Conference 2022: The Message of Massage from workshop leader Earle Abrahamson

In writing this blog, I decided to reflect on my experience as a therapist but equally advisor and educator. I discovered massage when I sustained a life changing knee injury as a youth. I was an enthusiastic cricketer, and whilst batting in a cup match I lunged forward and felt that awkward twist in my right knee. This was swiftly followed by an audible popping sound. I was overcome by pain and shock and recall being carried off the pitch. Apart from the physical discomfort I became psychologically aware of what my future in the sport may become. Endless appointments with consultants and specialists served to enforce the prospects of never being able to competitively play the sport I enjoyed most. I was determined to find a way back, to research possibility, and discover hope. My resilience and perseverance paid off when I met a musculoskeletal physician. This doctor took time to explain the dynamics and mechanics of the injury, involved me in the decision making, and exposed me to the world of soft tissue therapy. This impactful and empowering experience let me to understand how manipulation of soft tissue enables enhancement of movement. For me, the inquiry into discovering possibility changed my perceptions and hope of outcomes.

I use this experience of my own injury and management thereof, to frame my philosophy in treating injury and ailment and supporting my clients back to health. For me, the magic and message of massage is not simply doing, but rather developing techniques, knowledge and understanding of doing it better. Soft tissue therapy, and massage in particular, is often considered a solution to multiple musculoskeletal problems. I have seen and learned that many of my colleagues are determined to recruit and keep clients without fully recognising the limits of the soft tissue scope of practice.

Massage has developed from integrating therapies and disseminating best practices. The therapeutic side of massage is so much more than the application of technique. It relies on client education, assessment of treatment goals, engagement with difficult and challenging conversations, and reflection on experience. It relies on understanding situation, context and culture and learning to manage reality. Through my years of experience as a therapist, I have learned to critically reflect on what matters most. I have learned to develop and use my soft tissue toolkit, which is populated with techniques, evidence-based resources, and conversations and observations with other practitioners. I have learned to be honest and practise with integrity.

At the 2022 MTI conference I am keen to share my experience and knowledge of building my practice and learning from lessons of reflection. I am interested in dissecting the concept of massage as medicine and carefully and purposefully situating my practice within a preventative and restorative framework. I aim to disrupt convention and challenge identity within the broad field of soft tissue therapy. For me, it is not what we see that is important, but rather what we fail to see and acknowledge. From prehabilitation to rehabilitation and constructively building a lens to discern acute from chronic and attend to “what matters most”, is central to my presentations at the conference.

A willingness to admit “I don’t know” and a passion and determination to learn how has epitomised my identity as a practitioner. My message of, and for, massage is being able to design treatments that clients understand and have included voice in considering outcomes and implications.

I conclude with words that resonate with my philosophy of practice. These words come from Amanda Gorman’s poem, read with intention and purpose, at Joe Biden’s inauguration as US president.

“It is not what lies between us that matters, but rather what lies in front of us”. Together we need to learn with and from colleagues and design a massage future that addresses issues that matter most. Our skillsets are shared across disciplines but find a unique home in considering our clients holistically. It this holistic approach that sets us apart, yet brings us together.

Conference 2022: Dementia, trauma and how therapists can help

By workshop leader, Nicolle Mitchell originally written for FHT.

Being diagnosed with any serious illness can be traumatic, and dementia is no exception. However, I believe that by understanding a person, their story and their needs, we can help them to live well and improve their
quality of life.

Over the years I have witnessed people living with dementia also living with the following examples of trauma:

• The trauma or shock of being diagnosed

• The trauma of being constantly unsure and fearful

• The trauma of being unable to make sense of the world, especially after a move to a care home. Now commonly referred to as ‘transfer trauma’, this is more likely to occur in the earlier stages of dementia, where old routines have become a source of survival for the person.

• The trauma of reminiscence or living with post- traumatic stress disorder (PTSD), or late-onset PTSD, most notably in veterans.

When exposed to stress, it leads to a state of fight, flight, freeze, friend, flop or – some new ones I heard recently – fall over or fool around. These are all ways that we respond to stressful situations in order to cope or survive. Chronic stress and adversity can lead to trauma, just as much as any life-changing event.

Compound the diagnosis of dementia with knowing that your cognitive health is going to progressively decline – it’s no wonder that many people living with this condition also live with depression, anxiety and other mental health illnesses.

THE STRESS RESPONSE AND DEMENTIA
In survival mode, the upper brain (prefrontal cortex) shuts down. This means that executive skills, such as reasoning, foresight, initiating, understanding facial expressions and relating to people, can all go out of the window. We rely much more heavily on our emotional brain (the limbic system) and survival brain (brain stem).

We can also become hypervigilant and anxious, and if our cognition is already compromised because of dementia, this can make already difficult processes even more tricky. With prolonged trauma, the limbic system starts to shut down too as the brain fully commits to survival mode.

Our ability to function can become compromised as we try to make sense of seemingly strange surroundings, people or events. We might try to use old memories to relate to or make sense of a situation, but this can be hard work when we try to put together pieces of a puzzle that no longer fit, especially when parts of the brain constantly go offline, making access to vital information inconsistent or impossible. The more the brain struggles, the more stressed we become. It’s a vicious circle, as the very stress response designed to help us survive is shutting down parts of the brain that deprive us of ourability to function.

DEMENTIA, HALLUCINATIONS AND PTSD
I have witnessed clients experience the horror of hallucinations and PTSD. People living with dementia can re-experience old memories as if they are occurring right now.

Although PTSD typically affects a person within six months after a traumatic event, late-onset PTSD is now being recognised as a mental health issue in its own right. Some veterans going through the early stages of cognitive decline experience PTSD for the first time, decades after the traumatic experience.

I remember entering the room of a client I was treating weekly, who could see ‘bloody, dead bodies everywhere’. I acknowledged how horrible this was for him and took his hand. I then explained who I was and told him I would take him somewhere safe. I talked him gently through what was happening and within minutes he was smiling and enjoying a leg and foot massage in the comfort of his armchair. I had taken him to a safe place in his mind, creating and holding a space where he could feel not just comfortable, but happy and engaged in the present.

SUPPORTING CLIENTS WITH DEMENTIA AND TRAUMA
As therapists, how can we help with the enormity of this? Part of my approach is to acknowledge a client’s relived experience and help them to feel they are able to cope. I use positive touch and a calm voice to reassure the client and help them self-regulate. Sometimes it’s about acknowledging the pain and anxiety a person is feeling in that moment and simply holding space (being present) with them, so they can come out the other side in their own time, knowing they are safe to feel whatever they feel.

Expression is so important.

A client with dementia is constantly reminded that they are going to lose their past, as well as their ability to cope and function in the present. They worry about the future and what that may hold. Some feel scared all the time. Consider the impact of all this chronic stress – they are more likely to snap and become the less than best version of themselves. Anger is often the easiest way to express any number of feelings, especially when we feel threatened.

As therapists, we may not be able to immediately work out what it is that the client perceives to be a threat. This is where curiosity on our part can help us to understand the driver behind a particular behaviour.

When caring for, supporting or treating a client living with dementia, it is helpful to bear in mind their upstream swim, and to do what we can to help them navigate their way through any rough water by using the survival starter kit (see Survival Starter Kit panel, above).

Although not an exhaustive list, these are some of the quick and practical ways we can help a person reaccess as much of their brain as possible. A calmer client can make more reasonable and rational decisions about how to react to any given situation and their life in general, and the beauty is that any therapist can learn to facilitate this process.
When the building blocks of trust are in place, and a safe relationship is established, true healing can occur and quality of life can be dramatically improved.