Ep 29 - Ask ABMP: Your Questions on Topics from COVID-19 to Body Mechanics to Intake Forms

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01:00 Darren Buford: Welcome to The ABMP podcast. My name is Darren Buford, I'm Editor-in-Chief at Massage & Bodywork magazine and Senior Director of Communications for ABMP. I'm joined by my co-host, Kristin Coverly, licensed Massage Therapist and Director of Professional Education for ABMP. Our goal is to connect with luminaries and experts in and around the massage, bodywork and wellness profession in order to talk about the topics, trends and techniques that affect our listeners practices.

01:26 KC: Thanks for joining us for this special ask ABMP edition of the podcast. We reached out to experts in the massage and bodywork field to help us answer listener questions on topics ranging from COVID-19 to body mechanics. Have a question of your own for ABMP or a leader in the massage profession, send it to us at podcast@abmp.com.

01:49 DB: Our first question is from Christine F, "Is it safe to work on post-COVID patients, especially since it looks like a vascular component with possible blood clots and lingering symptoms?" For the answer, we turn to pathology expert, Ruth Warner.

02:03 Ruth Warner: Yeah, I get this question a lot, and the answer is, as anyone who spends any time with me will predict, it depends. Mainly what it depends on is the current state of your client who is recovering from COVID. If they're back to normal levels of activity than their massage can go back to normal pre-COVID levels of intensity. But if your client who had COVID is now limited in terms of their ability to be physically active, if they're having symptoms that look like chronic fatigue syndrome or fibromyalgia, if they have other complications that could involve things like blood clotting or lung damage or heart damage or kidney damage or seizures, that list goes on and on. Then obviously, we need to make appropriate accommodations. I've been tracking the literature and scientific discussions about COVID long-haulers pretty carefully, and at this point, I am not seeing medical professionals express a lot of concern about coagulopathy issues. While I'm sure there are exceptions to this rule, it looks like at this moment in time, at least, that that risk of rogue crazy out-of-control blood clotting is fairly low for people who are not very, very ill, and of course, in people who are extremely ill with COVID, we clearly see a much higher risk for blood clotting that we've seen then linked to all those other consequences like stroke and pulmonary embolism and organ failure.

03:45 RW: So to get back to our client who... Our post-COVID client, I just recommend doing a really thorough intake as always with some special attention to what kinds of complications or long-term effect your client is having with the intention that you wanna get a really clear idea about their resilience and their activities of daily living, because that information along with whatever medications they've been prescribed, those are really going to be your guides for your clinical decision making. If it's useful, I'd also like to point people to my latest article in Massage & Bodywork, which focuses on post-COVID complications in the context of massage, because that might provide you with a little more specific information.

04:32 DB: Thanks, Ruth.

04:34 KC: I'm here with Laura Embleton, ABMP's director of government relations to help us answer a listeners question. Laura, Whole Body Lifestyle sent us a question on Instagram about state license renewals. She asks, "What if we've only taken online CE classes and no in-person classes because none were offered locally due to COVID-19 restrictions, will I be able to use the online only CE to renew my license in Pennsylvania?"

05:00 Laura Embleton: Yes, most states revised their CE requirements through the pandemic. Many states, a majority of states, in fact, offer online or live regularly, so they didn't have to change the regulations, but those states that do require lives, all but one so far have amended and in Pennsylvania this year, all CEs can be done online. Many states have either allowed for a online only or for example, New Mexico is requiring people to renew this October like they would normally renew, but their CE requirement, part of that renewal isn't due until six months after the pandemic is over. So different states have done it in different ways, but many of them have just said, you can just go to straight online, and that includes Pennsylvania.

05:52 KC: Great, thank you. And I know that you and your government relations team have been very busy trying to keep up with all of the regulations and rules that are changing in all the states, seemingly daily, from an outsider's perspective. And you're gathering that all together for our members and the profession so can you tell us a little bit more about that?

