Show Notes:

36: Whitney Lowe talks with Robin Anderson about her new role as president of the Massage Therapy Foundation and how research plays an important role in our field. They also dive deep into some issues around curriculum design and the crucial importance of developing solid educational programs to ensure the future success of our field.  

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Til Luchau Advanced-Trainings        whitney lowe
Til Luchau                          Whitney Lowe

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Til Luchau Advanced-Trainings
Til Luchau

whitney lowe
Whitney Lowe

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(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

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The Thinking Practitioner Podcast:
Episode 36: Research and Education with Robin Anderson

Broadcast date: 04/14/2021
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Whitney Lowe:

This episode of the thinking practitioner is sponsored by Handspring Publishing. Handspring has become one of the preeminent publishers focused on manual therapy topics and their catalog reads like a who's who of great pioneers in our field. Handspring also offers a series of webinars called Move to Learn, which are free 45-minute segments featuring their authors, including a recent one from Til. Head on over to their website at handspringpublishing.com to check those out and be sure to use the code TTP at checkout for discount. Thank you again, Handspring.

Whitney Lowe:

Welcome to The Thinking Practitioner again. Til is off this week and I'm delighted to be joined this week by my friend and colleague, Robin Anderson, who is the recently elected President of the Massage Therapy Foundation. Robin, let me just have you take a moment tell our guests and listeners a little bit about yourself for those who don't know you yet.

Robin Anderson:

Sure. Thanks, Whitney for having me this week. I appreciate it. My name is Robin Anderson. I am the Director of the Massage Therapy Education Program at the Community College of Baltimore County, in Baltimore, Maryland. I've been a massage therapist for 15 years. I am board certified. I specialize in orthopedic techniques and manual lymph drainage. I do run a private practice with a plastic surgeon and a plastic surgeon's office. I do a lot of postop work.

Robin Anderson:

Those techniques that I've learned have come in handy over the last few years but I've worked in a bunch of different settings. I mean, I've done the spa thing. I've done private practice. I've worked in occupational health clinics and hospital settings. I've worked in pretty much every setting there is.

Robin Anderson:

Then, I also have a background in ergonomics assessment. That was one of the skills that I picked up in working in occupational health. It's really helped my career in terms of practice, as well as in education.

Whitney Lowe:

The thing that continues to amaze me and you continue to inspire and boggle me so frequently, just any one of those positions, the Massage Therapy Foundation and running the CCBC program and your private practice could be more than a full time job for you. I don't know how you juggle all three of those and then still continue to have a life alongside.

Robin Anderson:

I don't know, either. When people ask me, "So you have a full time job?" I'm like, "No. I kind of have three jobs." There's like, "Oh, my word." I really only practiced one or two days a week. The foundation stuff is stuff that just has come up, that's become more of a prominent responsibility, of course becoming president and then of course, my full time job.

Whitney Lowe:

Right. You recently took on this position of the presidency of the Massage Therapy Foundation. Can you tell our listeners a little bit about what the foundation does and what it's all about, for those people who are not really familiar about it? Lots of people have heard about it, but don't really have a good understanding of what the foundation is about.

Robin Anderson:

Okay, sure. The Massage Therapy Foundation, our goal or our mission is to support research, community service, and education for the massage therapy profession. We are a nonprofit organization. Every dollar that we bring in is put back into programs, grants, projects that help to support the profession. We also fund a peer-reviewed research journal called the International Journal of Therapeutic Massage and Bodywork.

Robin Anderson:

We support that, as well as student case report contests. We support research grants. We do community service grants, which help to serve underprivileged and underserved populations in need who may not have access to massage therapy. Then, we also produce eBooks and other types of resources that can be used, either in a practice office or in an educational setting. We really strive very hard to make sure that we have tons of those materials available to people so that way they can stay evidence-informed in the field of massage therapy.

Whitney Lowe:

Yeah. Can you make a brief distinction and tell us a little bit about the importance of some things with, I want to focus on the journal for a moment...

Robin Anderson:

Sure.

Whitney Lowe:

... because I get this question all the time from people who I think and again, you and I have talked about this at length and we'll probably not get into this again here but the fact that our profession doesn't really exist within sort of the more traditional kind of academic models has some challenges for us and in particular, what I run across frequently is people not quite understanding the difference between peer-reviewed research that might be published in something like the IJTMB versus that which appears in a popular trade publication.

Whitney Lowe:

Can you give me a little bit of just, again, what is the kind of distinction between some of those popular culture publications and those in what is really considered peer-reviewed research?

Robin Anderson:

Sure. When we talk about trade publication, generally somebody, there's an author that may have read an article or may have been understanding of an article, and they summarize it and they put it in that trade journal, or it even could just be somebody who's a subject matter expert who may have done some anecdotal stuff or even done some research themselves, but they've written an article about it. It's not any different than if you were to read Time magazine or any other magazine. It is not peer-reviewed.

