CNHC update for camclub enews November 2013
Success on the Side – Jing
Are you converting enough beta-carotene to Vitamin A?
CNHC update for camclub enews November 2013
CNHC special announcement
1. CNHC celebrates new quality stamp of approval at camexpo 2013
CNHC’s register has been approved as an Accredited Voluntary Register (AVR) by the Professional Standards Authority for Health and Social Care (PSA). PSA is the independent government-appointed body that oversees the work of the nine statutory medical, health and care regulators. It also accredits registers of health and care occupations that are not regulated by law and CNHC has now successfully completed this process.
CNHC’s Chair John Lant made the announcement at camexpo on Saturday 5th October and commented: “Today marks the next step for CNHC as the voluntary regulator for complementary therapists. I’m delighted that CNHC has met the Professional Standards Authority’s rigorous standards, and practitioners on the CNHC’s register can now use the new CNHC Accredited Voluntary Register quality mark. This reinforces the confidence that the public, employers and healthcare commissioners can have in choosing CNHC registered practitioners.”
Marilyn Glenville, who was present at camexpo said: “This is great news for CNHC and for all practitioners who are on the CNHC register. It’s so important that we demonstrate our commitment to high standards. CNHC’s accreditation will give extra peace of mind to anyone looking for a complementary therapist.”
Rachel Fairweather, joint winner of the 2011 and 2012 camexpo Outstanding Achievement Award added: “I’m delighted that CNHC has achieved this accreditation. As a CNHC registered practitioner and member of CNHC’s Profession Specific Board for massage therapy I’m looking forward to continuing to support CNHC’s work in whatever way I can. I encourage all CAM practitioners concerned about regulation and standards to support the excellent work of the CNHC”
What does this mean for CNHC registered practitioners?
All practitioners on CNHC’s register can now say that they are on a voluntary register that has been accredited by the Professional Standards Authority. No additional steps are necessary. All new registrants will also automatically be included on the accredited register.
This also means that all registrants can use CNHC’s revised quality mark which now includes the confirmation of registration with CNHC’s accredited voluntary register. Using CNHC’s quality mark shows your commitment to professionalism and high standards.
This new quality mark is available for CNHC registered practitioners to download by logging into My CNHC along with the revised terms of use which must be read and adhered to.
As the voluntary regulator, CNHC registration is already required or recommended by an increasing number of employers and commissioners of services. We are now working hard alongside the PSA to raise awareness of CNHC’s accreditation amongst the general public and a wide range of organisations.
CNHC’s aim is to enhance the importance of looking for CNHC registration and to maximise the advantages of being on CNHC’s accredited voluntary register (AVR) including:
• greater awareness amongst NHS employers and commissioners
• more chance of referrals from healthcare providers and insurers
• providing additional assurance for standards of patient safety and service quality in the Any Qualified Provider (AQP) scheme in England.
We will provide further updates about the AQP scheme and other benefits of CNHC registration as they become available.
What PSA accreditation is NOT – dispelling the myths!
We realise that this can seem confusing so here we dispell some of the myths:
• PSA accreditation is not regulation. PSA is not a regulator and having PSA accreditation does not make an organisation a regulator. CNHC is already a regulator. Accreditation means that the organisation has been accredited as the holder of an Accredited Voluntary Register or AVR.
• PSA does not accredit individual practitioners. PSA accredits organisations.
• PSA does not endorse any treatment or service. It accredits the register, not the therapy or profession.
• PSA does not hold a register of individuals. It holds a directory of organisations that have been accredited. CNHC is now on this directory.
2. HMRC health and wellbeing tax plan launch
HMRC has launched its health and wellbeing tax plan. This is a three month window for health and wellbeing practitioners to notify HMRC if your tax affairs are not in order – or if you think they are not. Any practitioner who thinks they are behind with any tax issues or who has put off contacting HMRC has this opportunity to do so in order that HMRC can work with you to bring your tax affairs up to date and get the best possible terms.
Practitioners have until 31 December 2013 to notify HMRC and then until 6 April 2014 to pay anything outstanding.
We strongly recommend that any practitioner who has a concern or any doubts about their tax affairs contact HMRC under this scheme as soon as possible.
Anyone who would like to disclose unpaid tax to HMRC can call the Campaign Voluntary Disclosure helpline on 0845 601 5041.
