Mrs R, a 57-year-old housewife, accompanied her husband for a treatment and ended up having a treatment herself. She was suffering the effects of a frozen shoulder: she was unable to abduct or rotate her right (dominant) arm and she was also kyphotic, with her shoulders hunched forward. She was unable to sleep properly, stir custard or brush her hair. This was a chronic condition due to overuse over a long period of time, combined with some lifestyle stress. The treatment consisted mainly of general massage and some STR techniques applied around the shoulder, with special attention paid to the rotator cuffs. It took four treatments to make a significant change, which included loosening holding patterns and readjusting her posture. Now, Mrs R is continuing with treatment - and she has become a sports

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addict! Case Study 4 - Knee Injury Mr S, a 26-year-old long-distance club runner had suffered for two years with sharp pain in the outside left knee diagnosed as being caused by damage to the iliotibial band (IT), having had a range of treatments including physiotherapy and chiropractic. One treatment of mainly deep tissue massage (DTM) into the tensor fascia lata (TFL) muscle took tension off the knee and enabled him to restart his running. Further treatments of DTM and STR into the lateral side of the thigh and on the border of the IT band by the knee and "it was almost like a little miracle". After three or four treatments, the condition was repaired. Thereafter it was a question of aiding the strengthening and stretching to confirm the repair, and also of breaking down the chronic holding patterns (e.g. his pelvis had got a bit out of alignment) that had developed over the two years. The TFL had been the root cause as it was scarred up and needed deep hands-on treatment. He had seven treatments in all. Conclusion, and a Caveat So, you see, what's learned for the athlete is also valuable for you and me. In each of the above case studies, the subject was an ordinary person who was suffering from an inhibiting physical condition that was righted with the help of sports massage. What is learned at the cutting edge of extreme physical activity can benefit us all. However, practitioners with this level of skill are hard to find as there are few training schools teaching to the requisite standards. Also, the medical profession itself is not generally aware of this sort of work and therefore does not refer on. So, if you want treatment of this calibre, riiiddker seek out a well-qualified sports massage therapist and ask the right questions first. There is a lot of sports massage that is little more than a rubdown. However, that said, the UK Sports Massage Association is having its inaugural meeting on 18 January 2002 and then a national register will be set up. A new era will begin. And that should provide a much needed boost to the profession so that there can be many more 'little miracles' in the future.
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This is the nearest equivalent to the US model, and it is to be hoped that its standards will be high and not reduced to the lowest common denominator, although this remains to be seen. The example in the UK of osteopathic and chiropractic regulation should inspire the leaders of the
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profession to action. They might consider defining a scope of practice, along with a well thought out set of competencies (standards) which all therapists should reach. This would help define a basic core of knowledge and abilities which schools would have to teach. We might then begin to see the true value of massage therapy which has potentials beyond the imagination of many of its practitioners. The bottom line, of course, comes down to safety and efficacy, the ability to recognise what not to treat, what conditions and patients to refer (and where), and the competence to safely and beneficially handle neurological, or inflammatory, or post-surgical, or acutely traumatic, or chronically painful or fibrotic or psychologically induced conditions, among others. Research in the US – largely by the Touch Research Institute at the Miami School of Medicine – has validated the benefits of massage in a host of conditions ranging from AIDS to fibromyalgia, burns patients to premature babies. There are, of course,riiiddker patches of excellence in the gloom of UK massage therapy – for example the efforts made by the Fellowship of Sports Masseurs and Therapists which has painfully and efficiently hauled its membership standards to a level which bears some comparison with that of the best in the US (and which has been active in consultation with Government regarding national vocational qualifications). In addition massage therapy degree courses (BSc) now exist for nurses, which will help ensure that standards of massage provided by that important profession evolve and improve. So the answer to the question I am often posed as to comparisons, is that many British massage therapists practise to a high standard, and can compare favourably with the best anywhere, however, the majority have poor training and they and their patients deserve better. If massage therapy is ever to be incorporated widely into mainstream settings in the UK, NHS or private, criteria generally have to rise. For this to happen the profession has to set its own agenda – including establishing basic massage therapy competencies, standards (including compulsory continuing education), regulatory machinery and goals.

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