Robin Anderson:

Peer-reviewed means that you actually have colleagues, people with educational research backgrounds, massage therapy backgrounds, who actually read your work anonymously. You don't know when you submit your research. You don't know who's reviewing it. There are criteria that you have to meet. It has to be completely referenced in a proper format with all the different resources that have been used and it is reviewed and you're supposed to make edits and updates to it to meet that criteria. The objective is to try to make sure that it is viable research. Lots of people write articles, but there may not be any data or support to back it up.

Robin Anderson:

In a peer-reviewed journal, that's what those peer reviewers do is make sure that they ask the why, how did you get this information? How did this study work? In a trade publication, that doesn't happen. It's just literally being written. Now, you can certainly have references with a trade publication, but it's not the same thing. It's definitely much more strictly reviewed.

Whitney Lowe:

Yeah. I think that's such an important distinction because there is a, I think, a misperception oftentimes just because something got published in a publication that it's viable and accurate.

Robin Anderson:

Right.

Whitney Lowe:

I've certainly written my fair share of letters to the editor over the years about stuff that got published in a lot of our trade publications that I just said, "I'm sorry, but this is bunk. It's not true."

Robin Anderson:

Right, right.

Whitney Lowe:

That's an important part of developing that sort of critical thinking process of recognizing how to see stuff that's not so accurate there. Tell me a little bit about your background with the foundation. How did you get interested in working with the foundation in general?

Robin Anderson:

Well, believe it or not, the foundation has been a part of my profession ever since the very beginning. When I was a student, I actually entered the student case report contest and I won.

Whitney Lowe:

All right.

Robin Anderson:

I won a bronze level award.

Whitney Lowe:

I didn't realize that. That's great.

Robin Anderson:

Yeah. I wrote my case report on the effects of massage with rheumatoid arthritis. Then, a couple years later, I also entered the practitioner report or a case report contest when they used to have that. I got an honorable mention with that one. Then, a few years later, at a conference, I was talking with Brent Jackson, he's a colleague of ours and he said, "You really should volunteer with the committees," and I said, "Sure, I would love to do that. I mean, I've always loved the foundation."

Robin Anderson:

I started out serving on the education committee and community service grant committee. Then, probably about a couple years later, I was asked to join the Board of Trustees. Since that time, I've served on as a vice president for a year and then President Elect last year and then President this year.

Whitney Lowe:

Wonderful. Yeah.

Robin Anderson:

Yeah.

Whitney Lowe:

Wonderful. Tell me about your perspective on some of the things that the foundation does but in particular about disseminating and getting research out to the public. We hear all the time from the media or other people in our profession, lots of people say it's really important to keep up with research. How does that impact the average massage therapists on a day-to-day basis? Because there's a lot of people that say, "I don't read."

Whitney Lowe:

I have to be honest with you and tell you, I even have had one of the very prominent educators in our field say to me one time, "Oh, yeah, you read all that research and stuff," and I just, I don't bother getting into that. I was really kind of astonished.

Robin Anderson:

Wow.

Whitney Lowe:

Tell me, what is your sense of, how do you describe this to people? What's the real importance of research in terms of how it affects the average massage therapists practice on a day-to-day basis?

Robin Anderson:

Well, I actually teach a research course as part of my program here in Baltimore. One of the things that I explain to my students, because I usually get that kind of feedback from them, I mean, they're like, "I want to learn massage therapy. I don't want to read research. I hate writing research papers." I get that feedback all the time.

Robin Anderson:

I point out to them, one of the resources that actually the foundation has that I absolutely love is the five myths and truths of massage therapy. I point out to them in that ebook that there are things in that book that was taught to me when I was in school, but if I didn't read research and I didn't pay attention to that, I would still be passing those misnomers and that inaccurate information to my clients, to you as my students. That's the importance of it is that you need to stay relevant.

Robin Anderson:

Most healthcare practitioners, most, have to do this as part of their profession to stay relevant, to stay current. Things change in the healthcare and wellness industry very rapidly. It's important to make sure that you stay on top of that.

Robin Anderson:

Now, when you get that pushback from people, they're like, "Well, I can't sit there and read for hours and hours on this stuff." This is where the Massage Therapy Foundation, we've kind of responded to that sort of need. We have resources like infographics where you can print out a card on very common conditions that have been researched and you could print those out and you could give them to your clients, to give them information about that particular condition and why you're taking a particular approach with their treatment.

Robin Anderson:

Other things that you can do is listen to the research podcasts that we have. If you don't want to read it, well, maybe you'd like to hear a 20-minute or 30-minute episode from the researcher themselves or people who are experts on a particular topic about the research on a particular topic. That helps you to stay relevant.

Robin Anderson:

I tell my students, yes, you can read the stuff that's in your trade publications, I appreciate that but you really do need to pay attention to the trends of things that are happening. One that was the most significant that I pointed out to them and I'm sure you're aware of this, Whitney, is the systematic reviews that came out just a couple of years ago, with regards to pain management and massage therapy, and how important that research was, especially now while we're in the midst of opioid crisis and we're dealing with COVID and all this other stuff, I mean, pain, chronic pain, different types of pain, very important. It's our wheelhouse as massage therapists so that we can have a positive impact.

