Ep 136 - The Pressure Scale with Tracy Walton

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0:01:26.7 Darren Buford: Welcome to The ABMP podcast. My name is Darren Buford, and I'm Editor-in-Chief of Massage & Bodywork Magazine and Senior Director of Communications for ABMP.

0:01:35.2 Kristin Coverly: And I'm Kristin Coverly, licensed massage therapist and ABMP's Director of Professional Education.

0:01:40.7 DB: Our guest today is Tracy Walton. Tracy is a researcher, writer, award-winning educator, and specialist in massage therapy and cancer care. A dynamic voice for the power of touch, she is the author of the pathology textbook, Medical Conditions and Massage Therapy: A Decision Tree Approach. Hello, Tracy, and hello Kristin.

0:02:00.4 Tracy Walton: Hi there. Good to be with you.

0:02:01.4 KC: Tracy, so good to have you here with us. We have so much that we wanna talk to you about today, but let's start by introducing you to our listeners, the few out there who don't already know who you are, but let's tell everyone a little bit about your story, what brought you to massage therapy and specifically to oncology massage.

0:02:19.7 TW: Well, if you have a few hours, I can tell the whole story to you, but the abbreviated version is, I was drawn to massage therapy first because I was having some struggles in my own body, and it led me to a massage therapy table, and that table belonged to one, Ben Benjamin. He was my first massage therapist, and I loved the work and ended up in his school and got some help with my body eventually and could really do the work. And so if you'd asked me in second grade what I was gonna be when I grew up, it wasn't massage therapist, but it was a happy chance to do something new. So I guess our paths are not all that linear sometimes, right? So I ended up in massage therapy school, I loved it. I had come from my master's program in biology, biochemistry, and so I ended up teaching science at the school and notably physiology, and then it was the first time in... It was really the beginnings of massage therapy schools also teaching pathology. So I put together a curriculum around making decisions of how to work with people with simple and more complex health histories.

0:03:31.6 TW: So at the same time, I was starting my private practice and working in a spa, it was pretty busy. It was a busy private practice and I... Well, let's see, I don't remember exact day, month, or year that my first client appeared on my table who was in cancer treatment, but they appeared and they were in cancer treatment, and we had all been taught... I was teaching at the time what I'd been taught, which was we couldn't necessarily work safely with people with cancer, but the client was pretty determined and, you know, "No, this is exactly why I'm here, because I'm in cancer treatment, I need the stress relief, I need the support." So I had to figure out how to work with her, so I had to teach myself and develop a curriculum for myself to do so. And once that curriculum was established, I was my first student, I started over the years to work with more and more people, they were drawn to the work, and then in 1998, began teaching it in a really small limited form. It was sort of a journal club with a handful of therapists, and it grew into a much longer endeavor, for sure. So the short answer is, clients needed the work, and they specifically needed the work during treatment, post-treatment, and beyond, years later, restrictions in their body because of late effects of cancer treatment, and so I and others were really responding to the articulated need in the community of people with cancer.

0:05:03.6 DB: Tracy, many massage therapists have expressed that they're intimidated by the idea of oncology massage and working with clients with cancer. What would you like MTs to know about this important modality?

0:05:14.2 TW: Well, I would say first that I have shared that intimidation, right? It was really daunting. I found that it was really hard to just get my mind around an array of treatments, complicated treatments, they were changing all the time, and side effects and what that meant for massage therapy. So it can feel pretty overwhelming, just the breadth and depth of what can be going on in people with cancer, in cancer treatment and even, and I just wanna emphasize this again, later affects, post-treatment, five, 10, 15, 20 years out. So I have shared that feeling of being a little bit intimidated, and I will say that even though I have done this work for 30 years now, certainly oncology massage therapy for more than 25 years, I still read everything I can, right? There's a lot of stuff I don't know, and so I still read everything I can out there about cancer and cancer treatment, and what they're finding out, how the treatments are changing, how the side effects are changing, and how people's experiences might change with that. So I definitely share that. And the good news is a certain amount of intimidation is not a bad thing. It's not a bad thing. But the good news is now there are lots of resources available.