HMRC has also launched a video on YouTube to help people who have undeclared tax understand what their obligations are and what they need to do: www.youtube.com/watch?v=hP6xMaiiYw4
You can see the full details of the scheme here: https://www.gov.uk/voluntary-disclosure-health-wellbeing
Check CNHC’s facebook page for the latest CNHC information and news updates
For further information about the CNHC and how to register or renew call 020 3178 2199, email info@cnhc.org.uk or visit www.cnhc.org.uk
Success on the Side
It means being able to: 1) treat a client who is in significant pain, remedially 2) use a variety of master techniques to get a reduction of pain 3) achieve an increase of ROM (range of motion) and 4) allow time and energy to make the client feel safe, taken care of and experience a nurturing, fluid treatment. Sounds like a tall order. But one of the best things you can do is work with your client from every angle – figuratively and literally. Treating clients prone, supine and on the side allows you to treat hard-to-access muscles and anatomical structures. In addition, it gives you, the therapist, a positive position to work from that decreases risk of injury to your precious fingers, thumbs, wrists and back.
Perhaps even more importantly, it gives you an option to treat those clients, who might not find it so easy to be prone or supine for 30 minutes or even at all. This means being able to treat individuals in different settings like a hospice or hospital. Also, it is the recommended positioning for pregnant women in all trimesters. Below are some different techniques that we have developed at the JING Institute to treat chronic pain in the side-lying position. Each one has been designed to achieve a specific outcome as part of JING’s advanced clinical massage protocol series for treating chronic pain. However, if you are a qualified therapist, you can get started right away and incorporate these into any treatment and see what happens.
THE BASICS – Recovery position
First, let’s get the positioning right. Ask your client to lie on their side as if they are sleeping. This helps to generally get in the position. Bolster under the neck and between the knees or under the top leg, with knee and hip in flexion. Then support her to straighten her spine including the cervical spine. Some clients tend to roll forward – consider a bolster for her to hold onto. Most clients will be so happy and
comfortable in this position – you might have an even harder time getting them to leave your clinic.
Draping – My students know, I am a real stickler for draping and towel techniques: especially, in the side-lying position. This is because to be 100% professional and for your clients to feel comfortable and safe, you must keep your draping tight; in the side lying position we use something called T-draping. One towel/sheet along the length of the body and the other placed on top and horizontally. This allows for maximum access to different areas as well as maximum coverage of areas not being worked on at certain times.
Table height – Your table height needs to be very low as working with someone on their side means the body itself has more height. If you stand next to your table it should be at least as low as your mid-thigh. This way you can use proper body mechanics to sink into your work and apply appropriate pressure without over using your shoulders and arms.
JING’s advanced clinical side-lying techniques. Treating: Neck and shoulder pain as well as migraine suffers Deep fist/forearm effleurage with trapezius stretch:
Success in the art of a balanced clinical massage is a beautiful thing to achieve.
1. Stand behind client. Interlace your caudad arm under their exposed arm.
Wrap your fingers around genohumeral joint.
Place cephalad hand at base of occiput – apply gentle pressure and lean back to achieve a
stretch.
2. Use soft fist or forearm to carry out deep effleurage from inferior to superior. From acromion – clavicular joint to occiput. Circumduction of Gleno-humeral joint
In the same position as above, place cephalad hand on flat of posterior scapula.
Lightly compress scapular thorasic joint and engage GH joint into circumduction – 3 x in one direction then the other. Each time with a slightly larger ROM.
Note: This is a great technique for assessing the client’s passive ROM at the beginning and end of treatment. Especially for anyone experiencing pain on active movement but not passive movement.
STR (Soft Tissue Release) for Trapezius
STR in the UK has been categorized mostly as a sports technique, but in the US and many clinical and remedial massage schools; STR is used to treat all kinds of patients in treatment and rehabilitation.
Using very little or no lubricant – so as to be able to be as specific as possible
Use cephalad thumb to compress upper fibres of trapezius and then lean back for a 2-sec
stretch
Repeat 4–6 times with different points of compression (or locks) in the muscle
Stretches must be quick to achieve best results
For low back pain: Quadratus lumborium trigger point release
1. Trigger points in the Q.L
Trigger points in the Q.L are responsible for the low back pain symptoms of approximately
75% of my clients. Even those who have been diagnosed with disc problems or have had surgery in their history, usually have a need for the Q.L to be worked.
In the side-lying position, it is easy to access the lateral aspect of this muscle with hands supporting each other, work between the 12th rib and the iliac crest. Any trigger point should be found and treated accordingly. At JING, we apply static pressure for 8–10 seconds and repeat 2–3 per session for primary trigger points.
2. Q. L and Abductor stretch
This is a great position to stretch these structures.
Allow the top leg to drop down off the table, making sure the knee clears the table.
Place your forearm just inferior to great trochanter.
Ask the client to take a deep breath and on the exhale use your weight to apply appropriate pressure through forearm until client feels a stretch. Hold for at least 15–30 seconds. The longer, the better with passive stretches. You can easily hold for a minute to get great results.
For everyone – Arm stretches
This is a great position to really stretch the arm in all directions. Clients love it and its great for your body mechanics as it is little or no strain to you.
Take the client’s arm into abduction, so that it is at 90 degrees from the torso. Support proximal to elbow and wrist and lift.