Robin Anderson:

When I showed them that it's like basically 120 pages worth of text, they're like, "Oh, my God. I am not going to read that." I'm like, "You don't have to. We actually have these simplified things." When you give those to your clients and your patients or if you are well-versed in it, that makes you a much more relevant practitioner, because you're talking about the latest and greatest information about it.

Whitney Lowe:

Yeah, for those people who are not really well-versed in some of the terminology here, can you speak for just a moment about why something like a systematic review is so pertinent and important as opposed to a single individual study about something that might have come out? What is a systematic review and why does that matter?

Robin Anderson:

Okay, systematic review is one of the highest levels of quality of research. There is a pyramid and I'm going to reference my friend Ruth Werner here because I know that she's put this in her textbooks, there's an Oxford pyramid, where you have the lowest bottom of the triangle or the pyramid are anecdotes or case studies or case reports. These are all just individual cases of, just noted information about something they apply to treatment, and they got an outcome.

Robin Anderson:

But as you go up that pyramid, things like randomized controlled trials, where you have the patients or the study subjects and the researchers are blinded. They don't know where the treatment goes or who got the right treatment or who got a placebo or a sham treatment.

Robin Anderson:

I know I'm really throwing out a lot of terminology here but I guess what I'm getting at is that you work up that ladder and then the systematic review actually takes a look at everything below it, and analyzes that data, analyzes that information and says, "Well, do we have a consistent trend here that shows that it should become a standardized practice or should become part of evidence-based practice." When you have enough of that information, that's where that becomes so important is that it looks at everything, all the different types of studies. Yeah.

Whitney Lowe:

I think that's one of the other really valuable points is that you get better information by consolidating a lot of different perspectives about things. Keep in mind that each study has strengths and weaknesses. You can't rely on one single study to tell you things...

Robin Anderson:

Sure.

Whitney Lowe:

... but a systematic review does a better job of filtering out those key factors of strengths and weaknesses to give you a better clinical picture of things that are going on oftentimes, I think. Yeah.

Robin Anderson:

Right and exactly, because a lot of times, when I talk to my students about it, I said, "Pharmaceuticals tend to have the best sort of reference in terms of the different types of evidence because they will go up that chain very easily," and you can see the case studies, then you can see the clinical trials and then you can see the other information. You can see how that's how they determine the efficacy of any particular drug or treatment. I mean, currently, I'm sure that's what the CDC did when they looked at the evidence for the COVID vaccines that are being used today. It's because they went through that process.

Whitney Lowe:

Yeah. I've got another question for you around this too, in terms of educational things, because this came up in a discussion in an online conference I was in this past weekend when we were talking about how do you get practitioners to develop that a bit more of a sort of an evidence-based perspective to begin looking at things and become critical of the literature they read and analyze things and look at stuff and say, "Is this done well? Does this really make sense or how does this conflict with what I learned when I was in school?"

Whitney Lowe:

These are all things that seem to come from developing a lot more sorts of critical thinking processes. As an educator and a program developer too, I'm curious from that perspective as well as from the foundation perspective, what can we be doing in our fields to help encourage better training and development of evidence-informed thinkers in our field?

Robin Anderson:

Well, I think we have to take the scary or take the fear of research out of people. I really think it's something that should be an entry level education because if you don't learn to do it from the very beginning, it's really hard to understand the reasons why you do it later on.

Robin Anderson:

Secondly, when I teach it to students, when I teach it to continuing education courses, workshops, and so forth, what the two things that I tell my learners is, is this generalizable? Can it be applied to the masses? What you're reading, can that be applied to the masses of anybody who has that particular condition? Number two, is it reproducible? That's the key for me whenever I read something, and whenever I have my students read something.

Robin Anderson:

I particularly make them go to the methods section more than anything else, not even just the results, how the methods section of each of those research studies are written? Can they understand it? Can they duplicate it? Does it make sense to them?

Robin Anderson:

Then, when we do talk about results, and of course, the first thing that students or practitioners say is, "Oh, my God, all those numbers. What do they mean? What do they mean?" I said, "You know what? Don't look at the numbers.' I actually look at the discussion section because sometimes, not that the data doesn't matter but if you don't understand it, try and give them a hard crash course and statistics is not necessarily an easy thing to do.

Robin Anderson:

You can point out a couple of simple things but what I have them do is go to the results section. If it seems like what they're saying, isn't really supported by the data tables that they're showing, they're really working hard to try to sell it to you without a whole lot of backing up that yes, we believe what we got is great, or no, we didn't get it. That's where you start to question it and you start to question the efficacy. That's what I usually tell my students to do.

Robin Anderson:

Mainly, what I want them to understand is when they look at something, first of all, it never hurts to look up a particular diagnosis or disease or condition. We all go to school. I don't remember everything that I studied in my pathology and pharmacology class. Sometimes we have to look those things up. When we do look them up, we should look for is there anything current that's being done that maybe I could use in the treatment room that could help my client or patient?"

