When Muscles and Joints Come Together
Massage Therapy and Chiropractic Services
As cousins in the extended family of complementary medicine, these two professions play an increasingly important role in Americans' health care. Each has proven that its manual techniques are effective for relieving many problems allopathic medicine treats with drugs, Alternative treatments provide a strategy for preventive care that many health-care industry analysts believe will provide the framework for 21st century medicine.
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As numerous massage therapists and chiropractors have already discovered, when the two professions work together they create a dynamic duo that benefits their clients' health and their individual practices.
According to a survey of massage therapists, 12 percent of massage therapists work with chiropractors. And a survey in Chiropractic Economics reveals that 51.4 per-cent of chiropractors offer massage to their patients. This includes the use of mechanical massage devices, hands-on work they do themselves, and services rendered by a professional massage therapist.
Meanwhile, massage schools are encouraging their graduates to seek employment at chiropractic offices. The benefits of working for an established chiropractic practice are numerous for a massage therapist just starting out:
Benefits of a Clinic Setting:
- Hands-on experience in a professional environment
- Continuing education about physiology and anatomy
- An opportunity to get your name into the community.
Concerns in a Clinic Setting
- Negative Impact of a clinical rather than relaxing environment
- Lost of Autonomy
- Ensuring a fair work exchange
Those who have successfully navigated the chiropractic-massage relationship say it's worth investigating; when done right, theirs is a win-win partnership.
Muscles and Bones
Chiropractor's treat musculoskeletal and general health problems through spinal adjustments. It is based on the fact that spinal dysfunction, or subluxation, affects the nerves and compromises health throughout the body. Manual adjustments, which release small amounts of carbon dioxide from the vertebral joints, reinvigorate the nerves and allow the body to heal itself.
Massage therapy focuses on manual manipulation of the muscles and other soft tissues of the body, in order to reduce pain and enhance relaxation. Other noted benefits include stimulation of blood and lymph circulation, and reduction of stress, heart rate and blood pressure.
Although the focus is different for each modality, practitioners in both camps agree that when massage is incorporated into a chiropractic-treatment program, the results are better. Musculoskeletal problems are a combination of subluxation, as far as the spine is concerned, but also the muscles attached. By loosening muscle attachments to the spine, the therapy is working on both muscle and skeleton for a net effect. The adjustment is more effective and longer lasting.
"Chiropractic and massage have always worked well together," says Daniel Picard, D.C., who has rented office space to massage therapists for more than 10 years. "Chiropractors work with muscle, bones and nerves. But we don't spend the amount of time on the muscle that massage therapists do."
The Right Stuff
Working in a chiropractic environment is different from working in most independent massage-therapy practices, spas or wellness centers. Chiropractic is a clinical modality, and because of its reliance on insurance payment, uses treatment protocols documented in standardized health terms. For example, massage therapy is prescribed in units, or 15-minute increments, by the chiropractor for the purpose of treating a diagnosed medical condition.
Massage therapists who seek employment with chiropractors must be able to conform to such clinical standards. Even contractors or referral relationships with chiropractors require the therapist to have a firm grasp on clinical terminology and protocol, such as taking SOAP notes, for insurance purposes.
But for massage therapists who have successfully forged relationships with chiropractors, the collaboration offers advanced training in a clinical environment that enhances their skill set and benefits their own practices.
Eric Brush honed many of his skills working with a chiropractor. His school, the Shiatsu School and Clinic, held class at the chiropractor's office one day per week. "We got hands-on training (our instructor was there) and also got training in what it was like to work under a doctor's supervision," Brush says. Upon graduation he worked part time at the office. "The chiropractor did a lot with injury rehabilitation and sports injury, so I got to see a tremendous amount of sports injuries in addition to motor-vehicle and Workers' Compensation cases," he says.
Even massage therapists who work as contractors or by referral basis benefit from the clinical affiliation.
They "stand to learn an enormous amount about clinical scenarios and recovering from physical injury [working with chiropractors]," says Rubin. "It will take their work to a more complex level."