If needed, get on the table behind the client for extra stretch.
Take the client’s arm over their head and lean back, stretching latisimous dorsi and entire lateral side.
Arm can be placed in all variation of planes of movement to stretch different structures and fibres of different muscles.
Pregnancy
Side-lying is the preferred and recommended position for treating pregnant woman at any stage of pregnancy. This is a safer position for the body and allows for maximum access to all structures that might be causing pain, like the Q.L. and Piriformis causing ‘sciatica’. It also good for great work under the occiput and around the temple
where woman might have trigger points that lead to headaches. In addition, many women suffer from Carpal tunnel and oedema in the lower leg. Side-lying is the perfect position to treat these common conditions. Please be aware that most professional insurance will not cover you to work with pregnant women, if you have not undergone specific training. Also, if you want to work with women in the 1st trimester, make sure it is covered by the course you take.
From an Eastern perspective
Gall bladder meridian – I always tell my students it takes at least one lifetime to begin to grasp the enlightening complexity of Eastern Medicine. As Shiatsu was my first training, it has always informed my practice and therefore informs the way we teach at JING. Although, I am not a proponent of the modern teachings of specific points for specific outcomes, i.e. press LI 4 to get rid of headaches. That is too simplified. Having some understanding of the foundation of Eastern practice can inform and enrich your Western table-based work.
Undergoing further training in any Eastern practice can give you additional skills to ground yourself and protect yourself for the long term. It can also give you tools to work with clients living with systemic conditions such as fibromyalgia, chronic fatigue and anxiety-related conditions. Traditional Chinese medicine often works with 12 major meridians. Each meridian is a pathway for chi to flow through the body. If at any one point, the flow of chi is disturbed, by eitherbecoming stagnant or abundant, that is when disease occurs in the body.
The gall bladder meridian runs along the side of the body, through the temples down to the toes. So obviously this is a great position to treat it. The gall bladder energy or chi flow is meant to
facilitate decisions making and judgment, as well as courage and initiative. Known as the ‘Honorable Minister’, the gall bladder works to clear the body. It is the meridian that many tension headaches build in. The gall bladder energy affects quality of sleep. If it is deficient, then an individual may wake up suddenly with anxiety in the early hours of the morning. Or have fits of short sleep unable to sleep through the night. By working this meridian you can encourage balance in the body and create a more harmonious mind–body system.
If you have tried these, and enjoyed them, there are many more structures you can work from a side-lying position.
For instance:
Subscapularus for frozen shoulder
Illiotibial tract for runners and anyone who suffers from knee injury
Gastrocnemius and soleus for lower leg cramps. You can also stretch these structures in this position in a quick manner to achieve a lymph pump for suffers of ankle oedema
Psoas for lower back pain.
The possibilities are endless. If you haven’t played with this position then give it a go. We have incorporated them into our protocols for neck and shoulder pain, all of our stretching work and have developed a very unique three-day pregnancy side-lying course – where one can learn techniques that are applicable for anyone who you want to treat on the side.
If for no other reason, try it because it’s different. Doing interesting and memorable things is good for you and your clients. Variation reduces the incidence of therapist RSI – repetitive stress injury. Working from different angles allows you to be more specific and gives an indicator to clients that you are different than the therapist down the road. This is really important especially in this moment in time when clients are letting go of luxury treatments, yet will happily pay for clinical treatments that reduce their chronic pain. Clients – like us, want to know that we are in expert hands that are educated and confident in treating pain and discomfort in creative ways. Enjoy!
About Meghan Mari and the Jing Institute of Advanced Massage
Meghan Mari is co-founder and director of the Jing Institute of Advanced Massage. Based In Brighton, London and Edinburgh we run a variety of courses in advanced techniques to help you build the career you desire. Our short CPD courses include excellent hands on learning in all the techniques described above including trigger point therapy, myofascial release, stretching and orthopedic assessment. For the therapist who wants to be the best they can possibly be, we offer a BTEC level 6 (degree level) in advanced clinical and sports massage – the highest level of massage training in the UK.
The work we teach is serious but we do it with a lot of laughter. We use innovative teaching methods that ensure that you leave courses with the material in your hands, head and hearts. All work is taught practically so that you can use it right away in your clinic.
Want to find out more? Please contact The JING Institute!
To find out more, visit Jing’s website www.jingmassage.com, as well as its Twitter and Facebook pages.
The Jing Institute of Advanced Massage Training, 28-29 Bond Street, Brighton, BN1 1RD
Tel: 01273 628942 Email: info@jingmassage.com Website: www.jingmassage.com
Please call or check our website for further information and course dates.
www.jingmassage.com
info@jingmassage.com
Tel: 01273 628942
Copyright Jing Advanced Massage April 2013. Text: Rachel Fairweather. Photos Meghan Mari
Are you converting enough beta-carotene to Vitamin A?