0:06:48.7 TW: And when I was doing this 25 years ago along with a good friend, Gayle MacDonald, who's the author of, Medicine Hands: Massage Therapy for People with Cancer, and has written for your publication, and we've shared the presentations and work over the years, when we were dealing with this in the '90s, there was nothing there, so we were really having to make it up, but now it's all out there. A lot of it is free, a lot of it is online. I've written tons of articles, and so has Gayle and other authors as well, that can just be accessed online to get more information. And there are a couple, a few really great books. I'm thinking in particular of MacDonald's Medicine Hands: Massage Therapy for People with Cancer, which is now in its third edition. I'm thinking of one that just like hot off the presses, Janet Penny and Rebecca Sturgeon, Oncology Massage: An Integrative Approach to Cancer Care, which is a lovely book and really comprehensive, and then lots and lots of articles. So there is information out there, and one doesn't have to go to or settle for going on social media for a client the next day and saying, "What do I do with this client?" And having everyone chime in with misinformation as well as information. So that's a change.

0:08:10.8 KC: Tracy, I'm excited to talk with you about this next topic, the Walton Pressure Scale. This is something I wasn't introduced to until continuing education courses, it wasn't taught in my core program, but that may have been a timing, I'm not sure when the scale was developed, when you created that. But let's start by describing it to listeners who aren't familiar with it. Can you talk about those five different pressures listed on the scale?

0:08:36.2 TW: So it's got five different levels, one, two, three, four, five. It's not subjective, it's not based on the client's response. You know those... A lot of people use scales, and they're great, "Zero to 10, is this a five-level of pain?" Whatever. Pain, pleasure, border, those things. It does not have to do at all with the client's assessment, it is completely separate. It is strictly looking based on how much of the tissue gets displaced when the hands press at this level, and what do we think are the levels, the layers of tissue underneath our hands that are being displaced, what happens to the body. At a three, the adjacent joints start rocking a little bit. You're using a three on the shoulders, and you see the neck start to rotate a little bit with your movements, just the rocking on the massage therapy table. A five is more sort of bone-on-bone, you can feel your pisiform bone and the bones of the hip as you are there, they move together. And a one and two are probably most important... One, two, and three, most important to oncology massage therapy.

0:09:50.4 TW: One is called light lotioning. So everyone has a number and a name. One is light lotioning. Two is heavy lotioning. Three is medium pressure. So light lotioning is the pressure that you need to spread lotion evenly around on the body so it doesn't have those streaks or the oil isn't dripping down the sides. It's that. It's strictly spreading and distributing lotion, maybe the skin moves, and that's it. Two is heavy lotioning. And if you think about rubbing that lotion in so it disappears, that's a level two. And there are all sorts of descriptors about which layers are being moved, etcetera, etcetera. But these are very common sense-wise, and they're very easy to explain to the nurse of a patient, to a family member, to a physician, and mostly to a client. So one, two, three, four, five. The actions on the joints, the therapist's body mechanics, the soft tissues being moved, and a common sense analogy are components of each level of pressure. So those are the five levels of pressure.

0:11:06.5 KC: And what inspired you to create the scale?

0:11:09.4 TW: So that's where the background is really important, because I learned about pressures one and two from another instructor, from Gayle MacDonald. She was teaching using those in her oncology massage therapy courses. And she got the concept of light and heavy lotioning from Dawn Nelson, who is another huge advocate and mover and shaker in the work of working compassionately with people who are ill. And I went to her, and I said, "So these terms, I know they're not trademarked or registered terms, but is this okay that we're using the... I just wanna talk about the terms," And she said, "Oh hey, we use the word... There's nothing special about the terms lotioning." She said, "We use the terms lotioning because we weren't allowed to do massage in the settings we were working in, but we could lotion." If she were working in a memory care unit, she could lotion people's arms, right? So I loved the terms. I borrowed those two and how Gayle was teaching them, and I expanded them to three, four, five, and put all those other levels of descriptors.

