M - Manipulation - Soft Tissue or Bones?
When you hear the word ’manipulation’, what do you think of first? Bones or Muscles? Whenever the word is used in relation to soft tissues - muscle, connective tissue, fascia there is often a look of surprise on the face of the client. This stems from the assumption that its joints/bones that are ‘manipulated’ and soft tissues are massaged!
It is this confusion that often leads ‘massage therapists/practitioners’ to venture outside their scope of practice. In order to manipulate joints/bones it’s important to not only have received the appropriate education but also to have the correct insurance.
I’m writing about this as I feel many soft tissue/massage therapists are placing themselves and possibly their clients at risk by not clearly distinguishing the ‘intent’ of the treatment.
Intent is coupled with informed consent. We all understand the need to have the client consent to the proposed strategy and intervention. This we get through our often talked about components of consent - what, where, why, when, who, how, risks and alternatives. The client then with all the required information to make an informed decision either accepts or declines the proposed treatment. If declined then the therapist would usually refer them to an appropriate practitioner for an alternative treatment.
So how does intent affect this? It is clear when visiting an Osteopath, Chiropractor of Physiotherapist that if a joint or bones are to be manipulated an appropriate assessment, discussion and consenting process is adhered to and the client understands that their joints are to be manipulated. The ‘intent’, is to ‘move’ that joint/area with a variety of levels of force which either ‘mobilise’ - within client control to stop that intervention to the area, ‘grades 1-4’, or what is often referred to as a ‘grade 5’ manipulation is applied - outside client control and not able to be ‘stopped’. The intention to manipulate directed to an identified joint/bone.
However, with soft tissue manipulation the ‘intent’ can vary depending on the method, hand-skill or mechanism of release being used, but it is all ‘soft tissue’ to which we deliver our techniques. When using general massage skills if a joint ‘moves’ or makes a sound ‘click/clunk’ it is a by product of the intent to work soft tissues. Yet more and more methods which fall in the ‘Muscle Energy Technique’ of described soft tissue work have intent to ‘move joints/bones’ .
Is this an area of concern for the massage professional?
It’s clear that when working in sporting & private clinic environments the greater the depth and breadth of skills available to the practitioner the more success they are likely to have if problems presenting are more than the general ‘massage’ for stress and feel good factor type sessions. The Question Is - Will an insurance for massage or sports massage protect the practitioner in the event of a claim when the technique seeks to manipulate a joint? My instinct is it will not. Why do I think this is the case? The majority of courses that teach Muscle Energy Technique do so to” Non regulated professionals” and in doing so provide little or no ‘competence’ assessment and guide students to ‘risk based insurance’ policies.
Therefore if the skill has intention to manipulate joints and not soft tissue then to be insured it must fall within your scope of practice. This scope for massage does not include joint manipulation.
If in seeking an addition to a basic massage insurance you add a ‘risk based’ element to cover joint manipulation, not only is it expensive but may not cover you in the event of a claim as you are unlikely to have proof of competence!!
Competence, communication and evidence of consolidated skills within your scope of practice is essential. The saying “Buyer beware” is extremely applicable to the addition of skills which “trespass” on the regulated professionals scope of practice. I frequently hear that in our industry ‘the claims are small’ or “too few to worry about”…..
Only time will tell whether the overlapping of skills across the regulated and non regulated groups of professionals causes an increase in claims or an increase in ‘substantial’ damages being awarded. If this happens insurance will be vastly more expensive or define the role of the masseur/soft tissue practitioner or therapist more accurately.
If you need any further help, support or guidance then contact us to arrange a One to One or attend a course in advanced soft tissue skills, assessment or agree a bespoke education programme to meet your needs.