Contraindications.

[Iphoneiede]

After reading more and more topics on contraindications I though I would get on my soapbox about this disturbingmodern trend.[/align][/align]Contraindications used to apply to thing that would probably cause harm to the patients but there seems to be a serious trend towards nonsense contraindications.[/align][/align]I think one of the problems these days is the people who are running these courses possibly do not understand what they are teaching or the people who are setting the teaching materials are seriously misinformed or undereducated themselves.[/align][/align]According to a lot of posts on these forums most things are slowly becoming contra indicated with nothing at all to back up the contraindications.[/align][/align]If we continuealong this roadthen we will end up with more instructions on how not to treat then how to treat and the therapies will become largely ineffective, I do appreciate this is in the interest of pharmaceutical companies etc. butthisis not in the best interest of the patients.[/align][/align]IMO ifthere is a contraindication then it need to have merit, with the research and proof to back it up, not just we do not understand this or that so lets play safe and list it as a contraindication, or I would not treat somethingso I don't think it is something that anyone else should treat.[/align][/align]Most therapists are responsible professionals, who doseek informationon any thing they are presented with, education is as such on ongoing commitment outside of the classrooms as we are constantly learning as we develop our practices.[/align][/align]I think it is well past the time when therapists and trainee therapist need to seriously question the teaching ofthis sort of thing and do their own research to establish in their own minds what is a serious risk to a patient and what is not. [/align][/align]I will get off my soap box now [/align]

 

[~Tyeashia~]

I understand exactly what you are saying, Paul. But many insurance companies stipulate that a therapist must only treat as they were trained to treat.

If the initial training is conservative, this restricts us, even if, in our own minds, we feel happy to treat, as it would be foolhardy to go against the guidelines of our insurers.

Possibly the answer is CPD, so that we can gain the knowledge to treat various conditions. Although I always check with my insurers before embarking on any training that I will be covered to use any of the knowledge gained during any such courses.

Lesley

 

[Myhoo]

Hi Lesley[/align][/align]I have just looked at my present policy and the only endorsement I have on mine is for one of my energy modalities, it is for the failure of the treatment to achieve it desired effect.[/align][/align]I know they used to stick a lot of restrictions in the policies you got cheap from most associations but when you are paying the full premium for your own policy directly from the insurance company then it might well be a different kettle of fish?[/align][/align]With my insurance company I simply tell them what therapies I want professional indemnity insurance to practice and how much cover and they insure me to do that.[/align]

 

[Peter Porker]

I'm just reading my policy now. Under contraindications, it states


This is Therapy Insurance Services Ltd, formerly the insurance offered by the FHT and I know I have read in their magazine that anyone with a medical condition or on medication should seek the approval of their doctor before undergoing treatments.

I do agree with you in principle, but I think it's the insurance companies which make therapists extra cautious.

Lesley

 

[Staggerlee]

hi paul and lesley,[/align][/align]the whole CI thing is a nightmare when it comes to teaching. as an experienced, professional, competant therapist, there are not many things i consider to be contraindicated. but then, as a tutor, i have to say there is. and maybe as students, they should be more cautious.[/align][/align]however, i do know that one ITEC CI is something along the lines of "anyone taking medication"!! well... hmmm, that kinda excludes the majority of the population! i do beleive ITEC are going to be looking into this and who knows, may even review and get with it in terms of how learners are supposed to learn their trade properly and then as lesley rightly points out, get insurance![/align][/align]its a big leap forward for students and professionals to be able to work with disclaimers rather than seeking GP permission, which was a bit like blowing in the wind! [/align][/align]it is, however, a very difficult subject and i never like addressing it![/align] [/align][/align][/align]ohhhh and edited to say... NO no no... CPD's are not the answer! sure, advanced training in specilised areas is a good thing, as basic training can only cover so much, but basic training, imo, should include the treatment of more common conditions, like high blood pressure, angina etc etc for which meds are often prescribed.[/align][/align]imo, CPD's are just another money making activity... in some cases.[/align]

 

[Skater dudette]