Robin Anderson:

That's kind of the mindset that I have. I try to get my students to think that way too and say, and I've even told them, the things I'm going to teach you today may be irrelevant in 10 years, and I'm okay with you doing that, don't say, "Well, that's the way I was taught." That's, yeah. Exactly.

Whitney Lowe:

Right. I was mentioning this and the thing this past weekend too, there was a quote that I've heard a number of times and came across from, I can't remember the gentleman's name, I think it was David Sackett. It was his name. That was the considered the father of evidence-based medicine, who told a bunch of medical school students, half of what you learn in medical school will be either dead wrong or out of date in five years from now.

Robin Anderson:

Right.

Whitney Lowe:

The problem is we don't know which half. The thing is what you really need to do is to learn how to become a good learner. I think that's where the critique comes in because this is the other thing, I see this a lot in looking at things and also talking to people about how to begin looking at research critically and analyzing things. You got to keep in mind, a lot of times there's a tremendous amount of pressure on a lot of people in the academic world to publish research.

Whitney Lowe:

Oftentimes, things get published, not because they're really a great research question, but because it's something they could figure out a way to study. It's almost like, here's something that we can measure. Let's write a study around it.

Whitney Lowe:

When you also really want to ask, what's the real world application of this information and does it really turn into something that really is useful and relevant for us because a lot of times, you'll see some of these things done and you actually, like you mentioned, dig into the methodology and look at these things and say, "Yeah, but nobody actually..." They measure what's the beneficial effect on circulation from 25 continuous petrissage strokes done on the patellar tendon is like, interesting that you figured that out, but nobody does that. It's just not realistic.

Robin Anderson:

Right, right. Well, I can relate to that. I did do a research study on the educational side of things. I took the combination of my ergonomics experience, my practitioner experience, and then my educational training to do a research study on studying how you could teach body mechanics to students using ergonomics methods. Yeah, it was part of my master's degree. It was part of my thesis presentation. Yes, I did have to do that but I actually, it wasn't a requirement. I actually talked to my professor and I said, "Look, I would really actually like to do this study." I actually and she walked me through the IRB process, which IRB is Institutional Review Board.

Robin Anderson:

I walked her through that process. I collected data on my students. Then, I went through this statistical analysis, which for me, like most massage therapists I am not a numbers person. That was really difficult for me to do that part but we did it and it was good. Then, I was able to write it up then and publish it. I actually have a colleague in Michigan that wants to duplicate the study. I'm excited that she's interested in doing that. It's pretty cool.

Whitney Lowe:

That's great. Yeah.

Robin Anderson:

Yeah.

Whitney Lowe:

What do you tell your students or the people who come to you? We've talked frequently, hear about the people that just don't want to get into the whole research world and they don't want to have to be delving into this stuff a lot but what about those people who do, who are curious about, "I'd like to know how to get more involved with this. This is really kind of interesting. I'd like to help our profession." Do you have suggestions or hints or ideas for people like how do they first get started doing something that might be relevant to help move us forward and participate in that?

Robin Anderson:

There's a couple things you can do. Definitely, you could read some of the resources that we have on the foundation's website. We have a ton of stuff there on how to connect with a researcher, how to think about doing research, how to understand it, and find a topic that interests you.

Robin Anderson:

I always tell my students, "Write a case report first," because that's the easiest way to study is to do it. There's resources actually with the IJTMB as well as on our site on how to write a case report. That's just as simple as I have this one client that had a unique condition. I had an idea of how I wanted to do it. This is how I did it and I described it, and this is what the results are.

Robin Anderson:

The hardest part about writing a case report, for most people, or just any type of research is how do I measure it? Massage therapy is very hard to measure. We don't have dosages like we do in medication or even in physical therapy, there's a certain criteria of how many sessions or how many exercises and so forth. We don't have that with massage therapy. It is very customized to each individual client based on the practitioner and what they can do.

Robin Anderson:

There are things that you can use. I do reference the PT world a lot because they use a lot of tools and surveys and things that we could definitely use in our practice too. For example, the DASH survey, which is Disability of Arm, Shoulder and Hand. You can definitely use the information that's on that survey to help evaluate your client to see if you can get results if you're working on arm, shoulder or hand. A goniometer measures range of motion, so that you can easily measure before and after to see if you had any effect.

Robin Anderson:

There are ways that you can collect information. You just got to do a little bit of thinking, a little bit of thinking about how to do it. Just saying you have great results just isn't enough. You have to think analytically. I know, that's difficult, but a case report is the best way to start. Then, once you feel like you've gotten your feet wet with that, then you could try to do a case series, work on something else.

Robin Anderson:

I'm actually working on a case series with the plastic surgeon that I practice with because we've just had such wonderful results postoperatively with all of his body contouring patients and I know, there's no research out there really to support it that specifically says massage therapy and liposuction and massage therapy and this. We're trying to put together a case series to get that published.

