Sandy Fritz, Owner Health Enrichment Center, Lapeer Michigan.
Author of Mosby’s Fundamentals of Massage Therapy
Mosby’s Essential Sciences for Therapeutic Massage: Anatomy, Physiology, Biomechanics, and Pathology
ONCE UPON A TIME A LONG TIME AGO
I began my career as a massage therapist in the late 1970’s (around 1977-78). I am self taught since there were no schools in my area. I came to massage through an interest in a holistic lifestyle and organic gardening. I was a young mother about 25 years old with an in-home daycare center. I read everything I could –no internet –really dark ages about natural health including various forms of bodywork.
The first book about massage was The Massage Book published in 1972. I even had a massage table built using the plans in the book and used it for years. It was really heavy. I practiced on family and friends for a couple years until my marriage failed and I had to generate income to take care of myself and kids. There were no rules or regulations to speak of.
There were two operational massage organizations: the American Massage Therapy Association(AMTA) and International Myomassethics Federation (IMF). The IMF is the first one I joined. A group broke away from the AMTA about 1970. The reason I became involved in the IMF is that around 1980 I have found my first real massage teacher Irene Gauthier and learned her style of massage in her basement. What I learned on my own from The Massage Book and Irene remains the foundation for my general massage style still today.
The two organizations AMTA and IMF did not get along and there was ongoing conflict. I did eventually join the AMTA as well. My number is 2094 meaning I joined when there were 2094 members. The leaders in both organizations we unhappy with me because of the duel membership–Conflict from the beginning……to be continued.
Remember all, these are my recollections. Others may recall events differently. The 1980s were busy. Deane Juhan Job’s Body still sits on my book shelf. John Travis ‘s Wellness Workbook was one of the textbooks when I opened my massage therapy school in 1985. I met and spent time with Fran Tappen one the highlights of my career.
Discussion began in the late 1980’s about the National certification exam. I was very frustrated at the time with the direction of the AMTA related to the focus of the National Certification Exam (more later). I felt as if the AMTA was splitting therapeutic massage and pushing toward limits in autonomy and scope of practice (also more later). I was speaking to Fran about this and she said to me something that I recall often. “The work will always emerge”.
The 80s was about bodywork and the hundreds of variations. A variety of cultural influences to bodywork emerged and I studied Shiatsu. The American Polarity Therapy Association was founded in the mid 80s and I spent extended time learning this energy based system. I still include it in the Fundamentals textbook as a model. Chair massage from David Palmer burst onto the scene. I continue to respect David and his vision. I attempted to take classes in as many different methods as I could. The 1980’s was the decade of the workshop. I don’t even want to remember how much money I spent and the number of hours on the road and how many initials I had on my business card. After a while I realized that most of what I was learning was actually pretty much the same with lots of different names. This began my focus on integration and outcomes vs modalities.
The 80s is when we also began to think “massage” was NOT what we did and again a search for a better term caused so much confusion and still does. The foundation of what is now the ABMP (Associated Bodywork and Massage Professionals) was laid and in competition the with the AMTA and the conflict among organizations escalated. More about the 1980’s to come. As a note, I am using Pat Benjamin’s book , The Emergence of the Massage Therapy Profession in North America to help me remember the timeline. If you really want to understand our massage evolution you should read it.
THE STORY CONTINUES.
The early 1990s. The decision was made, primarily by the AMTA active members, in the late 1980s to move massage therapy toward the health care model. I understood the motivation. The 80s was filled with the “New Age” ideas of multiple levels of experience. Massage practice and education was mixed in with a multitude of spiritual and energetic approaches. People were emerging as developers of new methods. Many of methods were almost cult-like. It was kind of weird.
Massage therapy leaders were attempting to differentiate massage from a cover for prostitution and an abstract “healer” approach. I think that is why so many gravitated to Dr Chaitow’s blue book. It was rational. My massage school was growing by leaps and bounds and the expanding instructor base at the time unsettled the balance I was attempting to create with massage therapy as a physiological process. This situation just about did me in and I almost left massage therapy. The research was scant related to the mechanisms of massage. I actually took many classes related to the New Age in an attempt to understand. Again I learned a lot with most information leading to mindful approach to massage as opposed to a mystical approach.
