What’s Your Scope?: Avoid Presenting Yourself As Having Expertise That You Don’t

-In working sports massage with the Boise Burn, I am fascinated how a team can work together to achieve a goal, each team member having just the right job.  In just the opposite way it would be catastrophic if I jumped out and tried to play referee for the game (although some of you fans would disagree based on the performance of the refs during the home game opener against the Tri-Cities Fever!). 


-Use your developed professional judgment to determine whether or not the issue being brought to your attention during treatment is for some other more qualified therapist (and then make sure you at least try to glean what their recommendation becomes, in order to enhance your global understanding!).


-Not all physical assessments need be brought to a patient’s attention; be aware and courteous of sensitivity to their own health deficiencies.

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility





What’s Your Scope?: Tip 2

Massage therapists don’t diagnose, and officially, we don’t do “evaluations.”  But Massage Therapists MUST be able to assess and critically think through the relative condition of each patient/client that they see.  We make observations that facilitate our treatments, and sometimes these observations help illuminate the overall condition.  Communicate with the health care provider who referred the patient.

What’s Your Scope?

Recently I grazed across an article in Massage and Bodywork concerning how to best define what a body worker’s scope of practice is.  As a Massage Therapy provider with a relatively new role in the Health Care Field, it is crucial that I understand and effectively define what my scope of practice is.  After One year and almost Six months of service with SLIERS Nampa North outpatient facility, and as a team Massage Therapist with the local Arena2 football team the Boise Burn www.boiseburn.com , I have learned how to better operate as a Massage Therapist within the realm of Physical Therapists, Athletic Trainers, Chiropractors, and Occupational Therapists, each with their own unique scope.  And through these experiences I am more comfortable operating independently as a Massage Therapist while maintaining the integrity of my own scope of practice, and the scope of my colleagues. 


First I had to operationally define my scope of practice.  Over the next few days I will Post suggestions for other Massage Therapists working alongside an assortment of Health Care Professionals. [Some of these concepts are paraphrased from McIntosh, Nina. “What’s your scope of Practice?” Massage and Bodywork, p.130 May/June 2008.]

First off:

  • Know Local and State Regulations:

-In Idaho there are no state Licensure requirements for Massage therapists.

-A Massage therapist (should) obtain a city business license if in sole proprietary business work.

-Although not regulated by our state municipality, It is a requirement that any Massage Therapist working with SLIERS have a certificate of completion in Massage therapy from an accredited school.

-It is highly recommended to obtain further credentialing through a National agency such as National Certification Board for Therapeutic Massage and Bodywork (NCTMB), Medical Massage National Certification Board, or to have legitimate training in any area of extensive bodywork modalities such as Rolfing, Myofascial Release, Lymphedema, or Cranio-Sacral work, not to mention many other valid modalities.  KNOW YOUR ETHICAL BOUNDARIES, as stated in your credentialing agency’s code of ethics, and demonstrate caution with multidimensional relationships.

-If working in a state that requires licensure (such as Oregon), a Massage Therapist must obtain Licensure from the appropriate municipal board (sometimes this could be county, or city depending on the area of the country).

-Extend your credentialing leverage through liability insurance with an accredited agency (such as AMTA or ABMP) –if working as a sole proprietor this is a must!

Paul Greear

Therapy Tech

MCTMB Massage Therapist

Nampa North Outpatient Facility



Lymphedema: Denial and Rebellion- It’s Only Human Nature

The human mind is an amazing thing.  Its ability to fool even itself to the detriment of the person is truly astounding.  I see it on a daily basis when dealing with Lymphedema patients.  The two I run into are denial and rebellion. 