Hi Lesley[/align][/align]That policydoes not appear to be a lot of good to most therapists,how would it servea clinical aromatherapist, qualified to treatdysfunctions with aromatherapy by dispensing them as an alternative medicine! that policy would probably nullify most of their treatments?[/align][/align]I suppose if you where only taught medial contraindication then that would not be so bad, but some people are listing things that should not be listed as a medical contraindication as there is no basis for them, it seems it is the organisations that are creating the problem not the insurance companies who are happy to do anything that limits their liability [/align][/align]I remember one of mine was not to massage women during menstruation! when I enquired about this stating the benefits of massage for some menstrual problems,it was shrugged of with horses for courses and some women consider themselves unclean during their period, now that may be true but that does not make it a medical contraindication.[/align][/align]I was also taught on a reflexology course not to use reflexology during the first trimester as you would probably cause an abortion, again this is not factual and there is no clinical evidence to back up such a claim, if it was that simple to abort a foetus we would not need abortion clinics all over the place.[/align][/align]This is why I think it would be a good idea fortherapists to question what they are taught as medical contraindications and find out what is the reason etc. some of them are sound and need to be followed for veryobvious reasons but others are very dubious to say the least [/align][/align]Hi Rosie[/align][/align]Yes I appreciate it is a difficult thing to teach, but if you taught sound medical contraindications like say thrombosed varicose veins which can obviously cause some acute problems if you work them are easy to explain and easily understood.[/align][/align]I agree that CPD are at best a money making racket and we are all capable of researching anything we chose, most cities have a medical library somewhere where therapists can register for a small annual fee and the information in them is tremendous ;-)[/align]

 

[sticks]

[/align][/align]you're lucky you got an explanation. and i agree with this one. and i am sure i know what method i would choose for termination, if reflexology was an option.[/align][/align]most times no reason is given. for a long time i thought the woman might explode . but actually, the reason more probably is possible litigation.[/align][/align]i also agree that reasons for such and such being CI'd should always be given because yes, as you say, we get an increased understanding. it seems too often now though, the examining body just makes judgement and passes it down.[/align][/align]as an aside, i also hear that ITEC do a sort of blanket CI list, so some of the contras for reflexology are actually making no sense whatsoever because they are topical in massage![/align][/align]but if a student passes ITEC exams and then gets insurance from ITEC, i would suggest that something is seriously wrong somewhere that they are churning out students that they cant then insure?[/align][/align]hmmm better go check my policy wording... (not itec i hasten to add!)[/align]

 

[xuecwuuqinnigmenv]

Hi everyone,

Great thread, Paul, and something I've had my knickers in a knot with for ages now. When I trained in reflexology, massage therapies, etc, 5 years ago, it was never fully explained when I questioned CIs. One of my bugbears at the time was being told that if someone with slightly high or low blood pressure was not on medication, then it was obviously not that serious in the eyes of their GP, and I could therefore treat them. I was also told that if a client presented and was on meds for their BP condition, then I could not treat them. My argument was that if they are on medication then their condition is being stabilised anyway, and I should therefore be able to treat them. I realise that these treatments increase the BP but then they balance out these conditions.

Another example comes from the care home I do some work in, giving aroma foot massages. One of the clients developed a condition in her lower limbs where they swelled up incredibly and the skin was stretched smooth and very tight. The carers thought it may have been cellulitis, and were awaiting the arrival of the GP. I said it was better if I didn't treat this client without the doc's advice, and I still maintain I was right to do this. However, after the doc arrived, I asked her, "Can I give her the treatment, I wasn't sure?" The doc replied, "God yes! Anything that will increase her circulation is exactly what she needs right now. Please carry on."

I was lucky I had the doctor there at the time to ask personally. Thinking about it in a bit more depth, it made perfect sense, but as my insurance binds me, sigh............ And I'm insured through the FHT too.