So in the midst of all of this the AMTA rolled out a strategic plan for the 1990s. The first piece was the National Certification program. Wow ! and what a churning that created. I was not supportive of this process and was VERY vocal. I was young and my communication skills were not as polished as they are today. I strongly felt that the massage community was not ready for type of exam structure. We were way too fragmented and the result to obtain buy-in from all the factions was an exam that touched on a little of everything.
I wanted a model license for massage therapy developed and a systematic approach to states for adoption. Very few states were licensing massage therapists but the need for some sort of regulation was becoming necessary since massage was regulated on local level through ordinances against prostitution. Through the 80s it was an ongoing battle to be able to practice massage in local areas. I fought this for years, one township or city at time. In the 1970’s I had been involved with local government so I understood how local government works.
I actually created an entire process for changing prostitution based massage ordinances in a written book that was used by many people. In my mind, the certification process being proposed by the AMTA would conflict with state legislation development. But I did not communicate this very well and I was not part of the inside AMTA group promoting the certification exam and the leadership at the time was committed to this path. I also felt that a lot of the development was happening behind closed doors and so myself and a couple of others blew the lid off. No easy task to contact people and share information at the time. No social media.
Robert Calvert who had launched Massage Magazine was also very concerned about the direction being taken by the AMTA. Robert organized a series of meetings called Head, Heart, and Hands and the conflict withing the massage and bodywork community expanded while at the same time groups also came together around the certification issue. More to come.
AND THE STORY CONTINUES
The 90’s were exhausting for me. I have always worked full time as a massage therapist with a client base of a minimum of 20 sessions a week until just the last couple of years when vision issues related to glaucoma have slowed me down a bit. My massage therapy school was much too big for me to manage and there was internal turmoil. My personal life was a mess with failed relationships mostly because of my attention to my career. I have been a single mother most of the time. I wrote the first edition of Mosby’s Fundamentals of Therapeutic Massage and the massage school became accredited with ACCSCT but these are additional stories. I have to manage my time somewhat right now and write is snippets because I am currently working on revisions for the 7th edition of this textbook.
The contention in the massage community was draining. Most of the issue centered around the development of the National Certification Exam. The focus on massage therapy became diluted as inclusion of a variety of bodywork methods and the leaders of these disciplines demanded to be at the the table and rightly so. If you have ever wondered why —AND BODYWORK is included in many descriptions of massage, it is because of the attempt for the National Certification Exam to be inclusive including Asian approaches, energy based approaches, structural integration approaches and all the rest. This is also why there is such a spectrum of continuing education approved within the National Certification structure a situation that has consequences today.
The first exam was in 1992. I took it and passed. Here is the thing. You need to be involved and my involvement with many others in opposition to the exam did not stop it, but it did influence and improve it. When something is done and going to occur, such as the implementation of the certification exam, then get on with it. Unfortunately the turmoil left lasting results on a personal level for many that persisted for years.
The ABMP- Associated Massage and Bodywork Professionals come into prominence as a result of all of the events and a decades long division and competition acceleration between the AMTA and ABMP. Not a bad thing. The competition is good. But this inability to work together creates interference for a unified professional development plan for massage therapy. Out of this chaos came the jewel. The Massage Therapy Foundation.
And the Story Continues…
My dear friend Dr. Leon Chaitow recently passed. He left a huge legacy related to massage therapy that took root in the 1990s. The very first edition of Mosby’s Fundamentals of Therapeutic Massage was published in 1995 and Dr, Chaitow wrote the forward. He wrote the forward for every edition since.
The mid 90’s-1999. The school grew. The Mosby’s Fundamentals of Therapeutic Massage textbook was released and received with mixed opinion primarily because of the push toward change. It was and continues to be an excellent book for teaching massage therapy. It has always been researched informed, critical thinking based and entry level and beyond. I am working now on the 7th edition with the same commitment to excellent, vision and professionalism. As an author, I have never written down to students but created stepped learning imbedded in the books. The books get progressively richer in content from each chapter to the next. I firmly believe in scaffolding material to reinforce understanding. The facts are in the books but understanding is most important. I was also working of my bachelor’s degree in health science from Central Michigan University.
