential advantages abundantly clear, and sports medicine professionals of all types are increasingly expected to be familiar with its techniques and applications.
During the three hours we spent together, I felt a shift in the athletic training students’ attitudes as their preconceived notions began to erode. As they practiced a few hands-on massage techniques and carefully observed me demonstrate my methods, it was like watching gears visibly click into place and appreciation emerge. We talked about a variety of real-life conditions they had dealt with and how they could be addressed with massage or other treatment modalities, and the students came up with great ideas and questions that I hadn’t even considered. I watched with pride and admiration as 10 aspiring trainers realized the enormous potential for treatment that they already possessed and carried with them wherever they went — their own hands!
Few things get me more excited and inspired as seeing young people engage with science, medicine, and discovery in a new and innovative way. I love teaching that class so much because the students I work with give me hope for the future of my profession, of sports, and of healthcare. Through recognizing the legacy of our medical forerunners and synthesizing their methods with emerging science and technology, we can accomplish extraordinary things; sometimes, all we need is the simple power of touch.