Tui Na and Bodywork Services
Rik,
cjurakpt makes some good points here. I’ve also thought long and hard about the issues he raises, and I also believe that there are important pros and cons to be considered if you decide to treat people outside the legal and ethical umbrella that attending LMT school will provide. For the record, I also think it’s a great idea to attend a massage school as it will only prepare you to better utilize the skills that you have learned. More about that below (I’ll address cjurakpt’s points one by one, as I think they provide an excellent scaffolding for discussion).
On the other hand, I have a strong anti-establishment streak and can appreciate the reasons why someone may choose not to go the LMT route. I am reminded of the “how do you like them apples?” scene in the movie “Good Will Hunting” wherein Matt Damon’s character dresses down the snotty grad student who has attempted to humiliate his working-class friend in the bar by demonstrating his superior “intelligence.” Damon’s character engages the grad student in an impromptou debate about 19th century economics and history and procedes to not only anticipate but throroughly dismantle each and every argument the grad student could have offered (if he could get a word in edgewise) by taking each one to the next logical level, and then to the level after that, etc. After demonstrating his complete and superior grasp of the subject matter, Will then says something like, “Now, don’t you feel terrible? You’ve spent thousands of dollars getting a (mediocre) graduate school education, and all you’ve needed all along was this free library card.”
It’s an entertaining scene and has philosophical merit. It also reminded me, when I first saw it, that one of the best professors that I had in college, a published scholar highly respected for his expertise in Medieval literature and a revered teacher (over 30 years at the same institution) never bothered to go beyond his B.A. degree. He was listed as merely “instructor” in the school’s curriculum guide, but apparently this didn’t seem to bother him or the thousands of students he taught throughout the years.
Of course, practicing bodywork carries different responsibilites than scholarship. Add to this the fact that both Will Hunting and the professor that I describe above were both able to florish within the walls of an institution that afforded them support and protection despite their maverick status. To carry the issue further, martial arts schools have for thousands of years offered bodywork therapies as part of their curriculum, and many schools have long traditions that require expertise in bodywork therapies if students are to become teachers. This is however an apprenticeship model of dozens of years within a traditional culture that allows for plenty of time to address the ethical caveats mentioned above, with strong mentorship on a constant basis, and a “client” pool that is much more tolerant of mistakes than the general public.
In your particular case you have the advantage of already teaching in this kind of culture, and I gather from some of your posts on forum that your teacher may be part of a similar tradition. I would suggest to any martial arts teacher that that if you (rhetorically) want to practice bodywork you start within the context of treating martial arts students on a pro bono basis, and that if you wanted to charge for your services you’d do so only after getting a lot of practice in this manner (it certainly won’t hurt your student attendence base). In addition, some might think that providing bodywork to students who are injured in the course of practice are just be part and parcel of the services that the teacher provides for his or her students. On the other hand, “getting the paper so I can practice legally” certainly has its practical merits, in addition to addressing the concerns described above.
That being said, let’s move on to cjurakpt’s points. I list them mostly to reiterate their good sense:
- no training in professional issues: practice ethics, guidlines, appropriate boundaries, how to do a proper intake / ask the right questions the right way, how to be actively neutral when listening to tales of woe (important for both patient and you) and other psychosocial issues, etc.; no training on how to "tough it out" as a practitioner when you are stuck with a difficult patient;
This is certainly true. LMT schools at least introduce the issue and provide resources for further study of which you may not be aware.
- no supervised training in clinical setting: all licensed professionals have undergone some sort of supervised clinical practice; this aspect is critical - it sparates the wheat from the chaff in a big way...
True again. However in your case the wheat may have already been separated from the chaff…
- patients treated by an unlicensed individual have no form of recourse should something go wrong, either in terms of the actual treatment (injury, worsening of original condition) or the action of the "practitioner" (e.g. - innapropriate comments / onduct / advice); they can't reort you to a disciplinary board, they can't sue you for malpractice, etc.; even if they filed a civil suit, given the situation it would be difficult to prove incompetance on the practitioner's part as long as they never advertised themselves as being something they are not...
I think that there is a lot to consider here. Add to this the fact that (in the context of treating students) there are transference issues from student to teacher, etc., and it gets even more complicated. On the other hand, it’s certainly arguable that
you’ve assumed an ethical responsibility qua martial arts teacher and that it carries over to any bodywork you decide to practice. Re. the issue of civil suits I should think that you are somewhat vulnerable if you practice bodywork in the context of “martial arts” and something goes wrong: i.e. “I wanted to learn martial arts and I got this cracked rib because I agreed to let my teacher practice “bodywork” on me,” etc. However I think that the risk is mitigated by the kind of student you are treating, and certainly an explantation of potential risk to the student (however unlikely) goes a long way of covering you both here. Most bodyworkers that I have learned from have admitted to making “mistakes” along the way to becoming experts in their fields; at issue is the strength of their training to begin with and their abililty to assume responsibility for their mistakes and rectify them.
- no training in diferential diagnosis, not so much to actually treat something, but to know when they need to refer someone out or get them to an ER immediately
Essential. As an example, I’m treating someone currently who tore his biceps tendon completely off his radius. My advice, on intitial consultation, was that he get an MRI, i.e., there was really nothing I could do for him at that point besides knock down the inflamation and swelling. After his MRI results came in (the next day) he asked be what to do next (I advised surgery). The end result is that he got surgery for his injury within days of it happening (when it was the optimal time to get it), and I was able to start treating him with herbs and acupuncture. Some three months later he is well on the road to recovery.
That’s a relatively superficial example. Your main concerns here, as I sure you are aware, are to rule out potential issues like heart attack, cancer, stroke, etc.
- no one treats in isolation - you are always part of a team - being an unlicensed individual limits your ability to communicate and share information with others on that team
True enough - although your “team” (health providers that you know) may in fact be extensive enough to provide your clients with adequate support if you think that bodywork may not be the complete answer.
with the exception of being able to “mobilize” (oscillate a joint specificaly) and “manipulate” (thrust the joint); to do those you’d have to get a PT or DC license (I don’t know if L.Ac’s can do manips legally, but I’d imagine that they can do mobs)
“Zheng Gu” (correct bone) is conceived as occuring within the scope and practice of Tui Na; I think a strong case can and should be made for not claiming to do Chiropractic “manipulations” and “mobilizations” insofar as we don’t go to Chiropractic school and learn their methods. In contrast, furthermore, Zheng Gu always involves extensive soft tissue work beforehand, and there is a separate theoretical context for performing these techniques. All the Zheng Gu that I have learned always involves taking the joint along its natural lines of movement.
Although it may be argued that this is merely skirting the issue, I think that there are important reasons for skirting it (!) - not the least of which is the fact that Zheng Gu existed for thousands of years before the advent of Chiropractic. Why get mired down in a non-issue IMHO?
Thanks for acting as a sounding board for the above considerations. I can’t pretend to present a complete answer to your question, but at least it should provide a start.
Best,
Steve