From time to time members of our various groups have asked, “just how do you go about finding a credible lymphedema therapist? What do you look for and what questions should you be asking?”
Also, I need to mention a growing concern of mine when it comes to a treatment program. There is an increasing trend among therapists to not due MLD or CDT. Instead they treat through compression bandaging. It is my opinion that MLD/CDT is the critical first phase of a treatment program. Once the leg or arm size is decreased, then the bandages help hold down the swelling.
Before you start a treatment program, get the details in writing from your therapist and it should specificy that you will receive both MLD/CDT and compession wrapping or bandaging.
Hopefully this can be of help.
As far as finding an actual therapist, the National Lymphedema Network has excellent requirements on this: As of November 1, 2002, the NLN requires lymphedema training programs to offer a minimum of 135 hours of intensive training (1/3 theoretical, 2/3practical) in order to qualify for a listing in the NLN Resource Guide (referred to as Affiliate Membership).
Lymphedema therapists (independents) must have completed a recognized 135 hour training program, and treatment centers must have on staff at least one lymphedema therapist who has completed such a program.
Please view the NLN Position Paper on Training (pdf format, 128kb) for more information on what you should look for in any lymphedema therapist.
National Lymphedema Network Therapist Position Paper
Finally, the Circle of Hope Lymphedema Foundation also has a page on questions you should ask when looking for a therapist:
1. Where did you get your training? 2. What approach do you use? Vodder, Foeldi, Casley-Smith etc. 3. How many hours of training have you had? (120 to 160 hrs. or more isgood) 4. Are you an OT., PT., MT. ? Where did you get your degree? 5. How long have you been doing CDT/MLD ? 6. What certification do you have? 7. How many times a week will I have treatment and for what length of time? 8. How long will my consultation be? 9. Will there be a therapist on call at all times? 10. Is there a doctor, APRN, or nurse connected with the facility? 11. How oftenwill I be seen by them?
Circle of Hope Therapist Page
Circle of Hope Lymphedema
has strict requirements that therapists must undergo before they can be credentialed through them.
Visit their website at LANA and here is their page on the LANA Exam Outline:
From the Lymphology Association of North America
135 (60 minute) hours of CDT training consisting of 1/3 theoretical instruction in the anatomy and physiology of the lymphatics, and 2/3 significant hands on mentoring.
1 year of documented experience AFTER receiving CDT training
Current, unrestricted licensure as an RN, OT, COTA, PT, PTA, MD, DO, DC or Massage Therapists who have completed 500 massage school hours and/or National Therapeutic Massage and Bodywork Certification.
180 hours college level human anatomy, physiology and/or pathology. (this requirement is automatically met with evidence of current professional licensure of: RN, OT, COTA, PT, PTA, MD, DO and DC disciplines).
Special thanks to Bob Weiss for this information. Gives a definition of what exactly massage therapy is on a state by state basis.
Thought it would be interesting to share.
Massage Therapist Description:
Massage therapists work to alleviate pain, relieve stress, and improve the health and well being of their clients by the mobilization of the soft tissue including skin, muscles, tendons, ligaments, and connective tissue. Massage therapy is defined as the manual manipulation or mobilization to affect normalization of the soft tissue of the human body. Massage therapists may include adjunctive therapies such as hydrotherapy, mild abrasives, heliotherapy, or topical preparations not classified as prescription drugs, mechanical devices and tools that mimic or enhance manual actions, and instructed self care. Massage therapy may be provided in response to a physicians prescription or in conjunction with other therapeutic modalities.
Alabama Board of Massage Therapy Keith Warren 660 Adams Ave., Suite 301 Montgomery, Alabama 36104 Telephone: 334-269-9990 FAX: 334-263-6115
Arkansas State Board of Massage Therapy
103 Airways Hot Springs, Arkansas 71903-0739 Phone: (501) 623-0444
Department of Public Health, Massage Therapy Licensure, 410 Capitol Avenue, MS# 12APP, PO Box 340308, Hartford, CT 06134-0308
Conn Department of Public Health
Professions and Occupations
CHAPTER 53. MASSAGE AND BODYWORK
Subchapter I. Board of Massage and Bodywork Massage and bodywork therapist” shall mean a person who represents himself or herself to the public by any title or description of services incorporating the words “bodywork,” “massage,” “massage therapist,” “massage therapy,” “massage practitioner,” “massagist,” “masseur,” “masseuse,” or who engages in the practice of massage and bodywork for a fee, monetary or otherwise.