Whitney Lowe:

Yeah, that's great. I think one of the big challenges when people start doing something like that with case study reports and especially if you haven't been sort of immersed in sort of being critical about looking at evidence and things like that is to fall victim to what we call the post hoc fallacy, which is making assumptions that like, okay, I had this client that had a shoulder problem and I did so and so. Therefore, this worked and that's why they got better.

Whitney Lowe:

Making a determination about why there was a beneficial change in what happened when you're not counting many of the different factors in there that could have been and we have to be really careful sometimes about jumping to saying, "Oh, because I did this that produced that result and that kind of solution there." That is a real challenge.

Robin Anderson:

That would be called confounding variables there, Whitney.

Whitney Lowe:

Exactly. Good. Good. We need to maybe, a nice little, do you have anything with the foundation, like a little glossary of those kinds of collection of important terms or things like that?

Robin Anderson:

We do. We do. Actually, in the ebook section of the website, there is an ebook on how to teach or teaching research to students. There's actually a chapter in there that is a glossary that has all of those different types of terms. It also has that Oxford pyramid in there that we were just discussing. It has that information in there.

Robin Anderson:

Just because you're not an educator doesn't mean you can't read that book and get some information out of it but we wrote it with the perspective of educators and how they could do things in the classroom for their students but it doesn't mean that anyone couldn't read it. You can download it for free. There's no cost involved. It's helpful, I think.

Whitney Lowe:

Yeah. Great. Well, I want to sort of shift track a little bit now to job number two of yours and talk about your role a little bit at CCBC with directing and developing curriculum there, because this is another place where you and I, I believe, love to live in the discussions of instructional design and curriculum development, things like that.

Robin Anderson:

Right.

Whitney Lowe:

One of the things that I have continuously lamented over the years of watching is what I feel to be some real challenges that are facing our field in that we have evolved so many massage schools in this country and we have not really evolved the educators to staff those schools or really the skillset needed to be involved with curriculum development, and you've done some specific work and graduate work in particular in this area.

Whitney Lowe:

I want to know, what kind of things do you see as some of the biggest, maybe deficiencies that we have with our educational programs because to me, this impacts the future of our profession? If we don't look at this whole role of how are we doing in educating our future clinicians and that starts with the educators themselves, how do we grow and where does the profession go in the future? What do you see is kind of like some of our biggest challenges in those areas?

Robin Anderson:

Well, I feel like the educational aspects are in sort of a mid-shift at the moment, especially because of COVID, because people in the last year or so, we've been shifting to more online education. I mean, I had to put all of my students online for quite some time. They actually still are online right now. We're actually doing a 70/30 split, where 70% of their lecture and didactic material is being taught online, but then they come to campus for clinics and labs and so forth. I feel like that online education element has crept its way into the educational model but also-

Whitney Lowe:

Let me interrupt for just a second and ask, have you got any kind of analysis at this point, the effectiveness of that versus what you were doing previously? I recognize that everybody was really thrust into emergency remote teaching, which is a bit different, like now that you've been, we're almost, kind of almost a year out from where many people were making that move, do you have any kind of analysis of like or do you want to keep any of this kind of approach when the COVID is over?

Robin Anderson:

Well, I actually started doing it about a year or two before COVID happened. I actually started moving some of my courses completely online. One of which was actually the research course that I taught because I felt that even though I could teach in the classroom, if the information that I was doing in person wasn't any better or any more substantive when I taught it in person, as opposed to an online asynchronous course.

Robin Anderson:

When I say asynchronous, meaning like on a weekly basis, you can watch a lecture, you can do your work by a certain due date, but you don't have to be in class at a specific time or date. Usually have Windows where you can submit your assignments, your exams, so forth. I had already started doing that. I have to say, I was very thankful that I did because when COVID happened, it was like, "Okay, I know what to do now, I mean, and I could convert the classes."

Robin Anderson:

To get back to your original question about instructional design and about the educational model, I think one of the biggest problems we have is that we're not very consistent in our educational structure. Some of that problem has to do with varying from state to state and the state requirements. Some of that has to do with just the envision of what is considered entry level knowledge and what isn't. I know that we've gotten into discussions about, well, practice settings don't matter. They do matter.

Robin Anderson:

My personal opinion is, at any given time, in any location that you are practicing in, you would have to know any different types of pathologies, conditions where you would have to make critical thinking, judgment calls, whether they're in a spa or a hospital, you would have to make a judgment call as to whether or not massage therapy is appropriate in either setting.

Robin Anderson:

My feeling is, is that because so many of us want to be considered healthcare professionals that seems to be the trend, if that's the way you want to be, then you have to step up your level of education. You really do. That means, being on the same playing field as those who are autonomous and can take individual responsibility for their clients.

Robin Anderson:

You have to remember that even those of us who run private practices, once somebody gets on their table, if you injure them, it's your fault. I mean, you can be sued for malpractice but even if you work in a franchise location, if you injure them, you can still be sued for malpractice. It doesn't matter. That's no different than a doctor, a nurse, PA, physical therapist, PTA.