I knew there needed to be a foundation science textbook targeting massage therapy. So I sought and was approved for an independent study project to write Mosby’s Essential Sciences for Therapeutic Massage. The head of the anatomy department was my professor and so the first edition was carefully reviewed. I got and A and 3 whole credits for almost 2 years of work. I really love the science book. It is were the knowledge to understand how massage works is provided. I smile now because I took the daring step to put the nervous system content before the bones, joints and muscles.
Oh my; what an uproar and vindicated I am because we now know that massage benefit is primarily related to the nervous system. The book was released in 1999. I am working on the 6th edition now.
1998 was when the Detroit Lions organization called for the school to provide some massage during their training camp. That educational partnership lasted 12 years. There was a rookie quarterback named Charlie Batch that had a kink in his neck. I was able to help him which began a relationship that lasts still today. He went back to Pittsburg and play 11 years as backup quarter back. I also drove back and forth to Pittsburg for a total of 14 years and provided massage for many of those teams players. That ongoing and consistent relationship was a major factor in my current position and Director of Massage Therapy with the Alliance of American Football where I will be part of building an entire integrated wellness and recovery program that will support research in massage therapy and integrated health systems.
My massage school also developed an onsite hospital-based massage program with the VA hospital in Detroit , and a residential hospice in 1999 that was in effect for 14 years until the State of Michigan would no longer allow entry level students to have any course work off site. We currently have an advanced program with the Detroit Pistons organization.
Dr. Chaitow visited the school once or twice a year during this time and I taught with him in other areas of the country. I have been so fortunate to have been part of Dr. Chaitow’s teaching. This was also the time that another teacher came my way. Dr. David Gurivitch from Russia. He had been the head of the physical medicine and rehabilitation program at a hospital in St. Petersburg for years before immigrating to the United States.
Dr. David Gurevitch from Russia came into my life in the 1990s. Like many things for me, the process was unexpected, unsolicited and I am thankful. He had been the head of the physical medicine and rehabilitation program at a hospital in St. Petersburg for years before immigrating to the United States. I learned so much from him as he taught at my massage therapy school for many years. His English was poor and my Russian was nonexistent but we managed to communicate. It was during this time that I had a “lowback” event. Who knows what happened and tests ruled out anything life threatening. He worked with me while the situation resolved. Over that particular year I felt quite sorry for myself. One day this gentle man who was all of 5 ft tall and about 70 years old, sat me down and took my face in his hands. Then he said to me, “Oh Sandy. It is only pain. This pain will not kill you. Your life may not be good, but you will not die.” Another thing he said to me in response to my never ending questions, with just an edge of frustration was,” I do not know why Sandy, I am not God. I only a doctor. Where is pain, I rub.”. Another time we were comparing medical practice in the US to Russia. He said,” In the US there is so much technology, so many medicines, so many procedures. In Russia, I did not have these things. I therefore had to be a very good doctor. I have to ask, listen, touch and watch to know.” He did so much for me and the school. I was able to give him one thing he always wanted. A new red car to drive. He passed in 1998 but his legacy passed to me continues……….
More of the 90’s
The textbooks. The first edition of Mosby’s Fundamentals of Therapeutic Massage was published in 1995.The concept evolved in 1990. My massage school was growing by leaps and bounds. I was searching for textbooks. There were three available: Beards Massage, Massage Principles and Techniques by Gertrude Beard,Healing Massage Techniques: Holistic, Classic, and Emerging Methods by Frances M. Tappan and a newly revised version of an older text Milady’s Theory and Practice of Therapeutic Massage by Mark Beck 1994. I never met Gertrude Beard but I studied her texts. I did have the opportunity to meet and spend time with Fran Tappan which I will cherish,
I had known Mark for years but did not know he was working on a revised version of the original book nor did he realize that I was working on a textbook which led to some interesting discussion.
I was bugging my sales rep for Mosby (now an imprint of Elsevier) for a textbook for massage. He was promoted to acquisitions editor for Mosby Lifeline and came to me to write a textbook and I said no but would help find and author and review. The reason for saying no was because I had made such a ruckus over the National Certification Exam process and the massage community was so divided that I did not think my name on a textbook would support use. I suggested a collaborative book with a variety of authors as a strategy for bringing the current leaders back together. Also, I am truly dyslexic and had no idea how to work a computer or write a book.