“Massage technician” shall mean a person, who is certified with the Board to perform certain functions within the practice of massage therapy, and who is authorized by the Board to use any title or description of services incorporating the words “bodywork,” “massage,” “massage practitioner,” “massagist,” “masseur,” “masseuse,” or certified massage technician” but shall be prohibited from using the words “therapist” or “therapy.”
Practice of massage and bodywork” shall mean a system of structured touch applied to the superficial or deep tissue, muscle, or connective tissue, by applying pressure with manual means. Such application may include, but is not limited to, friction, gliding, rocking, tapping, kneading, or nonspecific stretching, whether or not aided by massage oils or the application of hot and cold treatments. The practice of massage and bodywork is designed to promote general relaxation, enhance circulation, improve joint mobilization and/or relieve stress and muscle tension, and to promote a general sense of well-being.
The practice of massage and bodywork excludes actions by any person, who is certified or licensed in this State by any other law, and who is engaged in the profession or occupation for which he or she is certified or licensed, and actions by any person engaged in an occupation which does not require a certificate or certification, including, but not limited to, physical education teachers, athletic coaches, health or recreation directors, instructors at health clubs or spas, martial arts, water safety and dance instructors, or coaches and practitioners of techniques, who are acting within the scope of activity for which they are trained, or students of massage who are practicing within the scope of their course of study.
“Massage” means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.
(4) “Massage therapist” means a person licensed as required by this act, who administers massage for compensation.
1 “Massage”, “massage therapy”, and “Hawaiian massage” commonly known as lomilomi, means any method of treatment of the superficial soft parts of the body, consisting of rubbing, stroking, tapotement, pressing, shaking, or kneading with the hands, feet, elbow, or arms, and whether or not aided by any mechanical or electrical apparatus, appliances, or supplementary aids such as rubbing alcohol, liniments, antiseptics, oils, powder, creams, lotions, ointments, or other similar preparations commonly used in this practice. Any mechanical or electrical apparatus used as described in this chapter shall be approved by the United States Food and Drug Administration.
IOWA - none
“Massage therapy” means the manipulation of soft tissue for the purpose of maintaining good health and establishing and maintaining good physical condition. The term shall include effleurage (stroking), petrissage (kneading), tapotement (percussion), compression, vibration, friction, (active/passive range of motion), Shiatsu, and acupressure, either by hand, forearm, elbow, foot, or with mechanical appliances for the purpose of body massage. Massage therapy may include the use of lubricants such as salts, powders, liquids, creams, (with the exception of prescriptive or medicinal creams), heat lamps, whirlpool, hot and cold pack, salt glow, or steam cabinet baths. It shall not include electrotherapy, laser therapy, microwave, colonic therapy, injection therapy, or manipulation of the joints. Equivalent terms for massage therapy are massage, therapeutic massage, massage technology, Shiatsu, body work, or any derivation of those terms. As used in this Chapter,the terms “therapy” and “therapeutic” shall not include diagnosis, the treatment of illness or disease, or any service or procedure for which a license to practice medicine, chiropractic, physical therapy, or podiatry is required by law.
Massage therapist means a person licensed by the Department of Professional and Financial Regulation, who provides or offers to provide massage therapy for a fee, monetary or otherwise. Massage therapy means a scientific or skillful manipulation of soft tissue for therapeutic or remedial purposes, specifically for improving muscle tone and circulation and promoting health and physical well-being. The term includes, but is not limited to, manual and mechanical procedures for the purpose of treating soft tissue only, the use of supplementary aids such as rubbing alcohol, liniments, oils, antiseptics, powders, herbal preparations, creams or lotions, procedures such as oil rubs, salt glows and hot or cold packs or other similar procedures or preparations commonly used in this practice. This term specifically excludes manipulation of the spine or articulations and excludes sexual contact as defined in Title 17-A, section 251, subsection 1, paragraph D.
Massage therapy. “Massage therapy” means a scientific or skillful manipulation of soft tissue for therapeutic or remedial purposes, specifically for improving muscle tone and circulation and promoting health and physical well-being. The term includes, but is not limited to, manual and mechanical procedures for the purpose of treating soft tissue only, the use of supplementary aids such as rubbing alcohol, liniments, oils, antiseptics, powders, herbal preparations, creams or lotions, procedures such as oil rubs, salt glows and hot or cold packs or other similar procedures or preparations commonly used in this practice. This term specifically excludes manipulation of the spine or articulations and excludes sexual contact as defined in Title 17-A, section 251, subsection 1, paragraph D. [1991, c. 548, Pt. E (amd).]