Robin Anderson:

I guess, my point is, is that we need to start thinking along those lines. I think we tend to forget that. We just say, "Oh, it's just massage." I don't agree with that at all. Then, when you see how people are starting to take advantage of our profession in trying to practice without a license and so forth, it just downplays the whole field. My feeling is it's not that we're trying to exclude people out of the profession, we're just trying to get them up to par with people who are doing the same level of work that we're doing. Yes, it does require a little bit more education. I think it's important.

Whitney Lowe:

There's been this argument frequently in our profession about whether or not we need some type of tiered credentialing, just a base level for people who want to work in environments that are not really oriented toward healthcare versus those that are, but what is your sense of that? Do you think that's something that should happen at entry level or is that something that where there should be distinctions more at the post graduate, post schooling level like it is in some other professions?

Robin Anderson:

Well, not to compare us to medical doctors, but if you really think about it, the way that doctors, when they go to med school first, they all go through a basic level of training just to get into med school to become doctors, but then at some point, they pick specialties that they go into. Then, that's their pathway. You're not going to go to a plastic surgeon, if you're having problems with your knee. Okay? If you're having intestinal problems, you're not going to go to a dermatologist.

Robin Anderson:

I guess, my point is, is that we have massage therapists who have specialties, people who work with athletes specifically. I work in a plastic surgeon's office. There are others that like to do palliative care and like to do hospice. There's others who like to work in a spa environment. There are some basics that definitely go across the board but I do you think that as you go into more specific locations or more specific pathways, that there should be additional training beyond that.

Robin Anderson:

Tiered? I don't know if tiered is the right way to say it but maybe, we all have the same base level because, I mean MDs are still MDs, right? But then if they have their board certification in a specific pathway, then they're board certified in orthopedics or board certified and plastics or board certified in otolaryngology. That's what I'd like to see us do.

Robin Anderson:

I think that it would make things a little bit clearer to the consumer and the patient because that's the one thing that I run into a lot in my practice, is that I'll have somebody say, "Yeah, somebody said, they did lymphatic drainage, but it clearly didn't help." They didn't know what they were doing but then after they got off my table, they were like, "Wow, you really know what you're doing." I could explain it to them and I could tell them why it was being done and their evidence that goes behind what I'm doing.

Robin Anderson:

See, that's where you can tell where someone is a specialist or whether or not they're just dabbling in it. That's the thing that I truly feel is difficult is that there's many therapists who think that they are skilled in certain things, but they're really not. I don't mean that derogatory, I just mean it as that it's what dilutes the message about what we do and why don't you have a hard time.

Whitney Lowe:

Yeah, that model has really perpetuated a great deal by the fact that so many people get their base level education, and then they get a lot of their real world application in experiential learning after they leave and in continued education workshops, and there's a large number of people out there and sort of on the CE workshop circuit who say, "Come take my two-day weekend class and then I'll certify you in my method," whatever that happens to be. Now, you think you really know a lot of stuff because you took a two-day workshop with these folks. That's a whole different story of getting into why cramming information into 16 hours over a two-day period is not really good learning but there's all kinds of other facets of that, that make it more problematic as well.

Whitney Lowe:

I want to come back to this, circle back around when we talk about sort of entry training requirements because this is another big argument and discussion that's been prevalent in our appeal for so long. I'm curious to hear your perspective about this, I mean, do you, there's a lot of people who say, "We're never going to be taken seriously until massage therapy is a degree program." What are your thoughts on that in terms of whether or not we should be a degree program and have a similar type of base level training that you would get in a degree, a bachelor's degree, for example?

Robin Anderson:

Well, my program is currently an associate's degree. Yeah, I have several colleagues across the country who teach in a community college setting and they all have credit certificate programs. I agree with them to a certain perspective because in working with medical professionals and actually, Doug Nelson, the previous president, colleague of both of ours, and I have had this conversation when we've talked to medical professionals who refer clients to us or collaborate with us in terms of patient care, and one of the things that the doctor say is, "Where can I find more people like you? Where can I find more practitioners like you because I did not know that this existed and if I knew that, how do I find these people?"

Robin Anderson:

The sad part is, is we can't answer them, honestly, and that's where the difficulty lies. While I know this is not a popular opinion, I do think that if we had more of a standardized level of education, whether it's an associate's degree or a credit certificate, I just think that that's, it seems like it's the right thing to do. You have to look at other practitioners like athletic trainers, for example.

Robin Anderson:

Athletic trainers actually do a lot of the same things that we do as massage therapists but then they also do the training aspects. That's a master's level degree. Okay? How is it that we can do such a low and I don't want to say low level, but that's really not a good word but just such a basic level of training in six months or eight months or in a rushed period of time, that is equivalent to half of what an athletic trainer learns in their entire master's degree.