And I have another question that floats around me, and I've never received a satisfactory answer about: a friend of mine a few years back was diagnosed with pulmonary embolism - she was only 29 at the time, a real shocker. She lives a hundred-odd miles away from me, but likes to pamper herself and rang to ask my advice on whether she could book a massage or reflexology at her local salon. I advised her not to do this because I'd been taught that it was an absolute no-no - after the lungs, with increased circulation, the next stop is the heart, and it's game-over (obviously I didn't put it quite like this [&:]). Then she told me a week before she'd been for a full pedicure where they have her feet a massage, and massaged up towards the heart, one of the very things I'd been taught was definitely CI'd. Now, that pedicure aside, my pal likes to frequent the gym a couple of times a week, and goes mounting biking with her hubby - not just a slow Sunday jaunt on flat road, but around forest areas, up and down hill and rough terrain. So my long-winded set up ends with this question: why is massage, reflexology, etc, CI'd in this situation, when, at the same time, my pal was certainly increasing her circulation way past what I could have achieved while biking/working out in the gym?

I can only sign off agreeing with you completely, Paul. I do understand why these restrictions are there, but if one of our governing bodies could set up a panel of consultants in all of the (supposed) CI'd areas (and maybe some top insurance folk too), and spend a week bashing out whether they really are contra-indicated, that would be amazing. Hey, anyone want to start bombarding our GBs until they do this? It may be worth setting up a survey on here, then forwarding on the results.

.....[goes away to work out how to do a survey.......]

Here's to safe treatments with sensible outcomes.

 

[atredageplegep4]

Red Bess[/align][/align]Most therapies will either lower or stabilise the blood pressure, saying that we cannot overtly change it to a point where someone's blood pressure is going to be fatal to them, blood pressure is up and down all of the time quite naturally depending on what we are doing, even two BPR taken a few minutes apart will probably give different readings on the same person.[/align][/align]In most cases of oedema, improving the lymph flow will assist the fluid to be reabsorbed, this is as you state basic mechanics of body work and it is only in the more critical forms where they are receiving medial treatment for this that you should be expected to ask for permission to treat from a DR or consultant.[/align][/align]Pulmonary embolism is a different kettle of fish asthis one often involves blood clots and can be fatal, so with this one I would be seeking the advice from a GP before treating.[/align][/align]It is a good idea to have a small medial encyclopaedia or even amedical dictionary available during the consultation so you are sure of what someone is receiving treatment for, most therapies will not adversely affect most medical dysfunctions that people are receiving treatment for but withsome it can.[/align][/align]Unfortunately with a blanket ban on anyone receiving medical treatment for anything as your insuranceappears to be imposing at the request of some governing body, does not help the therapist to become aware of the more serious potential problems.[/align][/align]I am sure most DRsmust be sick todeath of requests from so called professional therapists whoare forced to asktheir permission about things that do not require any permission to treat, so please do not bombard them as they did not instigate this problem it is the people who teach and the people who set the tuition who need to address it.[/align]

 

[Julio]

Hi Paul,

Don't get me wrong, I've never bombarded any GP with requests to treat, and although it's probably against my insurance, I've treated people I've felt would benefit, regardless. I was only using my pal's previous condition as an example of how ridiculous it all is. As I say, I agree with you, and the governing bodies should sort this all out before we plough completely into the litigious society I fear we've already become - one where we can't treat a client without a doc's note first

 

[medecineqyy]

As conservative as the FHT is, it does not recommend that therapists write to GP's for their permission to treat, but suggests that the client/patient asks their GP if it si OK for them to receive massage/reflexology, etc. The GP is much more likely to co-operate and advise their patient.

The client then signs to confirm that they have their GP's say so to receive a treatment.

Lesley

 

[Roxie]

Hi Paul,

I have now practised as an aromatherapist for 18 years - when I trained we were advised of some obviously dangerous contraindications such as thrombosis (DVT) plebitis, serious heart conditions, kidney failure - but I feel that therapists are now so wary of treating any patients that are ill - and ironically these are the ones that really need our help, that therapieswill only be there for clients in good health, and there's nothing wrong with preventative treatments.

There is now some interesting research available on Cancer care - bearing in mind that cancer is listed as a contraindication - which shows that cancer patients do benefit from complementary therapies whether its reflexology or aromatherapy or massage or shiatsu and that metastasis does not occur because of massage. If it did we would be advised against rubbing our bodies when we wash ourselves. Hospitals now encourage massage for seriously ill patients - the Royal Free Hospital in Hampstead is an example.