Vitamin A
Vitamin A (retinol) is an essential nutrient that we need to get from our diets. It is needed for growth, healthy skin and hair, mucus membranes, digestive juices, our immune system, and also for good eye health and vision. Its name, retinol, comes from the fact that a lot of it can be found in the retina of the eye. For a long time nutritional science has stated that the human body can convert a brightly coloured pigment, called beta carotene found in fruits and vegetables, into retinol and it has been considered a Vitamin A precursor. So why is this conversion suddenly a hot topic in nutrition?
Beta carotene
For quite some time beta carotene has been presented as the recommended way to meet most, if not all, of our vitamin A requirements due to concerns dating from the 1980s about possible toxicity from excess retinol, so called ‘hyper-vitaminosis A’ which happens when storage space in the liver fills up and the vitamin starts to spill out, into the rest of the body, causing problems like swelling. Beta carotene has been thought to have the advantage of only being converted into retinol when it is needed in the body, and so has been presented as the safer option. In particular this recommendation has been fed to women of reproductive age due to concerns about excess retinol harming the foetus, causing malformations such as tiny ear canals, facial disfiguration or a cleft lip and palate. Until only very recently you would never find much, if any, retinol in a multi-vitamin tablet aimed at pregnancy or for fertility. On top of this issue many vegans or vegetarians choose beta carotene as their source of Vitamin A over retinol as it comes from plant-based foods and retinol is thought to only be found in animal products such as liver, eggs, fish and dairy.
The genetics of conversion
However the science of nutrition is moving at a fast pace and it has recently been brought to light that the conversion of beta carotene varies considerably among people. Ten years ago in California researchers discovered that only 45% of people could achieve adequate vitamin A status from beta carotene alone (Lin et al, 2000). This triggered further research on this topic to commence all around the globe, people wanted to know more about what was happening here. Researchers from Newcastle University (Lietz et al, 2009) found out that the reason behind this variability is the genetic variation of the BCMO1 gene, involved in the conversion. At the moment there isn’t a test allowing us to see if we have this variation or not and so there is no way to know if we are in fact getting enough retinol from our beta carotene – concerning! The studies have so far have focused on women.
Asking questions
At inSpiral we of course are asking questions; Why are our genes behaving in this way? Have epi-genetics (environmental and nutritional influences) played a role here? Are there things that we can change in our diets and lifestyle to support this genetic trait? There are studies currently looking at whether BMI (body mass index), obesity, diabetes or poor thyroid function play a role in the effectiveness of this conversion. We think it is really interesting that other studies are now examining the past claims of Vitamin A’s toxicity and investigating to see if it is actually the natural retinol that is problematic or if it is instead the cheap, synthetic forms of manufactured retinol found in vitamins that have caused the problems mentioned above.
True food supplements
At inSpiral we are now on the look-out for a pure, natural, vegan source of retinol and will bring one to our webshop as soon as we can. We believe in true food, pure supplements that are as close to nature as possible. We investigate everything that we sell on our webshop in great detail to bring you the best products that live up to our vision. inSpiral has recently started selling avegan vitamin D3, exclusive in that the D3 comes from an organic plant source, called a Lichen, and not an animal-based source. We are very proud of this. We also offer a vegan EPA supplement, the beneficial type of Omega 3 oil that is almost impossible to find in plant foods. Instead of coming from fish oils this EPA comes from algae. We have a live, fresh, dairy free, lactic acid-rich, probiotic, liquid drink, Symprove, which we believe is the strongest and most efficient probiotic available on the market.
We bring to you a great, raw, vegan Protein Powder made from brown rice which has been holistically bio-fermentated and combined with sprouted endosperm and bran to conquer the challenge of a perfectly balanced, vegan, amino acid profile. It is high in lysine, a nutrient that other vegan protein powders are often lacking in. Our Sunwarrior protein powder really is awesome! Check out our Five Alive green super foods powder, which we believe is the best on the market – and trust us, we did a look of research into them!
We have compiled our own collection of the best super foods on the planet
Finally watch this space for an exciting range of multi vitamins that will be arriving very soon.
References:
Lietz et al (2009) Two common single nucleotide polymorphisms in the gene encoding beta-carotene 15,15’-monoxygenase alter beta-carotene metabolism in female volunteers. The FASEB Journal. DOI: 10.1096/fj.08-121962. Available at http://www.fasebj.org/content/23/4/1041.full Accessed: 1st September 2013
Lin et al (2000) Variability of the conversion of beta-carotene to vitamin A in women measured by using a double-tracer study design. Am J Clin Nutr. 2000 Jun;71(6):1545-54. Available at http://ajcn.nutrition.org/content/71/6/1545.full Accessed 1st September 2013