Harold G.* came blustering into the group clinic, demanding to know why we didn’t have shower facilities for clients. Oh, and after business trips to Japan and Thailand, he wanted “Li’l Asian gals to walk on my back and stretch me from here to there.” It took time to convince Harold G. that ours was a group therapy practice, not a walk-in spa. He just didn’t get it.
I’ve polled colleagues in acupuncture and ABT as we continue to educate members of the public on dizzying levels regarding scope of practice. Yes, we have all been asked to perform neck and back adjustments by clients who believe this is a standard part of our practice, after they experienced adjustments from bodyworkers and/or acupuncturists in other countries.
Austin-based acupuncturist Alighta Averbukh says clients have even asked her to perform “manual pelvic floor” work. She explains it is beyond her scope of practice and refers them to a physical therapist.
Bone Setting?
True, bone setting is part of Chinese medicine. The Japanese equivalent (judo therapy) is part of martial-arts dojo training in Japan. But not in the U.S., where such techniques belong squarely within orthopedics or chiropractic.
Indeed, the chiropractic board in Texas went after a couple of licensed acupuncturists some years ago who insisted adjustments were a “traditional part of tuina.” Until Texas Attorney General (now Senator) John Cornyn came out forcefully and stated tuina was not part of Acupuncture.1
Acupuncturists who also practice tuina need to apply to become AOBTA certified to practice legally in Texas. (By the way, no other state singles out tuina in this way.)
The case was tested a few years ago when a freshly graduated acupuncturist advertised her tuina services, but forgot to mention she was also AOBTA certified. The state acupuncture board threatened to cancel her license until I involved a pro bono lawyer for her and supplied the board with AOBTA information supporting her legal right to practice tuina.
It was a tough time for us all but I’m happy to say she won her case. I elaborated on this in a previous column (July 2019).2
Blurry Lines Between Massage and Asian Bodywork
In spite of detailed and separate U.S. Department of Education3 definitions for massage (#51.3501) and Asian bodywork therapy (#51.3502), we continue to battle both public and legislative misrepresentations and misunderstandings.2 Many of us have appeared countless times at committee meetings at our respective state capitols to argue and demonstrate these differences.
Nini Melvin, owner of shiatsu and healing arts school Meridians – Pathways to the Heart in Northampton Mass., and author of recently published HUMANATURE, is very clear in her website and promotional material when it comes to shiatsu. Clients will be fully clad and are advised to wear loose, comfy clothing. But somehow, she still gets clients expecting oils and rubdowns.
Two well-known celebrities were offensive to her in different ways. One, a member of a famous British pop group, thought he was entitled to grab her breast during the session. The other, a high-profile wife of a former state governor, kept grumbling, “This isn’t what my practitioner does.” Nini and I agreed that there was no end to our ongoing quest to educate and inform, even after our four decades in the field.
A problem we all face is the licensed massage therapist (LMT) who has completed, say, a brief course in shiatsu or Thai or tuina, and claims to “do shiatsu” or “do Thai” or “do tuina”; as opposed to saying they “integrate certain ABT techniques” into their practice and explaining what this means.
Gua Sha, Anyone?
I watched AOMA graduates perform and explain gua sha at the end of a sensitive session involving the NADA protocol followed by tuina during the stress-busting episodes we initiated for ICU and ER crews at St. David’s North Austin Medical Center during the COVID crisis. This was a unique combo experience for many of the RNs and they loved it.
By contrast, a former student of mine, Robbie K.,* currently enrolled in a DAOM program, was concerned during the months he spent working as an LMT (prior to completing his LAc), when he was asked to perform gua sha, a technique in which he had not been trained.
The massage group he worked for, with franchisees throughout the U.S., advertises gua sha services in glowing terms on its website, without listing qualified practitioners. Robbie refused to perform gua sha and told his manager it was beyond his scope of practice. I contacted the group to ask what training hours it requires of its therapists. I still await a response.
Gua Sha Training?
Tuina and acupuncture expert Jamie Wu, LAc, PhD, and vice president of AOMA, who is also a former NCCAOM commissioner, says of gua sha: “I would recommend 18 hours didactic hands-on training, and another 18 hours clinical practice,” within the context of a full training in Chinese medicine.
I contacted Les Sweeney, president / CEO of Associated Bodywork and Massage Professionals (ABMP), to ask if gua sha is covered by its insurance policies. “Coverage issues are always a bit thorny,” he admitted, adding that ABMP policies would cover gua sha depending on the state’s recognition of it and the member’s training. “The therapist not having training would be a red flag,” he added.
I then ran Robbie K’s concerns by local and national colleagues. The head of the massage board in Texas said it wasn’t a matter for the board to investigate.
But AOBTA President Sarah Goldenburg expressed concern about “reckless practitioners” and ethical considerations regarding “overreach within an array of bodywork professions.” She added that it was up to the ethics committee of the AOBTA and other relevant organizations to investigate formal complaints.
AOBTA board member Cari Johnson Pelava, founder of CenterPoint Massage & Shiatsu School and Clinic of Minneapolis, Minn., said, “Every year there is a new violation of professional boundaries. It’s driven by employers, not by the schools.”
Bottom line? It’s those of us in Asian medicine who seem most aware of the possible misuse of one-off CEU techniques plucked out of context from the mosaic of our extensive training in ABT, acupuncture or both.
Acutely aware of how gua sha was included within his own extensive training, AOBTA Legislative Director Victor Manuel, LAc, DAOM, threw the topic into a general discussion at a recent meeting of the JGRC (Joint Government Relations Committee) of the Federation of Massage, Bodywork and Somatic Practices Organizations. The response from some of the 11 member organizations? Gua sha is used widely, even by beauticians for facial rejuvenation, and by chiropractors under the name “Graston Technique.”
As gua sha isn’t a registered name, the spokesperson for the AMTA said the technique could classify as a “mechanically assisted massage tool.” Ouch.
Finally, a sobering comment about gua sha from Cherie Sohnen-Moe, co-author with Ben Benjamin, PhD of The Ethics of Touch, and a former instructor and member of the advisory board of ASAOM in Tucson Ariz.: “I don’t think that the issue necessarily involves scope of practice, but more standards of practice and core ethics. The bigger issue is, are you properly trained?”
Editor’s Note: Some names (identified with * in the text) and locations used in this article have been changed from their originals to protect client privacy.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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