0:12:24.9 TW: So actually each pressure level comes with a photograph and a lot of different descriptors. But the thing that inspired me to create it was frustration in the classroom with describing... In two places, in the classroom to describe pressure, that was universal, and also I was working on a research project at the Beth Israel Deaconess Medical Center where we had seven massage therapists all on the in-patient units to start, and seven different days, different shifts, and we would ask a patient, "So how was that massage yesterday?" 'Cause we wanted to dial up or down depending on how it was. And you would say, "Oh, she was really nice, but it was so light. You can go deeper." [chuckle] Or you would say, "You know, that was a little bit rough," or something like that, but we had no common understanding of what that meant. So it was used in charting in sessions, talking in classrooms, and coding in that research project, and that's really how we used it. And then it grew and just a lot of people started adopting it, which was a great thing, but it really helps to communicate.

0:13:41.6 DB: Tracy, what year was this?

0:13:43.3 TW: I was using it in the early 2000s, and I first plunked it into my manual, my teaching manual in 2004, but it got... There have been some developments. It's evolved since, but the basic was 2004 and then it appeared in my book in 2010-2011.

0:14:04.1 DB: Let's take a short break to hear a word from our sponsors.

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0:14:46.3 DB: And Kristin, I'm so curious, you mentioned that you weren't taught this in massage school, and that might have been pre this being developed, so what were you taught in massage school that seemed so interesting, that to me then perhaps you didn't have a level of communication between students or between teacher and student that were the same talking about pressure?

0:15:05.3 KC: Well, that's a great question. And yes, it's true, as I suspected. I went to school in 2000, so it was pre the big launch of the Walton Pressure Scale so that does make sense. I'm glad to know that it wasn't just left out of my curriculum, but no, this is a perfect tool because in class, Darren, Tracy is right, a lot of it is based on what is the client's response to our pressure. We ask them to rank it on a scale, but we don't talk about having a scale ourselves and more I believe thinking back, is so old, such a long time ago, but thinking back to what we were doing in the classroom, it was more about describing what layer of tissue we thought our pressure was affecting. But again, that's not perfectly laid out so that every single therapist in the room is using the same scale to describe that or any universal language to describe that. So this is great.

0:16:01.0 KC: I was so excited when I was introduced to the Walton Pressure Scale in my CE courses because it felt like such a perfect tool to not only just think about myself, how I'm working with the client, but also to imagine communicating with another massage therapist, say, people are working in a clinic together, and I see a client one week and Tracy sees the client the next, if I can put in my chart, in my notes what pressure I use, then she has a much better understanding of what happened in our session and where she might wanna start or ask the client for feedback on how that was. And then also in any healthcare setting, working with other healthcare professionals, Tracy, have you found that it's really used as a tool often in, say, a hospital setting, when someone's doing charting?

0:16:47.9 TW: Makes it really easy to describe to nurses, to families of patients, to doctors who are... They think of massage and they think of getting really roughed up and they won't approve massage, but when they talk about... When they hear about massage has lotioning, it's much less intimidating, if you will. And if I can just add a couple of things about the pressure scale, it's not perfect. Each pressure is a zone, not a fixed point. There are differences in body types and thicknesses of different tissues, but it's a start, and I also would love to say that I never really named it the Walton Pressure Scale. I don't think of that being... If you'd asked me in second grade if that would be on my gravestone, I don't think that... It's not my thing. It came from observations of thousands of therapists who were often using the same pressure when they used the term deep tissue, right? Who were often using the same pressure when they talked about, "Oh, this is circulatory massage." It was really sort of notes from the field, and I just called it the pressure scale for a long time, and someone attached my name to it and it kinda took off and it can't be put back in the box, but a lot of people contributed. It's not perfect, it's a start. And I haven't actually, Kristin, heard about it being used a lot in so much in basic massage, entry-level massage training programs as more CE, like you said.

0:18:32.6 KC: That's a shame because it would be a really wonderful teaching tool in a core program.

0:18:37.3 DB: Tracy, let me ask you a question. Can it be taught? I'm just thinking right now, because of the environment we're in with a lot of people working remotely. Is this something that could be taught virtually, or is it a critical component to be learning this in person?