  • Denial #1: “I’m the exception to the rule!” Unfortunately there is no cure for lymphedema and it is a progressive condition.  Once Lymphedema has developed it does not go away.  It must be managed on a daily basis.  I can’t count how many times I have had patients report, “I tried going a day without using my compression garment and (surprise surprise) my arm/leg swelled.” 
  • Denial #2:  “I haven’t had any problems for years, I’ll never develop Lymphedema!” As well, patients who have been instructed that they are at risk for developing Lymphedema at any point in time after having Lymph Nodes removed and/or undergoing radiation for cancer treatment, even 10 years or more later, come in and report they had been following the Lymphedema Prevention guidelines, but then figured they have not had any problems for years, so they won’t get it.  Now, a month or two after, they are in my office with swelling. 
  • Rebellion:  “I’m fed up with dealing with this!”  I see this often as well.  A person, who has been doing well with maintaining their Lymphedema on a home program, gets fed up with having to do the self manual lymph drainage, exercises, and using the compression garments, so they just stop.  Months later they are ready to get back “on the wagon”, and come in to do the full intensive program all over again to get the Lymphedema back under control.

Don’t let human nature keep you from your success.

Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist

Snapping Hip Syndrome

Your outfit should be snappy, not your hips.  Unfortunately with marathon season underway that is exactly what ends up happening in many recreational runners.  Robie Creek anyone?

            Many runners begin feeling a snapping, popping or sometimes a painful sensation in their hips whenever they run, squat or stand up.  This is because tendons of the hip begin to swell and become irritated.  They swell up and become painful because they are constantly rubbing against part of the leg bone (femur).  The swelling can eventually become permanent if left untreated.

            There are many reasons why this happens, but most of the time it is from too much running and/or poor running form.  Stretching, icing, resting and contacting a physical therapist for more information will help you get rid of that hitch in your giddyup and back on the trails.  Happy running.


Tyler Jepson, PT, DPT

Emergency Department Physical Therapist



National Occupational Therapy Month!

SLIERS would like to reccognize our wonderful Occupational Therapists!  April is National Occupational Therapy Month, and all of the hard working OTs deserve to be recognized!  If you are not a SLIERSian, or have not be an Occupational Therapy patient, you may not know what OT is.  Here is a general definition:

” Occupational therapy is skilled treatment that helps individuals achieve independence in all facets of their lives. Occupational therapy assists people in developing the “skills for the job of living” necessary for independent and satisfying lives. ”

SLIERS OTs help treat over a thousend patients each year.  Their patients range from small children who are learning skills for living for the first time to adults regaining the skills they need to enjoy life. 

Remember to give every OT you see some EXTRA SLIERS Love this April!

For more info on Occupational Therapy, visit http://www.aota.org. 

Lymphedema: Two Tips to Start Out

The first time I see a patient is for the evaluation.  At the end of the evaluation I give my patients a packet of information to take home and read, instruct them in the Anatomy and Physiology of the Lymph System, and give them two things to get a head start on before we initiate our treatments.  These two things are:


  1. Any time you wash, dry, or lotion the swollen arm/leg, always rub up towards the body/heart.  What we generally do is rub up and down.  The lymph system is very close to the surface and the normal pressure we use to do these every day activities of washing, drying and putting on lotion is enough to stimulate that lymph system, so move the direction we want the fluid to go.
  2. Deep Abdominal Breathing:  The last tube of the Lymphatic system goes up through the chest passing through the Diaphragm. As we breathe the Diaphragm moves up and down massaging the lymph fluid up and into the Blood Circulatory System.  Thus, by doing Deep Abdominal Breathing it creates a “wicking” effect, drawing the lymph fluid from the limbs and body.
    • Deep Abdominal Breathing:  Place one hand on your chest, the other hand on your stomach just below the ribs.  Breath in slowly through your nose – your chest should stay still while your stomach expands out.  Then blow the air out through your mouth as if blowing out 50 birthday candles – your stomach should pull in.  Your exhale should be twice as long as your inhale.  Do 10 of these breaths as often as you can recall throughout the day.  (If you start to feel light headed stop and breath normal.  To not get light headed, pause for 2 seconds at the end of each inhale and each exhale.)


With these two activities I often see patients return to start treatment with some decrease in their swelling.


Sonja M. Maul PT, CLT-LANA

National Board Certified Lymphedema Therapist