He went about contacting the individuals I suggested and no one would do it. No one wanted to write an entry level book and on top of it if they did participate they wanted a big up front check called an advance and the publishers was not offering that. So I suggested some Ontario CA based educators who did sign to do the book but first drafts were not entry level and these individuals did not complete the contract. The project came back to me. The editors promised to help me with the writing. I reluctantly said yes, and my journey as an author began. I found a book for nursing assistants by Sheila A. Sorrentino and patterned the first edition after that. Dr. Chaitow also influenced how I wrote the textbook and true to his form was not very tolerant of my whining. He basically told me to begin, work on it every day and back up with research of which there was very little at the time . That’s how I became a textbook author.
I struggled with the book title. I was clear that it was entry-level so settled on the word Fundamentals of ——.what? Massage? The massage community was struggling with the status of massage and a clear differentiation was needed. What adjective would clearly indicate the professional practice of massage therapy The intent of the book was to also evolve beyond classical/Swedish massage as well. So over the 3 year time span of actually writing the book many of us struggled with the title. Finally, the clarifying adjective “therapeutic” was chosen and stands as a valid title still today.
Mosby’s Fundamentals of Therapeutic Massage. The textbook spans from the wellness sector of massage to the medical sector and primarily related to the definition of therapeutic as: : having a beneficial effect on the body or mind. serving to preserve health, beneficial, healing, restorative Administered or applied for reasons of health. Having a good effect on the body or mind; contributing to a sense of well-being.
From the very beginning the book was grounded as research informed, mentored again by Dr. Chaitow and he wrote the forward for that book. We know that this astounding educator and gentleman recently passed and as I am currently working on the 7th edition of the book I will continue to honor his influence on the integrity of the writing and the commitment to excellence. ………
Medical Definition of therapeutic
1 : of, relating to, or used in the treatment of disease or disorders by remedial agents or methods : CURATIVE, MEDICINAL
2 : having a beneficial effect on the body or mind
a.serving to cure or heal; curative
b.serving to preserve health, beneficial, healing, restorative
1.1 Administered or applied for reasons of health.
1.2 Having a good effect on the body or mind; contributing to a sense of well-being.
THE STORY CONTINUES. 2000-2010
What a busy decade. And what a roller coaster. There was a steady increase in massage school growth with the high point between 2004 and 2006. Schools teaching massage expanded and the large corporate multi program schools added massage to the offerings. The Franchise model was just beginning so the concept of massage therapists as employees was really misunderstood. Lots of push back, misunderstanding and fear that still exists mostly from the “old guard resisting change” but I knew it would be an important part of the future of massage careers.
Three editions of my textbooks were published – 2000, 2004 and 2009. I also wrote a book of massage for athletes and massage in the clinical setting. These we also the years of the Detroit Lions school program, Pittsburgh Steelers and the NBA Pistons. Upon reflection, I am not sure how I did it all but I did. This was also a difficult personal time for me. In 2006 between the Steelers Superbowl win and the Pistons all star break I ended up having triple bypass open heart surgery. I am loyal and I had promised two Steelers players that I would see them through the season run at the Superbowl. Both were older and knees were an issue. I was tired that season and my chest hurt a little but I was also driving a lot and working 60 hours a week. A comment by one of the Steelers players summed it up ” You could have dropped dead anytime. That would have sucked and put a damper on the Superbowl win.” Two of the well-known Pistons Players sent me flowers in the hospital. Staff came to visit to see the flowers – Ha!. I did the photo shoot for the Clinical Massage in the Health Care Setting Text 6 weeks after surgery.
Everyone responds different to major surgery and I had significant cognitive disruption and memory loss. These issues still affect me but the cognitive issues have improved. I still have episodes of aphasia and difficulty sorting things that are tangled . One of the funny things is that I have difficulty putting sheets on the massage table.–weird. For about six months I could not comprehend what I read and that scared me. I totally forget the process of writing the Clinical Massage Book which was also odd.
Then almost a year later my oldest son was killed by a distracted drive while crossing the street. He had just gotten married two weeks earlier and had a baby on the way. You do what you have to do when you have to do it and we did.