06:14 LE: Yeah, so we've been tracking what's going on in every state since the beginning of the pandemic. It was a little crazy at the beginning, and in fact, when all the financial information was coming out with the CARES Act, I felt a little bit like I was in The Matrix and somebody jammed a "Now you know finances" in my head. So we were staying on top of all the CARES Act stuff and the pandemic unemployment, insurance information, and the EIDLs and the PPP loans that are coming out of the Small Business Administration. In addition, then monitoring all the shutdowns in all 50 states, plus the District and other jurisdictions, and then all the openings up, and then all the new masks regulations that came out and who can practice where and how. And so we've been working really hard to stay on top of that to keep you all informed. If it's something that's really big, we try to send out an email to our members in that state, to let them know what's going on, but we also tweak things, so like for example, in California this week, a couple of counties moved from the purple tier up into the RED tier, so we posted on our website, at the ABMP COVID page that those counties were now in a red tier.

07:37 LE: We didn't message our members in those counties and just kinda like know. So if you need to stay on top of what's happening, you can always go to our COVID-19 page at abmp.com, it's, the link is right at the top of the page, you can click on that and then go down to follow what's happening in your state. And you can see what the latest guidelines are for your state.

07:58 KC: Perfect, thank you. And for listeners, you want that direct link, it's abmp.com/covid-updates. Laura, thank you so much, not only for joining us and answering our listener question today, but for everything you and your team have been doing to keep us informed throughout everything that's been happening, and not only during COVID times all the time. Everything you do to advocate for us in the profession. Thanks so much.

08:20 LE: Thank you.

08:23 KC: I'm happy to introduce a ABMP President, Les Sweeney to answer a question that was asked by several listeners. Les, massage therapists have been asking about how the profession is doing overall, can you share a snapshot of how things look today?

08:37 Les Sweeney: Thanks, Kristin, I'd be happy to. The bad news for members and for anybody out there is that I do not have an up-to-date crystal ball, so this is the challenging question to answer for sure. I think it's hard to look at the profession as a whole, certainly when we think about in the United States and be able to make a proclamation that all is good or all is bad, because there's so much that's regionalized and localized as it relates to how the profession is being regulated right now, what restrictions are in place, and obviously what the impact of COVID-19 is on every community, so it's a larger issue much beyond Massage & Bodywork, but clearly we're affected by it because the ability for people to resume "normal business" or life activities has clearly been compromised, and we've lived that for the last six months with our members as well. There are certainly some places where incidences of virus growth or infection are really subsided because of some really proactive efforts. The hard part about that is the proactive efforts include, in many cases, have been a restriction on the ability to practice.

09:48 LS: So one of the things that we've been doing, and as an organization on a daily basis is tracking what's happening on a regulatory basis, state by state, and in many cases, county by county right now, for example, California has really been one that's had the most widespread in terms of restrictions, and now there's limits on where people can practice by county. So one of the benefits that we have as an organization is all of this, as you know, talk to members on a daily basis, and you can reach someone who's in Florida and hasn't practiced in four months, or you can reach somebody in Texas who has a full client load. And it just depends on where they are. So I think what's interesting too is that we have heard from some employers and some booking agencies or software that say they view things that somewhere between 75% and 80% of normal, and I think that might be... It's a good national average, I think, to go by, but as we said, someone listening to this might say, it hasn't been normal for me since the middle of March, and somebody else may be saying, "Well, it was tough, but now I'm back and things are more regular."

10:53 LS: And clearly, massage is intimate and it is personal, and it's not the same as going into a crowded restaurant or even working in an office, but it is one-on-one, and we also know that there are vectors of transmission on an individualized basis, just like even though we hear most about the super-spreader circumstances or large crowds, it's why we're limiting football games, that's why all these things are happening in a sense that are without fans or without people, and that's why the big challenge in schools is, because bringing people together and we've heard that plenty from massage schools as well, because that's kind of a double layer between it's a school and it's massage. Put those two together and it makes it even more challenging. I'm a little surprised, I guess I would say I'm pleasantly surprised that the resilience that we've leave experience as an organization and the field has experienced. People are really tapping into their resourcefulness and figuring out ways to practice in a safe way.