We should educate ourselves and others about the benefits of our treatments and not be afraid to treat those that need us the most. I went through quite a long period of being afraid to treat certain clients. I have now come to conclusion that in some cases I may adapt my treatment, but very rarely not treat. If I am in doubt I get them to check it out with their doctor first.

I would be interested to hear if anyone who massaged someone with Blood Pressure problems
actually increased the BP - as my experience shows that massage (aromatherapy type) lowers it with the help of the right essential oils.

It is very good to network with other therapists to find out what others people do and I find this thread most interesting. I'm not advocating being irresponsible to the contrary think that we should learn more about the conditions that we are treating. Interestingly enough I have heard more scary stories about adverse drug reactions than adverse massage reactions.

Luv Binah

 

[i<3travisclark]

Hi Binah[/align][/align]Yes I think you have summed it up quite nicely, if we can only treat people with nothing wrong with them then we become ineffective, as for blood pressure and massage, in my experience it generally reduces it simply by the fact that most people relax when receiving massage.[/align][/align]Even with essential oils I feel there has to be a balance in the oils, so ifone is indicated for something and it would inadvertently lower the blood pressure then I would be putting another one in to balance that effect, I don't use aromatherapy as much as I used to but most of my blends ended up with about eight different types inthe formulasto achieve what I feel is a balanced result.[/align]

 

[StuGeoeoao]

After reading this post I have to say that it has certainly stirred up a few ideas why there are so many contraindications!

I work in insurance, have always thought that these would have originally come from insurance companies who, fearing the possibility of a flood of claims from therapists who have worsened a client's conditionput clauses into their policies (often called endorsements) which state that 'you cannot do this...' and 'you have to check with ...before doing that' etc.
These are obviously put there to limit the risk to the insurerand therefore make the therapy insurable.

As a result of this it has now become so complex that every little condition that a client may have is now coming into question as to whether people can treat them without jeopardising their cover and leaving them open to be sued!

My advice would be this,

When a client calls to book an appointment you ask at that point whether they have any medical conditions and are taking any medication (which i'm sure everyone does anyway!), if they answer yes, I would ask them to confirm with their doctor that they are happy for the client to be treated (if necessary give a brief explanation of the treatment to the client to give to the doc in case they are not familiar with it), and if the doc is happy for them to have it, then get stuck in! If not, then you don't need to worry as you won't be treating them.

This saves you worrying about whether or not you can treat your client without leaving yourself at risk of a claim should something bad happen.

You also need to remember that if you treat a client and they fall ill, although they may make a claim against you (although still very rare) it has to be PROVEN that your treatment was a DIRECT cause of the condition worsening, and as there is very little scientific evidence on how exactly certain therapies benefit clients that will often not be able to be proven.

As long as you don't break any rules on your insurance policy (e.g mine says I cannot give anaesthetic or injections to a client in one endorsement!) and you have asked the client to take advice from a doctor you are safe as safe can be!

The contraindications have stemmed from the insurance policies covering themselves, and have grown into a monster, with course providers fearing that if a therapist has a claim made against them ,the therapist could turn round and say 'well, i wasn't told in my training that I couldn't do this or that' and the claim is then passed to the college, uni etc.

Now I'm not up to speed with just how litigious (claim crazy) America is, but I would not be at all surprised if this type of claim was going on over there which has been picked up here.
This would mean that people are covering their own backs on the offchance that someone makes this type of claim.

Sadly there isn't a lot you can do about that, as the more fearful we become as a nation/species of someone blaming us for something, the more we will try to remove any possible link between ourselves and the cause of the claim.