Robin Anderson:

The second thing is in my experience with students coming into entry level and just using myself as an example, never say never. I've gone back to school three times in my lifetime and actually considered a fourth, so but the thing is-

Whitney Lowe:

Well, you may not be done yet. That's right.

Robin Anderson:

Yeah, I might not be done yet. I don't know but I guess my point is, is that if you have college credit and this kind of goes back to the beginning of our conversation, Whitney, where how do people get into research? Well, what if you do have that person that went to massage school and then they want to get their master's degree and then they want to get their doctoral degree, and they want to do research, they want to become a researcher.

Robin Anderson:

The way our educational systems are set up right now, those pathways are not easy. They're not easy at all. A lot of them are retaking classes. I've had several students come to my program and say, "Why do I have to retake anatomy and physiology? I took it and I know it." I can't give you college credit for something that isn't an accredited institution.

Robin Anderson:

I know that there's a real backlash about that. I know colleges and universities have very strict policies. I get it. My daughter transferred from one four-year institution to another one and it was a nightmare. Do you think that there's some definite reforms that need to happen at that level but I just feel like, it allows us to get true credit for what we know and what we do and it's not that I don't think that there are some private independent schools out there that are not good. I know many people who own schools that are fabulous instructors, that are fabulous school owners, and do a great job of teaching their students and preparing them for the workforce.

Robin Anderson:

I have to tell you, that's not the norm. I would say that the majority of schools that are open that's more the exception than the rule. That's not right. It shouldn't be that way. I think we all need to follow a standard. I guess that's the reason why I would like to see a standard level of education across the board that was equivalent. Then, once we can do that, then I think that that would help our legitimacy factor and kind of bring it back to what Doug and I were saying about, then there's more of us out there that you can find and you can be in that setting if you want to be.

Whitney Lowe:

Yeah. That certainly has been one of my primary interests in focusing on the world of credentialing for a lot of years, just because I see this as a bigger picture problem. I see this as like, how do we move the profession forward for acceptance and recognition by other individuals associated with the healthcare system and that always comes back to some aspect of credentialing and education and standard building and things like that.

Whitney Lowe:

It is clearly a very thorny issue because there's a lot of other things that have to be considered. I mean, right now, I think, and COVID has been just like a gasoline accelerant poured on this process of seeing, like, you're hearing this argument a lot from people who are in traditional outside of our profession, just traditional college programs when COVID hit and all of a sudden, they were doing this complete training by online education. These parents are saying, "Wait a minute, I'm paying $25,000 a year for this watching their kids just sit in their bedroom on Zoom and get some not great quality kind of educational instances." If you look again at the costs of traditional college degrees, in the rate of inflation over the last 30 years, it outpaces healthcare.

Robin Anderson:

That's true.

Whitney Lowe:

I think that a lot of these things bring up a lot of challenging questions for people, especially in our field, when we see we have so many people who leave our field after a relatively short number of years. They are going to be considering that whole return on investment idea and like how much is it going to cost to become a massage therapist and how much am I going to get back on this kind of thing? I agree with you. It's just, we have to look at these things, but boy it's thorny issues that don't have any easy solutions, I'm sure, because if it was easy, we would have done it a long time ago.

Robin Anderson:

Right. Well, I wanted to just say that there's one argument that you can make for this. Part of it is, so many of us want to be able to be accepting insurance. I know that that comes up a lot in conversation. I think they are kind of pushing for this because if you think about it, with insurance companies, they look for the credentialing, they're the ones that are looking for, they don't want just anybody off the street to be able to just submit an insurance claim for massage therapy.

Robin Anderson:

Again, it goes back to malpractice and it goes back to what's reasonable coverage. If you have different levels of education, and again, you're taking responsibility for the client that becomes a thorny issue, which is why a lot of the insurance companies don't cover massage and they'd like to see it done that way. Of course, consumers want it because they're paying a ton for health insurance. They want to use it especially when they're using it for chronic pain. Just something to think about.

Whitney Lowe:

Absolutely true. It will. It is becoming a bigger and bigger factor in both the recognition and the implementation of massage therapy into other healthcare environments. Even if you don't want to get into the process of doing the insurance billing yourselves, right, as you mentioned, it is a critical part of the overall perception and acceptance of massage as a viable means of a healthcare approach for so many individuals and especially those who would not have financial access to our treatments without it.

Robin Anderson:

Right.

Whitney Lowe:

Yeah, it's a big one coming down the road here.

Robin Anderson:

Yeah.

Whitney Lowe:

Well, I want to wrap up with one last question. I just want to ask you, what is your, what we call a BHAG, your big, hairy, audacious goal for? I mean, you've done some stupendous things throughout your career, but what do you see? Do you have any big bucket list items that you really want to see happen that are on your horizon?

Robin Anderson:

Well, I think we kind of talked about that already, Whitney. I would like to see us have standardized education. I think there are some elements within our profession that have the potential to create that standardization. I would like to see that happen because, as I said, I still don't know what I want to be when I grow up. I've gone back to school three times and maybe another time but I'm sure that there are lots of people just like me, that way back when, when I started my bachelor's degree in sports journalism doing radio broadcasting, I never thought 15 years later that I would be a massage therapist, and doing all this other stuff.

