This past summer the U.S. Department of Education released a fascinating research report comparing online education with traditional classroom based education (http://bit.ly/Xqyvc).  They evaluated over 1000 academic studies of online learning and applied rigorous criteria to find those of highest quality. The final meta-analysis yielded over 90 studies with appropriate methodology comparing online learning to traditional classroom instruction. Their findings?  “…students in online learning conditions performed better than those receiving face-to-face instruction.”

The Sloan Consortium performs a survey of online education in the U.S. each year  (http://bit.ly/Dws1L). According to their 2008 survey:
• Over 3.9 million students were taking at least one online course during the fall 2007 term; a 12 percent increase over the number reported the previous year.
• The 12.9 percent growth rate for online enrollments far exceeds the 1.2 percent growth of the overall higher education student population.
• Over twenty percent of all U.S. higher education students were taking at least one online course in the fall of 2007.

Business, universities, and K-12 schools throughout the country have recognized what a powerful and effective educational model online learning can be. Yet, in the massage profession we still don’t recognize or acknowledge this. Many states do not allow distance education as part of the entry-level curriculum in massage schools. In those states that do, very few massage programs use online learning at all.

I often hear the argument that online learning is not appropriate for massage because this is a hands-on profession. I would heartily agree that the techniques of massage should be taught in a supervised classroom environment. However, there are many subjects (anatomy, physiology, business, kinesiology, pathology, etc.) that could be taught very effectively using innovating online learning strategies. There are some exceptional new technologies that are highly effective at teaching these types of subjects and we are lagging far behind by not employing them for our students’ benefit. It’s time for us to start forging new ground as educators and explore the opportunities of innovative 21st century learning

There has been a great deal of buzz lately about the recent announcement from the NCBTMB regarding their advanced certification credential (tentatively scheduled for spring 2010). There is still considerable controversy within the profession about an advanced credential and a number of serious issues that must be sorted out. I have written before of the need for an advanced credential focusing on the healthcare/medical applications of massage and I sincerely hope this is the direction the organization chooses to pursue with this credential.

Regardless of the type of advanced certification that the NCBTMB chooses to pursue, they will have to grapple with a sticky issue when it comes to eligibility criteria. The nature of an advanced exam suggests that education above and beyond the entry level will be required to sit for the exam. However, in this profession we don’t have any existing model to evaluate what that advanced education looks like.

The most common method of evaluating additional education would be to simply add up hours of continuing education (CE) courses that an individual has taken. However, there could easily be loads of accumulated CE hours in topics that don’t significantly contribute to an individual’s advanced knowledge for addressing compromised health care conditions. There could also be years of clinical practice in a medical setting where there were no formal educational hours earned, but the environment was a valuable educational experience. How will the NCBTMB grapple with these diverse educational environments when attempting to evaluate advanced education? It remains to be seen how this will be done, but it will certainly be one of the most difficult aspects of developing this new credential.

I recently came across an advertisement for an essay contest in one of my favorite magazines, The New Scientist. The essay contest was asking if science could end the need for animal research. The ad asked: “Can you envisage how advances in technology—perhaps stem cells, tissue engineering or computer modeling—could end the need for animal research?” I thought about this for a bit and found it an interesting question because I frequently come across research studies where animals have been used for the research study.

Unfortunately I missed the deadline on the essay contest, but still felt it was worth thinking and writing about the issue. The question itself is interesting and reminds me of a similar question that we hear debated in much of the popular literature about whether science and technology can save us from global climate change. The answer to both questions, unfortunately, is no.

The reason that science is unlikely to end the process of animal research lies in the very title of the essay contest ad. It suggests that there is a need for animal research. I realize many people will argue with me about this and say animal research is necessary for advances in biomedical engineering, health care, etc. But this isn’t a question about science. It is a question of ethics.

Where do you place yourself in relation to the other creatures that inhabit the planet with us? The idea that science needs animal research is one that is based on the assumption that we as humans have the right to decide how we use other animals without considering if they want to be involved in our research. If we subjected humans to many of the processes that are used in animal research there is no doubt that we would call this torture. Yet, somehow we are able to look the other way and say it is OK because it saves lives. Well, it doesn’t save the lives of the animals that are “sacrificed” in the process.

