Merits of Massage

The following article is reprinted with permission from Advance for
Directors in Rehabilitation, March 2006, Vol. 15, No. 3

Clinicians can integrate hands-on approaches as part of therapy.
By Brian W. Ferrie

It seems that more clinics are offering physical therapy and massage under the same roof. As a rising trend, there's more than just one way to do it. Two clinics, one in Connecticut and one in Washington, D.C., both offer physical and massage therapy, but in fundamentally different ways.

At McLaughlin Physical Therapy & Sports Medicine Clinic in Southington, Conn., approximately 5 percent of patients receive massage therapy from the licensed massage therapist on staff. However, at Physical & Massage Therapy Associates in Washington, D.C., approximately 30 percent of the patient population receives massage therapy from the two massage therapists on staff, and about 75 percent of physical therapy patients receive some portion of massage that's been integrated in the plan of care.

Jay McLaughlin, MA, PT, owner of the McLaughlin Clinic, has been a physical therapist for 29 years and founded the facility in 1983. The clinic sees patients with a variety of conditions, such as post-anterior cruciate ligament and rotator cuff repair, traumas, cervical or lumbar strains, bursitis, arthritis, Parkinson's, sprains, strains, fractures, dislocations, chronic pain, fibromyalgia and rheumatic diseases, he says.

The facility progressed into offering massage therapy more than a decade ago. The licensed massage therapist on staff works about 30 hours a week, but she's also cross-trained to perform other tasks around the office. The volume of patients seeking massage at the clinic each week doesn't add up to 30 hours. In addition, there are six full-time therapists on staff, including McLaughlin, and one part-time therapist.

Extra Service

"Massage therapy here is treated as an extra service," says McLaughlin. "It's not tied into a patient's treatment. Patients may become aware of it, however, because they are coming in for rehab and we encourage them to think about it going forward, maybe once a month.

"A lot of times, once a patient is done with therapy, he will choose to have some massage therapy on an ongoing basis. Other times, people may just find out about the service through word of mouth, and they'll contact us only to schedule a massage and not for any PT services."

McLaughlin says that there are certain conditions where therapy staff will tell the patient to consider massage. For instance, clinicians target patients who have chronic back or neck pain, other ongoing problems or high stress levels, he says.

Physical therapists in Connecticut don't have direct access, so patients come to the clinic through physician referrals and generally pay through insurance. People who go for massage are paying out-of-pocket. Massages at the clinic are generally offered in 30- or 60-minute sessions. What factors led McLaughlin to institute massage therapy as a service at his clinic? "We like to incorporate alternative types of treatment, massage being one of them, to allow people to have options and additional therapies that can enhance their health," he says.

The McLaughlin clinic didn't incorporate massage services until it had been operating for about a decade. But Physical & Massage Therapy Associates, which was founded in 2003, offered massage services when the facility opened.

Like the McLaughlin clinic, patients with all types of conditions come to the facility for physical therapy treatment. The patient mix is similar to a general orthopedic practice, says clinic founder Mary Ellen Hood, PT.

Hood sees her share of chronic pain patients. But the list of other ailments includes: fibromyalgia conditions or painful scar issues; joint replacements or other post-op recovery; accident victims; back and neck strain/sprain and alignment problems; pelvic strain problems; shoulder, knee and foot injuries; migraine headache syndrome; and neurological disabilities, such as Parkinson's.|

Hood emphasizes alternative physical therapy and manual techniques in her practice.

"That's kind of the hallmark of my treatment," she says. But, in addition to massage work, Hood handles craniosacral therapy, visceral mobilization, lymph drainage, joint mobilization, muscle energy techniques, spinal mobilization and postural alignment work.

"We have primarily a hands-on approach, with a 1-hour time slot for each patient, and many long-term patients with an ongoing need for manual therapy," she says.

Integrated Approach

Hood remembers what led the clinic to offer physical and massage therapy in an integrated manner. The staff of one part-time physical therapist and two part-time massage therapists "had all come from settings where we did a similar combination of therapeutic work incorporating massage. And we've just had so many patients who respond to the idea of massage, as well as other people who have come in thinking that they only wanted a massage," she says.

In the case of this latter group, it becomes clear in many cases that there's a more medically significant problem that can be helped by physical therapy. As a result, Hood offers an evaluation to people who come in for a massage, but who may have other underlying needs.

"The other side of that is when somebody comes in for physical therapy, we will sometimes suggest that they also get massage," she says. "We're already oriented toward a manual therapy approach across the board because that's my specialty, hands-on, one-on-one."

The Personal Touch

Most patients at the clinic seem to respond to that approach, Hood says. "They get the individual attention that helps them feel they're having something taken care of that nobody else was taking care of. We make it more personal and intensive, with more depth and comprehensiveness."
Generally, patients who seek treatment from the licensed massage therapists at the clinic receive 1-hour sessions. Treatment from the licensed massage therapists is paid out-of-pocket, while therapy treatment at the facility is generally paid through insurance.

However, the time frames for treatment may be adjusted, depending on the patient. "If somebody really needs two PT sessions a week but their work schedule doesn't permit it, we might do one hour-and-a-half session per week," Hood says. "We try to mix and match according to what a person's scheduling needs are."

Hood feels that every condition can be helped by combining physical and massage therapy. "I can't think of somebody who wouldn't benefit from even a small portion of massage for an adjacent tissue area if I'm working on a primary joint structure.

"Patients come in with an expectation that they'll receive hands-on care, no matter what the clinical diagnosis is. That's built into our treatment, and we want to offer that because it provides the personal connection that makes the special difference. And I generally wouldn't exclude any diagnosis from some type of massage."

However, massage may become less of a focus, depending on the stage of rehab, she says. Massage may not be as strongly indicated after patients move through the bulk of their recovery and start thinking about active participation. At that time, the focus shifts to exercise, strengthening and range of motion, getting back into the community or returning to a sport.

"Their pain is down, their mobility has been restored significantly, their strength is returning, they're feeling better, and they're not so depressed or limited functionally," Hood says. "There is a shift from massage being part of the restorative care plan to an interval of more active exercise related to the physical therapy program. But afterward, massage can again become a beneficial treatment for the future to prevent re-injury and optimize ongoing self-care."

About the Author:
Brian W. Ferrie is on staff at ADVANCE and can be reached at bferrie@merion.com