“Massage therapy”, a health care profession which involves the treatment of the body's tonus system through the scientific or skillful touching, rubbing, pressing or other movements of the soft tissues of the body with the hands, forearms, elbows, or feet, or with the aid of mechanical apparatus, for relaxation, therapeutic, remedial or health maintenance purposes to enhance the mental and physical well-being of the client, but does not include the prescription of medication, spinal or joint manipulation, the diagnosis of illness or disease, or any service or procedure for which a license to practice medicine, chiropractic, physical therapy, or podiatry is required by law, or to those occupations defined in chapter 329, RSMo
Massage therapy shall mean the physical, mechanical, or electrical manipulation of soft tissue for the therapeutic purposes of enhancing muscle relaxation, reducing stress, improving circulation, or instilling a greater sense of well-being and may include the use of oil, salt glows, heat lamps, and hydrotherapy. Massage therapy shall not include diagnosis or treatment or use of procedures for which a license to practice medicine or surgery, chiropractic, or podiatry is required nor the use of microwave diathermy, shortwave diathermy, ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation of over thirty-five volts, neurological hyperstimulation, or spinal and joint adjustments; and
Description: Massage clients and administer other body conditioning treatments to promote, maintain, or restore health and well-being. Apply alcohol, lubricants, or other rubbing compounds. Massage body using hands or vibrating equipment. Related job titles include: massage therapist, bodywork practitioner, bodyworker, muscle therapist, massotherapist, or somatic therapist practitioner.
Definition of Practice of Massage Therapy - Education Law, section 7801
The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation.
“Massage Therapy” means the assessment and treatment of soft tissues and their dysfunctions for
therapeutic purposes as defined in the Massage Therapy Practice Act, NMSA 1978, Section 61-12C-3.E.
(1) The treatment of soft tissues is the repetitive deformation of soft tissues from more than one anatomical point by manual or mechanical means to accomplish homeostasis and/or pain relief in the tissues being deformed;
(a) “soft tissue” includes skin, adipose, muscle and myofascial tissues;
(b) “manual” means by use of hands or body;
© “mechanical” means any tool or device that mimics or enhances the actions possible by the hands; and
(d) “deformation” specifically prohibits the use of high velocity thrust techniques used in joint manipulations.
(2) The practice of Massage Therapy applies to Shiatsu, Tui Na, and Rolfing.
(3) The practice of Massage Therapy DOES NOT apply to the practice of: Craniosacral, Feldenkrais, Polarity Therapy, Reiki, Foot and Hand Reflexology (without the use of creams, oils, or mechanical tools), and Trager
Massage and bodywork therapy. – Systems of activity applied to the soft tissues of the human body for therapeutic, educational, or relaxation purposes. The application may include: a. Pressure, friction, stroking, rocking, kneading, percussion, or passive or active stretching within the normal anatomical range of movement. b. Complementary methods, including the external application of water, heat, cold, lubricants, and other topical preparations. c. The use of mechanical devices that mimic or enhance actions that may possibly be done by the hands. (4) Massage and bodywork therapist. – A person licensed under this Article. (5) Practice of massage and bodywork therapy. – The application of massage and bodywork therapy to any person for a fee or other consideration. “Practice of massage and bodywork therapy” does not include the diagnosis of illness or disease, medical procedures, chiropractic adjustive procedures, electrical stimulation, ultrasound, prescription of medicines, or the use of modalities for which a license to practice medicine, chiropractic, nursing, physical therapy, occupational therapy, acupuncture, or podiatry is required by law.
The General Assembly recognizes that the practice of massage/bodywork is potentially harmful to the public in that massage/bodywork therapists must have a knowledge of anatomy, kinesiology, and physiology and an understanding of the relationship between the structure and the function of the tissues being treated and the total function of the body. Massage/bodywork is therapeutic, and regulations are necessary to protect the public from unqualified practitioners. It is, therefore, necessary in the interest of public health, safety, and welfare to regulate the practice of massage/bodywork in this State. However, restrictions must be imposed to the extent necessary to protect the public from significant and discernible danger to health and yet not in such a manner which will unreasonably affect the competitive market. Further, consumer protection for both health and economic matters must be afforded the public through legal remedies provided for in this chapter.