In 2008 the economic bottom dropped out and it was especially bad here in Michigan. I kept the school doors open doing lots of massage and using savings. Enrollment dropped and I significant downsized the school. I dropped ACCSC accreditation after being accredited for close to 15 years.
I was also betrayed during this time by a trusted employee who embezzled a lot of money. We no long had audits mandated by ACCSC so she could get away with it and I was vulnerable because of the cognitive issues related to the heart surgery and grief from my son’s death and focus shift to support my daughter in law and baby granddaughter.
Yet here I am with the school intact, still writing fantastic textbooks, still begging for a real ergonomics and bio-mechanics analysis so massage therapist can provide massage without hurting themselves and blessed with 2 fantastic granddaughters and two wonderful grandsons. And I am developing an entire integrated multidisciplinary massage therapy program for a new and innovative football league that is committed to research. .
From 2010 until 2017 financial survival was the plan. There was a huge drop in school enrollment that is still continuing but not as severe. I don’t understand why since the employment opportunities are the best they have ever been. The massage community continues to struggle with the concept of employment as massage therapists and continue to be confused about the economic differences between an employee-based wage and self-employed gross business income. This has improved in the last year but still an issue. Massage therapists also need to come to grips with working full time or when working part time realizing that you cannot be paid fulltime wages for part time work. Along with the idea of full-time work is that ability to work 25 hours of massage in a 35-hour work week. The massage community desperately needs a real independent ergonomics and biomechanics analysis so that massage therapists can actually work full time.
In 2015 my family made the leap to open a massage franchise in the same location as the school. Wow! Hard, hard work. Lots of risk both financial and personal and tons risk management and a huge learning curve. I did it because I am confident that the future of massage practice will reflect strongly this business model. There remains confusion, misinformation and fear in the massage community about the progress of massage therapy as an employment career. When I first announce that we would be opening a Massage Franchise, I received a lot of really bitter and cruel feedback. My goal has been to make massage practice better and to resourcefully adapt to the inevitable changes. What better way to move into a strong current and future trend then to work from the inside? I understand the backlash was (and still is) fear based but still—–. Anyway, our Massage Green Spa is steadily growing but for an owner—a ruff road to travel. For our employees (who are fantastic) we have made their journey as smooth as possible. We are a team. 2019 will be year 4. As typical we as owners have not taken one penny from the business and our employees have always been paid fairly and on time. Hopefully this year will be the year of reaching business stability.
I am willing to help anyone understand concepts changes but I will not argue with people especially when they are basing the arguments on misinformation. There remains the ability to build a strong sole self-employed massage career but it is HARD WORK and when income is compared based on what people pay personal income tax on, there is little difference if the massage hours are similar and the demographics are similar.
I remain committed to the future of massage therapy but frustrated with the sense of progress being stagnate at the professional organization level. I am concerned about future leadership in the massage therapy community. I would love to be able to focus primarily on my massage therapy school, writing the very best massage therapy textbooks and creating a great massage therapy program with the Alliance of American Football.
Honestly, I have been attempting to step back for about 5 years now and yet hesitate based on a lack of confidence in the Massage Organizational Leadership. Not the great massage therapists involved but the intrenched staff behind the scenes. Also we as the massage community have to begin working together. The infighting and lack of progress for even an agreed upon definition of massage therapy let alone other issues makes me weary.
The Massage Therapy Foundation is doing good things and I will always support these individuals in leadership roles. I support the Alliance for Massage Therapy Education. I support Board Certification and hope that soon people will realize that we have a tiered system in play if we develop it. I am proud of the work I did to partner NCBTMB with Siena Heights University for both an associate degree and bachelor’s degree in Massage Therapy. That was a 22-year long journey.
I am planning on attending the International Massage Therapy Research Conference May 9-10, 2019 in Alexandria, Virginia and the Educational Congress hosted by the Alliance for Massage Therapy Education July 25-27, 2019 in historic Philadelphia, PA.
2019 will be a busy year for completing the 7ed .of Mosby’s Fundamentals of Therapeutic Massage and 6th ed. of Mosby’s Essential Sciences for Therapeutic Massage. And the massage therapy program for the Alliance of American Football will launch.