11:54 LS: We jumped in early with a Back-To Practice Guide and put together a lot of resource materials, but ultimately, all these decisions are individualized in the sense of how does a therapist feel about seeing people and how do clients feel about being in a room? And I think there are precautions that can limit exposure, and we were just referencing, there was a CDC release recently was about how being in a salon or a spa is less risky than other circumstances and experiences. That's gratifying, and I think it's also a testament to the work that our members and people in the profession are doing. But one of the things that we said six months ago is there's no zero risk activity at this point, if you leave your house or you have any interaction with any other individual, there's some element of risk and social distancing and mask wearing our behaviors and obviously hygiene or behaviors that can minimize those, but it can eliminate them, and so I think the other reality is we're probably looking at doing the same thing for the next six to nine months, and that's the hard part because we're heading into winter.

13:03 LS: But I do think some of these precautions that people are enacting and taking seriously have enabled people to continue to practice, and we know that there are people who haven't been able to practice who have been frustrated, and there are other people who are in places where they would like to start practicing or they're allowed to practice, but then they say, "You know what, it's just not worth the risk right now." So that's a long wishy-washy answer that tells you that it depends on where we are and it depends on each individual circumstance, but are we in a better place than some other fields and professions out there? Absolutely. Would we like it to resume to "normal?" You bet. But I think we're in for this for a period longer, but I think, as I said before, the resilience and creativity of our members and of therapists in general has been able to keep this happening, be able to keep massage in people's lives. It's just a challenging period of time right now.

14:03 KC: Absolutely, yeah, I think you hit the nail on the head with a lot of those key pieces. No crystal ball, it depends. But also really to the heart of it, the resilience and the ability for massage therapists to adapt and change. Change their protocols, change their intake processes, their sanitation, everything to make it as safe and as positive as an experience for everyone involved, client and therapist. So you hit it right on the head. Thank you so much, Les, for sharing your time and sharing your information with us, we really appreciate it.

14:35 LS: My pleasure as always.

14:37 KC: We're turning to Debbie Higdon in ABMP's risk management department to answer this next question. Debbie, Bounce Back Bodywork, a mobile massage therapist on Instagram asks, "Do we need to adjust our intake forms at all during COVID?"

14:50 Debbie Higdon: Absolutely, whether you have a private practice or a mobile practice, you should adjust your intake forms. ABMP has put together some excellent forms for you to utilize in your practice starting out with office policies, these are policies during these times that you may need to change or take advantage of the information on that form. The next form would be a pre-screening, a screening questionnaire that you wanna go through with your clients, and then a check-in screening form, so that when your clients arrive for their appointment, you're checking them in, asking them questions, so that you know that massage is indicated for this day, or if it's best to maybe delay that appointment for that day. We also have a very important form, it's a COVID addendum form, you add that on to your client's health history format, it's an informed consent, and it's strictly designed for COVID. Very important to use these forms, and remember this is all to keep yourself safe, to keep your clients safe and the public in general, and so that we can all be safe.

16:05 KC: Absolutely, thank you, yeah. And also as a reminder for listeners, the forms that Debbie is referring to are available to both ABMP members and non-members on the website, so if you're interested in taking a look, visit abmp.com and follow the COVID-19 update link to get to our Back-to-practice guidelines page. All that information is there for you. You can download those forms and use them as is, or you can just use that language as inspiration to create your own forms, but I think the point that we're all taking away, and Debbie, thank you so much for enforcing this, is that, yes, we need to do things differently right now. We need to change the languaging, we need to add additional screening and additional questions, so thank you so much for being with us and making sure that everyone knows that, yeah, we've got to change with the times. And things look a little differently right now.

16:53 DH: Thank you.

16:54 DB: Our next question is from Gina D. "Body mechanics feels so awkward, and all I've done is get corrected on them while giving massage. Tried raising and lowering my table and it still feels awkward, newest massage student here. Please help." For the answer, we turn to 20-year massage veteran and Chief Wellness Officer for Elements Massage. Eric Stephenson.