[sm=soapbox.gif]


It just worries me that before long therapists are going to have to be as difficult as training schools in order to cover themselves, and we end up having to ask clients to get written confirmation from doctors of no underlying conditions before we feel safe enough to treat them[][][]

I pray this is NEVER the case![sm=newangel.gif]

 

[Tman33]

another problem ive come across (prob not as relevent to what your all talking about). From doing work experience in various salons is that if you are actually this carefull (as in asking clients of any problems on the fone and to get doctors permission before a treatment begins) then you loose out on alot of clients as they dont want to go to this trouble so they will just find someone who will do the treatment with no medical consent!

one salon i have worked in was over catious (in my opinion) and lost out in alot of clients due to this yet more salons ive worked in were not catious (again in my opinion) and always got clients but im sure one day they will have a law suit on their hands!
ive worked in salons in between who were catious but not overly catious and did have a balance and alot more respect from other therapists and the public in general.

i guess wat im getting at here is where do you find that balance of being carefull? knowing wat are serious problems not to treat, not scaring your clients and hoping that they will not find someone careless enough to treat them anyway and start loosing clients to uncareful people?

as im only training these last 2 years i must admit that wen i started last year i was over catious even with people i was doing my case studies on due to the very wide rang of ci's but as time went on i found out wat are more specifically contraindicated to specific treatments and areas but i would love some clarification to avoid all the problems these issues pose!

its an interesting topic and im looking forward to where it leads to!!!
thanx for reading my little rant
jayne

 

[Arman Z]

Hi Steveo[/align][/align]A medical contraindication has really got nothing to do with insurance as the risk is for the treatment applied in conjunction with a medicalcondition which is assessed during each consultation.[/align][/align]Massaging over the site of a recent operation is an absolute contraindicated as you might well spit it open but you can work above and below or around the area to assist the healing process, so it is only therecent operation which is contraindicated not the person.[/align][/align]Varicose veins are a partial contraindication as it is thrombosed varicose veins which are a potential problem and are an absolute contraindication, normal varicose veins are not a problem, so if we are unsure then a doctors advice is sought before treatment commences on the affected area.[/align][/align]Hi Jayne[/align][/align]It is in the hands of the individual therapist to decide what is a safe application of their therapies in any given situation, sensible contraindications will point us in the right direction but where there is uncertaintyand the warning bells start to ring then do seek advice fromthe persons doctor or have them do it.[/align][/align]I suppose the first thing to ask yourself is can this or that therapy harm someone? if so in what way and in what situations is this likely to happen, from that you will be able to put your risk assessment together.[/align][/align]Unfortunately a lot of this comes with experience and that is the one thingwe do not get in the classroom but as I said earlier there is plenty of material available to research each condition we are presented with and increase our understanding.[/align]

 

[cyborg ninja pirate jesus]

I'm going to be quite controversial here and say that there are too many people trained in body massage and other holistic therapies, who want to treat medical problems. Unfortunately you cannot if you are not trained to do it.

If a client has amedical condition then you shouldmake sure they are well enough for you to give a treatment to, and if that means that they have to go to their GP to get advice then so be it.

On the matter of contraindications, I agree that there are too many tutors who are not qualified or experienced enough to be teaching. There are contraindications and there are precautions, two different things. Legally, if text books say a condition is contra-indicated, and you perform a treatment then you can end up in serious trouble.

I disagree with those of you that say that CPDs are just a money making scam. Yes, if you are a massage therapist, and then go and do a CPD on how to talk to your angels, then this shouldnt be allowed as CPD credit, but there are a whole host of CPD workshops that will enable you to 'identify' medical conditions, and therefore make it easier for you to refer clients back to their GP.

Going back to my original point, I know of therapists who will treat medical conditions after doing basic swedish massage courses. This leaves the whole industry open to accusations of quackery and unprofessionalism.

 

[Gorgious]

Hi Sportstherapy[/align][/align]I agree that if you are only taught general body massage then you are not insured or qualified to treat dysfunctions and that is possibly the bones of the problem, general body massage was always taught to be applied in a health spa type environment, not to set up as a massage therapist who treats muscular/skeletal dysfunctions.[/align][/align]Established health spas have their owncriteria forassessing someone before treatment is given and the contraindications are probably a lot more that would apply to a sports injury/remedial massage therapist.[/align][/align]There will always be differences between this and that training for the same therapy, so it is up to the individual to asses what they wish to do with the training before committing themselves to time and money, generally speaking you payconsiderably more for clinical therapy training as opposed to general therapy training.[/align][/align]Another guide is how they teach you to address the person you are going to treat, if you are taught to call them clients then you are probably not insured to treat dysfunction but if you are taught to call them patients, keep clinical records and liaise with doctors then you probably are.[/align]