Hanging in there has been the theme. My son Luke and I are working on Fundamentals of Therapeutic Massage edition 8 and Mosby’s Essential Sciences for Therapeutic Massage edition 7. The Alliance of American Football program integrating massage therapy as an active part of the care of athletes was successful. TaDa! However the start-up league did not make it. Yet the model that was created for integration of massage therapy into the interdisciplinary care of athletes remains
We made it through the pandemic and learned a lot about flexibility in education for massage therapy using technology.
The Massage Green Spa franchise was acquired by Hand and Stone. This seems to be a trend with various franchises being acquired by equity firms. My family will be continuing to operate independently since the semi-rural demographics of our area is much different than Hand and Stone which is quite progressive and does good work as a massage employer. We will be expanding and integrating even more with the school into an integrated multidisciplinary wellness center, which is the trend.
I turned 70 in 2023. Vision issues related to glaucoma have made travel difficult. My MENTORING TIPS on Facebook remain popular and I often ZOOM in to various classrooms around the country.
I worked very hard and continue to support on an important project called the International Consortium on Manual Therapies. A SCIENCE-BASED INTERDISCIPLINARY RESEARCH COMMUNITY FOR PRACTITIONERS AND RESEARCHERS (https://www.icmtconference.org/)
Brian Degenhardt, DO, Paul Standley, PhD, and Francesco Cerritelli, PhD, DO(Europe) founded the ICMT after collaborating at several osteopathic manipulative medicine conferences. They surmised that to truly advance the manual therapy field both scientifically and clinically, the 20th-century silos between professions needed to be removed and communication and collaboration needed to be established. To begin this process, they decided that fundamental yet critical issues needed to be overcome, such as variation in nomenclature systems within and across professions, and to build a platform to improve communication between clinicians and basic scientists. Membership in the International Consortium on Manual Therapies is open to practitioners who provide manual therapy, including athletic trainers, chiropractors, doctors of chiropractic, doctors of oriental medicine, doctors of physical therapy, manual medicine physicians, massage therapists, osteopaths, osteopathic physicians, physiatrists, physical therapists, and structural integration practitioners, as well as researchers in the fields of anatomy, biomechanics, circulation, kinesiology, motor control, neurophysiology, pain, pathophysiology, physiology, and sociology.
I had met Brian and Paul previously and felt that this was a major initiative. I was frustrated however since very little engagement from the massage therapy community occurred. We have a paper coming out soon published by Taylor & Francis Production: Journal of Manual & Manipulative Therapy. Again, a great opportunity for collaboration was missed. Yet great things happened and ongoing work is occurring including collaboration with NCCIH research networks to develop resources to refine and test key concepts that will advance and further support study on the neural mechanisms and biomechanics of force-based manipulations (FBMs). FBMs refer to the passive application of mechanical force to the outside of the body with therapeutic intent, often as part of pain management care, rehabilitation care, or general wellness and disease prevention. Some examples of FBMs include light touch, pressure, mobilization, thrust, adjustment, and/or needling. Our fundamental understanding of the mechanisms by which FBMs exert their effects is underdeveloped, and synergy between this basic understanding and the application of manual therapies is largely unexplored.
Currently there are issues occurring that will impact the massage therapy community. I foresee and hope for collaboration but wait cautiously. The massage therapy community tends to lag a bit too far behind the trends and then finds that the opportunity to influence was missed. There are educational issues related to access to federal financial aid that have many vocational based occupations, not only massage therapy, needing to revamp programs. This in turn will alter practice for entry level. I am actually not overly concerned about these changes since I have operated a massage therapy school for over 37 years without federal Title IV. I think the massage franchise sector will quickly embrace the wellness center integrated model. I also this this sector will provide it’s own schools.
The major community division I see massage therapy career pathways as employee or self-employed. A real division has occurred in the past 5 years. Why do we do that? Both are career pathways deserving equal respect.
Massage therapy still struggles with stigma related to illicit sexual “parlors”. But awareness is shifting very slowly. The franchise model has actually made a big difference is the public’s perception of massage as a therapeutic occupation.
I am concerned about the lack of engagement in local, national and global issues influencing massage therapy practice. Over my very long career advocating for massage therapy has often been like pushing up a river. I don’t think the current and emerging massage therapists have the time, motivation and patience to fight the status quo and old think. My hope is that new and innovative leaders will emerge soon.
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