Massage/bodywork therapy” means the application of a system of structured touch of the superficial tissues of the human body with the hand, foot, arm, or elbow whether or not the structured touch is aided by hydrotherapy, thermal therapy, a massage device, human hands, or the application to the human body of an herbal preparation.
“Massage therapy” means the manipulation of soft tissue by hand or through a mechanical or electrical apparatus for the purpose of body massage and includes effleurage (stroking), petrissage (kneading), tapotement (percussion), compression, vibration, friction, nerve strokes, and Swedish gymnastics. The terms “massage,” “therapeutic massage,” “massage technology,” myotherapy,” “body massage,” “body rub,” or any derivation of those terms are synonyms for “massage therapy.” Practices in massage therapy include the use of oil, salt glows, heat lamps, hot and cold packs, and tub, shower, or cabinet baths. Massage therapy constitutes a health care service if the massage therapy is for therapeutic purposes. Massage therapy does not constitute the practice of chiropractic. The terms therapy and therapeutic when used in the context of massage therapy practice do not include (1) the diagnosis or treatment of illness or disease; or (2) a service or procedure for which a license to practice medicine, chiropractic, physical therapy, or podiatry is required by law.
“Practice of massage therapy” means: (a)the examination, assessment, and evaluation of the soft tissue structures of the body for the purpose of devising a treatment plan to promote homeostasis; (b) the systematic manual or mechanical manipulation of the soft tissue of the body for the therapeutic purpose of: (i) promoting the health and well-being of a client; (ii) enhancing the circulation of the blood and lymph; (iii) relaxing and lengthening muscles; (iv) relieving pain; (v) restoring metabolic balance; and (vi) achieving homeostasis; © the use of the hands or a mechanical or electrical apparatus in connection with this Subsection (6); (d) the use of rehabilitative procedures involving the soft tissue of the body; (e) range of motion or movements without spinal adjustment as set forth in
(f) oil rubs, heat lamps, salt glows, hot and cold packs, or tub, shower, steam, and cabinet baths; (g) manual traction and stretching exercise; (h) correction of muscular distortion by treatment of the soft tissues of the body; (i) counseling, education, and other advisory services to reduce the incidence and severity of physical disability, movement dysfunction, and pain; (j) similar or related activities and modality techniques; and (k) the practice described in this Subsection (6) on an animal to the extent permitted by:(i) Subsection 58-28-8(12); (ii) the provisions of this chapter; and (iii) division rule.
When you are choosing a provider for rehabiliation or other services, you may have many questions. Below are some suggestions for questions to help you make an informed choice.
Do the services match your needs?
What services do you offer?
Where are you located and are you close to public transportation?
What are your hours?
Will the staff use language that I understand?
Will there be bilingual staff or sign language interpreters if I need them?
How can your services help me?
Am I eligible for services?
Will my services be covered by insurance, government funding (such as Medicare or Medicaid), or other resources?
What will be my out-of-pocket expenses?
Can I talk to other people who have used your services?
How do you feel when you walk in?
How do the staff members respond to the people receiving services? Are people treated with dignity?
Do the staff members appear to respect cultural differences?
Do the premises appear to be well maintained, clean and safe?
Is the building accessible? Are there features like handrails, elevators, automatic doors and ramps for people who need them?
What do staff members tell you about the services?
When you talk with staff members, you may have lots of questions.
What services can I get?
How long does it take to begin services?
How often will I receive services and how long will they last?
How will the services be individualized to meet my needs?
How will reasonable accommodations be provided if I need them?
How will I be involved in planning my services?
What are the opportunities for my family or others to participate?
What benefits can I expect from the services I receive?
What can I do if I am unhappy about the way I am treated or the services I receive?
How will my privacy be protected?
If I need transportation, how can you help?
If I need other assistance, such as help with feeding or toileting, is it available?
What about quality?
What have been the results for people like me who have used your services?
Are people you serve involved in planning for the future of your organization?
Is the organization involved in community advocacy effort?
What advocacy and community groups are involved with your organization?
Are your staff members licensed, certified or credentialed for the work they do?
Are your services accredited by an internationally recognized organization?
Where can you find an assurance of quality?
This information is from The Commission on Accreditation of Rehabilitation Facilities (CARF)
Information You Need When Selecting a Physical Therapist You are the most important member of your own health care team and are entitled to choose the most appropriate health care professional to meet your goals. The American Physical Therapy Association (APTA) has provided the following three guidelines for choosing a physical therapist for your care.
