Q & A: Massage & Chiropractic Working Collaboratively

Here is a brief article that Chiropractic Economics Magazine asked me to write that answers questions about how DC's and MT's can work together most effectively and enhance the referral process.

Give me a short description of what the practice of massage is.

Several massage concepts and approaches exist as is true in chiropractic. A primary massage intention is stimulating the nervous system to help reduce muscle tension, general stress, and pain. 

How can massage complement or work directly with chiropractic? And is it better to get it before or after?

Massage and chiropractic work most effectively when applied in a well integrated manner. Most DC’s focus on detecting and correcting spinal, soft tissue and neural dysfunction. Many Massage Therapists focus on relaxing hypertonic muscles and calming sympathicatonia. 

Massage applied before chiropractic care helps reduce hypertonicity which often allows easier and more effective adjustments. However, I find it more effective to provide adjustments first to a typical patient, because freeing spinal-neural problems allows the nervous system to send proper action potentials to muscles which prevents massage from struggling against the current of unnecessary hypertonicity. Patients receiving massage following their adjustments tend to stabilize better.

What can massage “not” do? In other words, are there times when a chiropractor shouldn’t refer someone to a massage therapist and instead to a different practitioner?

While many MT’s have superb education and expertise, one challenge DC’s have when referring patients is not knowing how well a particular MT can assess and work with contraindications and restorative processes ranging from recent trauma such as whiplash injuries to spinal-neural-soft tissue corrective care. A DC can provide the MT with specific recommendations to help insure safe approaches, but assurance of their ability to provide collaborative care is often uncertain. 

In other cases such as those involving post surgical or injury rehab, most PT’s are reliable referral sources for managing the process.

Of course patients can benefit from proper exercise instruction, nutritional counseling, stress reduction and other self care methods. Some DC’s are trained to help in these areas and many refer patients to specialists. Many MT’s are knowledgeable in these areas but their scope of practice is often limited in providing clients with such self care strategies.

Chiropractic can be preventative. Explain how massage can be.

Chiropractic helps prevent many conditions, limited function, and pain from occurring or escalating. Massage can also help prevent limited mobility by reducing muscle tension and emotional stress by calming the nervous system, certain myofascial adherences, and in many instances help prevent or reduce pain. 

Can you give me some examples of when a chiropractor could/should refer a client to a massage therapist? 

Myself and other DC’s recommend massage to patients because the effects are far reaching, we don’t have time to provide full session massages, plus many MT’s have specialty expertise that patients can benefit from, such as pregnancy massage, certain myofascial release techniques, and neuromotor reprogramming. But I only refer to MT’s who understand the nature of the care I provide and the importance of working collaboratively.

It’s important for a doctor to know the type and quality of care an MT provides. It;Its understandable that doctors are reluctant to refer patients to an MT if they cannot be certain they can trust that the MT is trained to provide quality care that’s integrated with the doctor’s care or recommendations.

What should a DC look for in a massage therapist? What kind of credentials?

It’s challenging for a DC to know what to look for in a MT, which is a huge barrier for many DC’s referring patients for massage. 

Knowing which MT a DC can rely on is not so much an issue of the MT’s credentials or techniques they know, but what a the doctor really needs to know is that an MT understands the nature of chiropractic care, listens to the DC’s recommendations, and provides supportive care that works integratively with the care the doctor provides for the referred patient. Without this assurance, safety, quality, and complementary case assurance can pose a risk for patients.

Most MT’s are conscientious practitioners with reliable skills, but the issue in the referral process is compatibility with patients’ referral needs.

In my experience most every patient can benefit from appropriate chiropractic and massage, some benefiting more from one therapy than the other at times. But it’s important for all practitioners to acknowledge that there should never be a competition when treating patients, or touting whose care is “best.” Instead, the goal is collaboration.

Having graduated from an 18 month internationally recognized massage program and opening a massage center where several of us practiced, then later going to chiropractic college and seeing over 300 patients a week and referring patients for massage, I’m well aware of what chiropractic and massage each offer and how to make them work well together. But there’s a huge divide between the two professions, where mutual understanding of what each one does is missing, coherency in treating patients is lacking, and the doctor and MT aren’t certain how to work integratively.

More DC’s will refer to MT’s when this gap is closed, so they they can be assured an MT understands basic chiropractic principles, the doctor’s treatment objectives, and how to provide massage that’s aligned with them. 

Each profession’s intentions and approaches overlap to some extent, but also maintain unique distinctions. The goal for the professions and practitioners is learning how to treat patients most integratively while respecting the important role that each provides. This creates a win-win situation for practitioners and patients.

Few DC’s have formal massage training and few MT’s understand chiropractic. I spend considerable time with massage teaching and online and know first hand there’s a huge need to bridge the professional gaps. Because this problem is so glaring, I created a comprehensive course certifying MT’s to know exactly how to work integratively with DC’s and referred patients, found at chiropracticintegratedmassage.com. The course provides essential protocols and communications that help an MT and DC’s to work in a well organized, efficient, collaborative manner.

I strongly believe that MT’s wanting to work with referred patients ought to learn these professional protocols and procedures to insure they know how.

When MT’s learn these well integrated methods, they can help make a DC’s referral process easier and more effective by instructing the DC in ways to refer that help eliminate confusions and guesswork, so the referral process is straightforward, seamless and assuredly safe. The course provides valuable insights about spinal-neural-soft tissue relationships that the MT can educate and share with a DC so they can better understand the chiropractic-massage interface from both perspectives.

DC’s would be wise to refer patients to MT’s who have this knowledge and skill set. Without such training there is too much room for misunderstanding and uncertainty in care. When such disconnects exist, everyone suffers. When they are resolved through proper training, integrative care prevails and everyone benefits!

There’s a trend toward building a multidisciplinary approach with health care. Suppose a chiropractor was thinking of bringing on a massage therapist in his/her business. Please explain the best way to do this, even in terms of payment.

There’s no set answer. Preferences vary depending on a clinic’s goals. Some clinics hire MT’s as employees instructed to provide specific types of care. Others are extremely lax and MT’s rent space and practice however they wish. There are some massage centers that have DC’s working for the MT’s or renting space to fill that need.

I work in a multidisciplinary clinic with four DC’s, four MT’s and an L.Ac. The MT’s rent space and while we never tell them how to practice, we consult with them regularly about patients’ needs and share mutual suggestions. The MT’s have also benefitted greatly from opting to study the Integrative Care Mastery course information.

What is important to do in order to be fair for both practitioners?

The best way to make arrangements fair and harmonious for all practitioners is to be very clear about the expectations that a clinic or practitioners have with one another through written policies that all parties agree on. Work related agreements should not be a power grab, but instead strive to create optimum cooperation so all parties are satisfied and patients’ needs are best served.

Providing satisfying, integrative care among DC’s, MT’s and others is the ultimate formula for practicing successfully! 


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