0:18:50.0 TW: I know oncology massage therapy instructors who are teaching virtually, who are describing it in beautiful terms, like what is the pressure that tips over, you put something on the tissues and it tips over when you press it at that pressure, right? I'm thinking of Johnnette du Rand of Greet the Day who's just ingenious, describing pressure and she's pivoted to virtually. We're not teaching virtually right now, so I haven't had to do that, but there are photographs and so I think with photos, video and the narrative descriptors are really extensive, so I think it could be at least communicated reasonably well remotely, if not... And possibly assessed remotely, if not mostly.

0:19:42.3 KC: Tracy, I'm curious. What are you passionate about right now? What's next for you?

0:19:46.6 TW: I am passionate about the same thing I've been passionate about for a long time, which is delivering massage therapy to people during important times in their lives, and cancer, cancer treatment, the caregiver experience, the experience of lay caregivers, as well as healthcare professionals, healthcare workers of any station in life that asks for the presence, the non-judgment, the acceptance and the healing of massage therapy. And I've been thinking a lot recently, I'm actually expanding my private practice right now. We're not traveling to teach, and we hope to be returning to that soon, hopefully in 2022. I wanna always be teaching, always, always be teaching with my glorious staff of oncology massage therapy instructors.

0:20:50.1 TW: Right now, I'm focused on expanding my private practice because the pandemic kind of certainly affects that, but it doesn't have to be planned as far in advance as teaching. We plan our schedule a year in advance, usually, so the way the pandemic affects closures and all that can be done in waves, but it's not... You don't have to anticipate it so much, you just follow what the guidelines are and close and open as needed. But I think a lot about what our work as a massage therapist is gonna be like in the coming years as our world recovers from this pandemic and especially the effects on our beloved healthcare workers, people who have been cleaning hospital rooms, and people who have been caring for patients, people who have been... Their work has been sidelined and they've had to adapt and learn new skills to deal with the crisis, I wonder what our role will be in being with people through massage therapy as we move forward and begin to heal and begin to make some changes so something like this doesn't happen again to this level.

0:22:13.4 DB: Tracy, what final thought would you like to share with our listeners in the massage and bodywork community?

0:22:18.0 TW: I'm digging for something super deep here. At the time of this recording, there's a great need for massage therapy, and I think there's gonna be a tsunami of interest in what we have to offer. There already was before the pandemic, and possibly not enough massage therapists to meet the demand. So I guess I hope that to meet this demand moving forward, we focus not just on quantity of massage therapists, but quality, and that schools really train people for what's next, trauma-informed massage therapy. We've been through a collective and many individual traumas during this pandemic and the many crises we've faced in this landscape, and so that's gonna reverberate for a long time, so how do you train a massage therapist to really be with someone.

0:23:20.0 TW: A training in not just skills, interview skills, all those things, we talked about hands-on, getting the right pressure, but it's a training in working enough on your own self so that you can be with someone else. Not without fear, but without that fear affecting someone's care. So we really need to be thoughtful looking forward to that, and I'm thinking in particular of the... There's a Facebook group on massage therapy and COVID for practitioners, that's very thoughtful on all accounts of the nitty-gritty of working during COVID or not as the case may be at certain times, but also what it just means to kinda hold someone's body during a really epic time. I think a lot about what are the stories we're gonna tell in two and 10 and 15 and 20 years ago about this time, and I hope some of those stories are about massage therapy delivered with kindness and a passion and skill and presence. That would be my highest hope.

0:24:29.6 DB: Beautifully said. I wanna thank our guest today, Tracy Walton. To find out more information about Tracy and the massage therapy pressure scale, visit tracywalton.com. Listeners, the ABMP Podcast is produced by the team at ABMP, a professional membership organization supporting massage therapists and bodyworkers. Membership includes liability insurance, free continuing education, helpful reference apps like Five-Minute Muscles, and the award-winning Massage & Bodywork magazine. Go to abmp.com to learn more about becoming a member. Thanks, Tracy, and thanks, Kristin.

0:25:02.9 KC: Tracy, thanks not only for being with us today, but for everything you've done and are doing for the profession. We appreciate you.

0:25:08.4 TW: You too. Thank you.

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