You have the freedom to choose your own physical therapist. Most states allow you to go directly to a physical therapist without a physician's referral first. Click here to see if your state allows you to see a physical therapist directly.
Keep in mind that your insurance policy may require a visit to the primary care physician first or limit your access to only preferred providers.
Your physician may refer you for physical therapy that is to be provided in his or her office or to a facility in which he or she has a financial interest. If either situation is the case, insist that your physical therapy be provided by a licensed physical therapist.
Physical therapists who are members of APTA are bound by the Association's Code of Ethics and are especially committed to providing competent and compassionate care.
Make sure that you receive physical therapy from a licensed physical therapist. Physical therapists are professional health care providers who are licensed by the state in which they practice. If you are receiving physical therapy from a physical therapist assistant, be sure that he or she is supervised by a licensed physical therapist.
Ask the physical therapy clinic if they participate with your insurance company and/or will they submit claims on your behalf to your insurance company. Some policies require co-payments for services and the co-payment will be dependent on if the physical therapist is part of the insurer's provider network. You will also have to meet your deductible.
Find a PT. Click here to find a physical therapist in your area.
Your first visit should include an evaluation by the physical therapist. Your physical therapist will perform an examination to identify current and potential problems. Based on the results of the examination, and considering your specific goals, your physical therapist will design a plan of care to include specific interventions and will propose a timetable to achieve these goals and optimize your function. Your physical therapist will likely provide you with instructions to perform exercises at home to facilitate your recovery.
You should feel comfortable asking your physical therapist any questions regarding your course of care, including specifics regarding interventions and expectations.
* This information is from the website of the American Physical Therapist Association APTA
Visit the website:
From John Hopkins University:
The best way to find a good professional is to ask your friends and doctors for recommendations. Otherwise, you can go the “phone book” route.
Here are questions to help you select a good physical therapist:
Is the therapist a licensed physical therapist?
What credentials does he have? Has he treated this type of problem before? (Physical therapists have different specialties.)
Who owns the physical therapy facility: the physical therapist herself, an outside company, doctors or a hospital? It’s best to have independent treatment, and you need to know if a doctor will profit by referring you to a facility in which she has a financial interest.
Do I need to pay when I visit? Am I billed or does my insurance company pay?
What does the initial consultation involve?
What are office hours?
Where would I park?
Are there individual treatment rooms?
What type of therapy equipment is available? (Your treatment might require a specific piece of equipment.) This can include ultrasound, hydrotherapy and exercise equipment.
Will you report on my progress and your evaluation regularly to my other health care providers?
May I meet with someone on the staff or visit the facility? A physical therapist should be willing to meet with you and answer questions.
Will I get to discuss my treatment goals with a therapist? Will that person be responsible for my treatment?
What will my evaluation include?
From Laura Inverarity, P.T., Your Guide to Physical Therapy.
There are many specialty areas in the field of physical therapy. Although this is well known throughout the profession, it is often overlooked by the general public. Below is a brief description of the five most common specialty areas in physical therapy. Read on to find out what specialty area is most appropriate for you or your family member.
Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system as well as rehabilitate patients post orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post operative joints, acute sports injuries, arthritis, and amputations just to name a few.
Joint mobilizations, strength training, hot/cold packs, and electrical stimulation are modalities often used to expedite recovery in the orthopedic setting. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit from assessment by a physical therapist specialized in orthopedics.
Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to: arthritis, osteoporosis, cancer, alzheimer's disease, hip and joint replacement, balance disorders, incontinence and more.
Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, increase fitness levels and more.
Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common problems of patients with neurological disorders include paralysis, vision impairment, poor balance, inability to ambulate, and loss of functional independence. Therapists work with patients to improve these areas of dysfunction.
Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of patients with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing patient endurance and functional independence.
Manual therapy is utilized in this field to assist in clearing lung secretions experienced in patients with cystic fibrosis. Patients with disorders including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis are only a few examples of those who would benefit from cardiovascular and pulmonary specialized physical therapists.
Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration.
Children with developmental delays, cerebral palsy, spina bifida, and torticollis are a few of the patients treated by pediatric physical therapists.
Choosing a Lymphedema Therapist National Lymphedema Network
Finding a Qualified Lymphedema Therapist Step Up, Speak Out
Inclusion of these pages does not consitute an acceptance of the treatment modality. The pages are for patient information and education. In situations where I feel the treatments are either ineffective, dangerous or just plain bogus I have added my personal commentary.