Eliminating animal research would clearly slow the advancement of many medical procedures and processes. Many people feel that increased human survival offsets any moral obligation we have to the way we treat other sentient beings. I can’t agree with that. It is time to recognize that if we are holding ourselves up to be the most intelligent creatures on the planet, we must also confront the ethical dilemmas of our actions. I would agree with the underlying assumptions of the New Scientist essay contest that science can make significant advances without the need for animal research. But we must go much further than that and recognize that it is really time to end the use of ALL animal research.

The massage therapy profession sits in an interesting place. It seems to have these two separate identities which share some common ground but also diverge significantly. On the one hand is the practice of massage as what is called a personal care service for lack of a better term. This approach would include massage used in spas, cruise ships, or situations where the primary focus is general relaxation without the intent of addressing a particular health problem. The other approach to massage is when it is used as a health care discipline to address some ailment or pathology.

There has been a tug of war between these two approaches for some time when discussing educational standards and credentialing.  Those who want to make sure there are not unreasonable hurdles for entry into practice (especially for personal care service approaches to massage) don’t want to see rapidly escalating educational requirements. Those who emphasize massage as a health care practice recognize there is no way it will be taken seriously by the health care community unless the educational requirements are increased.

Can we have our cake and eat it too? Yes, I think we can. I do agree that massage is an important skill and there should not be unreasonable barriers to entry for those that want to practice it as a personal care service. I still think it is important for people who practice in this manner to have a solid foundation in the sciences because they are still performing a practice that can have adverse effects on someone’s health and they should understand this thoroughly. For that reason the existing entry level requirements (about 500 hours of eduction in most locales) is a good starting place. Of course it would be better to focus on specific competencies as opposed to hours, but that’s an issue for a different day.

For those that want to practice massage in a health care environment we need to have a credential that designates a higher educational standard—perhaps something like a “massage therapy specialist.” At this level there would be far more attention focused on the necessary knowledge, skills, and abilities that are missing in our current training to prepare people to work as a health care provider. The length of this training program should be constructed by investigating competencies needed by similar health care professionals. It will be hard to predict how that will be converted to hours, but it seems reasonable to suggest this could be at least 750- 1000 hours of additional training above the initial 500 hours that most people currently have.

There will clearly be many obstacles to this process, but other health care professionals are beginning to look at massage as a health care practice. I attended a recent meeting with the Academic Consortium for Complementary and Alternative Health Care. At this meeting it was clear that other licensed health care professions that fall under the CAM umbrella have substantially greater training requirements than massage therapists, yet we face many of the same clinical decisions. We simply can’t continue to be taken seriously as a health care field with only 500 hours of training required. It will take a long time to make this transition so the time is now to get started on this process.

There are a wide variety stretching procedures and it can be confusing to figure out which is the most effective. Some  practitioners advocate a short duration stretch (about 2-3 seconds) as used in the Mattes method of Active Isolated Stretching (AIS). Others advocate a long duration of static stretching (15-20 seconds or more), as in practices such as yoga.

The research literature has studied stretching extensively but there is no conclusive evidence for a best stretching method yet. It appears that certain stretching methods work better in one situation while others work better in another. As I was doing some research on stretching recently it occurred to me that there are some additional factors in stretching that we may want to investigate.

In any stretching procedure there are two primary components that need to be addressed to effectively encourage muscle elongation. The first is a neurological component that governs the muscle’s resistance to stretch. It is here that the proprioceptors play a major role in stretching techniques. Techniques such as PNF or other facilitated stretching methods have been developed to focus on the neurological components of stretching.

Another factor in stretching is the mechanical elasticity of connective tissue (fascia) that surrounds muscles and bundles of muscle fibers. This connective tissue has a resistance to tensile (stretching) forces when those forces are rapidly applied. As you hold tensile force on this connective tissue, its resistance to stretching decreases. The decreasing resistance to stretch tension in connective tissue is a property called creep. Maximizing the effectiveness of connective tissue creep is an argument for a longer held stretch.

Recent research into the physiological properties of fascia have shown that it contains contractile cells. It has also been determined that a prolonged tensile force on connective tissue, such as that used in myofascial release or other fascial techniques, can cause a reduction in contractile activity in these fascial cells.

We now know that connective tissue elongation is enhanced by manual therapy methods of stretching fascia. We also know that connective tissue stretch (resistance to creep) is a limiting factor in stretching methods.  What if we were to combine the two and encourage use of these myofascial techniques on muscles as they were in their fully stretched position? I’m sure some practitioners must be doing this already, so it would be interesting to see some comparative studies performed on this method.