17:15 Eric Stephenson: Hello everyone. Eric Stephenson, Chief Wellness Officer for Elements Massage, and I love this question. This is one I probably get asked the most frequently and have pretty much throughout my career, and that's a body mechanics. So I hear your frustration in the question, I hear that you're a new student, I hear you're struggling with table height, and what I tell therapists all the time is that body mechanics probably is one of the most important things after being present in a massage. So if you're not present during a message that's pretty much a deal breaker, so after you're present, and the most important thing after that is, how am I gonna use my resources to keep myself healthy in a profession that is really prone to injury and burnout? We gotta pay really close attention to this. So one of the things you wanna do when you are talking about body mechanics is to follow principles of spinal alignment to make sure that your spinal alignment is nice and long all the way from the bottom of your spine through the top of your head.

18:17 ES: Oftentimes in my workshops, I'll talk about massage therapist suffering from tilts, as head is too much as forward, this means that we're basically looking down at what we're doing all the time, when actually we can see with our hands. Our hands have excellent palpation ability, and they have eyes right here, so we don't need to stare down at everything we're doing, certainly we have to look down a lot of the times, but if possible, especially when doing a stroke like effleurage or petrissage, you bring your head on to the work and align your spine and bring your whole head back, so that you don't have that pressure going down your spine. I talk a lot about this in some of my videos, I'm going to reference here in just a second. The other thing is table height, so table height obviously is a concern you have to figure out what type of message you're actually performing, so if you're doing Swedish massage, you wanna have a certain table height, which reflects more a horizontal sort of approach, if you're doing deep tissue massage or something that has a deeper intent in terms of layers of musculature, connective tissue and even getting down to the periostin of the bone, you wanna have your table height probably a little bit lower, so you can go more vertically.

19:30 ES: So again, the Swedish massage will be more of a horizontal treatment, even though it can be deep, you're going back toward the heart per se, and then with a deep tissue massage, you're sinking in and going through layers. So one of the easiest ways to track this is to pay attention to your shoulders, if your shoulders are elevating when you're giving a stroke, that means your table is too high, and of course, if you're bending over to try to get to the client, breaking your spinal alignment, that would mean that your table is to low. Now, everyone is different, so you have to parcel this out for yourself, and that takes a lot of trial and error. The good news is, there's resources at the ABMP Education Center that you can reference, and I've actually done a webinar just on this topic, it's called Intelligent Deep Tissue Massage part one, body mechanics, and I go through the whole set up from standing to seated body mechanics, so you can go ahead and jump in the education center and watch that video. I've gotten a lot of great comments on this throughout a couple of years that it's been up there, and I feel like this is a really great place for you to go and get some really solid information about body mechanics.

20:49 ES: I thank all of my teachers that I've had through the years, especially early on in massage school, that actually put a foundation of body mechanics and ergonomics into my education, and quite honestly, it's been a life saver for me. I can't imagine not having been taught how to use my body optimally in this profession going on over 20 years. So the good news is there's no right way to do massage, but there's more optimal ways to do in massage and there's more optimal ways to use your body mechanics, and I think that the ways that I'm demonstrating in the webinar is really what I've found to be the most optimal, having traveled and taught and seen this in action with other therapists over the last 15 or 20 years, so thanks so much for this question, it's really valuable, 'cause a lot of therapists are there, and I hope that this was valuable, and I hope you'll check out that webinar on the ABMP Education Center. Thanks so much.

21:49 KC: Thanks for listening. Did this Ask ABMP edition of the podcast spark a question of your own? Send it to us at podcast@abmp.com.

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22:02 Speaker 8: This has been a production of Associated Bodywork and Massage Professionals. ABMP is the leading association for massage therapists and bodywork professionals in the United States and beyond. From liability insurance to Professional Advocacy, award-winning publications to the world's largest continuing education library for massage to this podcast, no organization provides more for its members and the profession than ABMP. ABMP works for you.

22:35 KC: Thank you for listening. If you haven't already done so, please subscribe to The ABMP Podcast on iTunes, Google Play, or wherever you find your favorite podcasts.