Mutual Respect
The relationship between a massage therapist and chiropractor seems to be a natural fit on many levels.
Done the right way, members of both professions say theirs can be a fruitful collaboration. But for the relationship to be successful, there has to be respect and understanding on both parts.
Communication is key: all expectations regarding patient care must be clearly explained by the Chiropractor to the Massage therapist. For a chiropractor, this means making sure he or she clearly communicates to the massage therapist what duties will be performed and any protocol that is expected, and that there is full agreement on a compensation plan, rental agreement (if applicable), hours worked and how appointments will be booked.
For massage therapists, it means understanding what working with a chiropractor means. When you go to massage school you are pretty much taught to be independent, but when you work in a chiropractic office, you have to remember that he is the doctor.
Chiropractor Dennis Jones employs three massage therapists in his multidisciplinary Community Medical Center. They work onsite for 40 hours per week with chiropractic patients as part of a treatment protocol and also as requested for relaxation massage. Both services are booked through the office. Jones pays them $15 to $20 per hour and supplies health insurance and a 401K-retirement plan. He also pays for continuing education required to maintain a state massage-therapy license. "Some massage therapists who have never worked with a group practice before may think, `I could be getting $50 to $60 an hour by myself,' but they don't think of the other things that play a role, like overhead, business licenses, taxes he says. "You don't have the other benefits on top of those, like laundry, supplies, tables and soundtrack."
The Right Fit
Whether this kind of environment is right for you "depends on your personality," Wallace says. Some people aren't cut out for employment in a clinical office.
"If you think you are going to get a private room with a table, lotion and a naked client, think again," says Rubin. "It's not always going to be that way."For others, it's the right fit.
"I find it good for me to plug into someone else's office. I'm that kind of person," says Preston." I'm pretty adaptable. And I don't really have strong business skills."
If working with a chiropractor is on your radar, Rubin had this advice.
Learn how to work on people effectively with their clothes on and get some advanced training in myofascial release, trigger-point therapy and stretching, which are conducive to a clinical setting. Take advanced coursework in anatomy and physiology. "That can only help the massage therapist in every aspect of his or her work," he says. And be flexible. Working in a chiropractic office—or any medical setting—requires different skills and carries different expectations. But if clinical experience, professional affiliation and steady work are what you're after, this may just be your ticket.
Both the massage therapy and chiropractic professions are in a growth phase. As each gains stronger footholds in the American health-care system, there will be increased demand for their services and greater opportunity for collaboration. Working as an employee, contractor or through referral, massage therapists who establish professional relationships with chiropractors stand to gain and so do patients . Packing a double punch, the massaage-chiropractic connection is a healing force to be reckoned with.
Three Basic Relationship Types
Employee: Working as an employee at a chiropractic office requires the same commitment as working in any professional setting: regular hours, dress code, and professional expectations. It also carries with it a regular paycheck, tax benefits, and sometimes perks like health insurance, vacation and a retirement plan.
Independent Contractor: Contract work means that you rent space in a chiropractor's office, see her patients, and are paid a percentage of what she charges for the massage service, which is usually based on how much insurance will cover. Percentages vary widely from practice to practice, from an 80/20 split (where the massage therapist makes 80 percent of the fee and the chiropractor keeps 20 percent), 60/40, and so on. The massage therapist handles her own taxes, gets no employee benefits, and is responsible for her own supplies.
The upside of a contract arrangement is that much of your overhead, including utilities and phone and sometimes things like advertising, insurance billing and reception service, are covered with your rent. You also have access to the chiropractor's patients. Depending upon your agreement, you may also be able to use the space during certain times for your own clients. However, it's important to establish an agreement up front that is fair to both parties.
Referral: This is the most independent kind of working relation-ship, where a chiropractor refers her patients to you, and you see them in your own office. You charge your own rates, or an agreed-upon rate with the chiropractor. Under this agreement, you would typically have to do your own insurance billing and scheduling, and absorb all overhead costs.
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