Robin Anderson:

But it was that basic degree that allowed me to only have to take the specific classes needed to do massage. Then, I was able to use some of that credit to get into my master's program. I'd like to see people have that ability to have stackable credentials or stackable degrees or something of that nature, whether it's through board certification, college certificates, I don't know but I think we have to let go of what we did before. We have to change our way of thinking.

Robin Anderson:

Then, just to touch on online education a little bit, I know that people are struggling with that and as you mentioned, remote learning is not the same thing as online education. That is definitely true. I would say that, in my experience, since I've been working with this for a couple of years, I'm not really seeing much of a difference in the outcomes with the students. I think they're pretty on par.

Robin Anderson:

The assignments that I did in my research class are the same assignments that I do in the online research class. Some of them are actually even better because the students are having more time to read the material, re-watch the videos, the lecture videos if they want to, so they don't get to just hear me say it once. Especially, with a topic like that where it's so difficult, being able to review it several times, helps. I do think that there is some value to it but it has to be done appropriately. You need to evaluate the instructional design. You need to make sure that you're screening people for it appropriately, those who can learn in that environment. Not everybody can. It's not a viable option for everyone.

Robin Anderson:

I would like to see us sort of shift into that sort of realm of having options but options that we can build on in online learning, in standardized education, in credentialing so that way, we are becoming more legitimate in the public eye. That's what I would like to see happen. I'm tired of the jokes at cocktail parties when we used to have them, "Oh, your massage therapist. Go ahead and massage me." It's like, "No, you can't afford me, okay? I don't just give my services out for free."

Robin Anderson:

I would like to see that for everyone. I'd like for entry level therapists to, once they've gotten a few years, they can increase their income, not just by taking more clients but because they're more experienced or because they have more specialty training or because they have that just like anybody else who has years in the profession. Now, you're supposed to be able to increase your income as you put more time in. I think that may be part of the reason why people are leaving too.

Whitney Lowe:

Yeah. Right. Well, Robin, this has been a wonderful inspiration for me, obviously, conversation. I love getting into these discussions with you. I want to thank you again so much for your time.

Can you let our listeners know any other ways, if people have additional questions or things maybe they want to pose to you about either the research with the foundation or your training programs at CCBC, how can people find you and get a hold of you?

Robin Anderson:

Well, first of all the resources that we talked about, from the foundation can be found on the Massage Therapy Foundation's website, which is massagetherapyfoundation.org. Probably the best email to reach me out, I mean, I have a couple emails. I'm going to just give out my generic Gmail account. Just because sometimes the CCBC one works and doesn't work. My email address is robinanderson1218@gmail.com and you can certainly reach out to me by email.

Robin Anderson:

I actually have a portfolio website called massagetherapyprofessor.com and you can take a look at some of my work there. I have my research up there, some of my presentations and things. Then, you can also message me. There's a contact form there that you can message me.

Whitney Lowe:

Cool. What was that again? That was massagetherapyprofessor.com?

Robin Anderson:

Professor.com, yup. Mm-hmm.

Whitney Lowe:

Okay. I'll go take a look at that. I wasn't aware of that stuff up there and saw what kind of goodies are out there.

Robin Anderson:

Well, I did it for my master's thesis and then I just converted it. I haven't updated it in a while. I've been a tad busy.

Whitney Lowe:

Yes.

Robin Anderson:

I need to update it a little bit to do some more stuff there but yeah.

Whitney Lowe:

Yeah. Great. Well, thank you again, so much. It's been a joy talking with you. I really appreciate your time today. We look forward to... We'll dive into some other topics like this, hopefully again, sometime here in the future.

Robin Anderson:

Sure. Absolutely. Thanks for having me, Whitney.

Whitney Lowe:

Good, great. ABMP is proud to sponsor The Thinking Practitioner Podcast and ABMP membership gives massage therapists and bodyworkers exceptional liability insurance, numerous discounts and great resources to help you thrive like they're ABMP podcast, which is available at abmp.com/podcasts or wherever you happen to listen. Even if you're not a member, you can get free access to Massage & Bodywork magazine, where Til and I are both frequent contributors and special offers also for Thinking Practitioner listeners at abmp.com/thinking.

Whitney Lowe:

We give thanks again very much to our sponsors and reminder to stop by our sites for show notes, transcripts and any extras. You can find that over on my site at academyofclinicalmassage.com and over at Til's site at advanced-trainings.com. Please, feel free also to drop for us questions or things you'd like to hear us talk about, email us at info@thethinkingpractitioner.com or you can look for us on social media as well under our names Til Luchau and my name, Whitney Lowe.

Whitney Lowe:

Thanks again so much for listening. If you will, please follow us on Spotify. Rate us on Apple podcasts or wherever you happen to be listening. Tell a friend and we look forward to seeing you again in two weeks. Thanks so much.

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