Lessons Learned (with Susan Salvo)

Summary: Susan Salvo has been a key contributor to the advancement of the massage therapy profession in the U.S. and abroad. She has been a school owner, practitioner, author, researcher, educator, and legal expert witness. In this episode, we talk about many of these different paths she has traversed and some of the important lessons learned.

 

Whitney Lowe:

Welcome to The Thinking Practitioner Podcast.

Til Luchau:

A podcast where we dig into the fascinating issues, conditions, and quandaries in the massage and manual therapy world today.

Whitney Lowe:

I’m Whitney Lowe.

Til Luchau:

And I’m Til Luchau. Welcome to The Thinking Practitioner.

Whitney Lowe:

Welcome to The Thinking Practitioner.

And I’m Whitney Lowe and welcome to The Thinking Practitioner, where Books of Discovery has been a part of massage therapy education for over 20 years. Thousands of schools around the world teach with their textbooks, e-textbooks and digital resources. Books of Discovery, likes to say learning adventures start here. And they see that same spirit here on the Thinking Practitioner Podcast and are proud to support our work knowing we share the mission to bring the massage and bodywork community enlivening content that advances our profession. You can check out their collection of e-textbooks and digital learning resources for pathology, kinesiology, anatomy and physiology at booksofdiscovery.com, where Thinking Practitioner listeners can save 15% by entering the word thinking at checkout. So welcome everyone to The Thinking Practitioner. I’m delighted today to have my friend Susan Salvo with me. So welcome Susan to The Thinking Practitioner.

Susan Salvo:

Thank you so much, Whitney. I am delighted to be here.

Whitney Lowe:

Great.

Susan Salvo:

I’ve been a big fan of yours for many, many years. Decades in fact.

Whitney Lowe:

Right. Yeah, we do go back. We’re all getting a lot older now, going back many decades and everything. Well, for those listeners who are maybe new to your world, can you tell us a little bit about your background and what you’re currently doing?

Susan Salvo:

Certainly. So I started my massage journey in the early ’80s. I went to the New Mexico School of Nashville Therapeutics in Albuquerque, New Mexico. Graduated from there and came back to Louisiana, which is where I’m in currently. And I started practicing and teaching and helped launch the charter for the Louisiana Chapter of ANTA and held a couple of offices and then started a school, the Louisiana Institute of Massage Therapy in Lake Charles, Louisiana. Taught there for 25 years. During that 25 year portion of my career, that’s when I started writing textbooks, probably in the mid ’90s. The first contract was with WB Saunders, and they were bought out by Elsevier about a decade later, and I finished a master’s in ‘2012, finished a doctorate in ‘2017, and currently-

Whitney Lowe:

Let everybody know what your master’s and doctorate degrees were in there as well.

Susan Salvo:

Okay. So my master’s was in instructional technology and educational leadership, and then my doctorate is in educational leadership. I did a dissertation on factors that influence online success and people of color, and that was a published dissertation. The joke is what is a good dissertation? A done dissertation. What’s a done dissertation? A published dissertation. So I was able to get that published. In fact, I got my literature review published. I don’t know if you know anything about that, but-

Whitney Lowe:

Oh, interesting.

Susan Salvo:

Academic publications. And then I started working for the New Mexico School of Massage about three years ago and helped launch their program because the school that… My alma mater closed during COVID, and then now I’m in Lafayette, Louisiana teaching for Unitech training academy, and all the different schools have such different programs. So it’s fun for me to navigate those different worlds. So I’m still writing, obviously, still teaching, still practicing.

I have a small practice at a local spa in Lafayette, Louisiana. And the only other thing I’m doing a lot, well, I work with the Massage Therapy Foundation doing case report evaluations. I work with NCBTMB. AMTA, I just finished a online course for them on burnout.

Whitney Lowe:

Oh, interesting.

Susan Salvo:

All research evidence-based stuff. And then that should come out end of this year, about few more months. And the only other thing I’m doing right now… Oh, and also working for the federation, some course content creation and then MBLEx writing and review items and a lot of legal work. So I’m asked to give opinions about legal cases that involve massage therapy, and right now, there’s five cases I’m working on in five different states. So it’s such an interesting career.

Whitney Lowe:

Yeah. When you started going through the list of things that you’re doing and you said something like, well, the only other thing I’m doing is this. And your plate’s pretty full, I think, of what’s going on there. So I want to touch base on several things that you had mentioned there in your background, because I’m curious, you and I, we’ve known each other for a very, very long time, but I’m not sure if I’ve ever asked you this. What was your inspiration to start writing the textbooks and get going with that stuff? Because I know at the time when you first started doing that, we didn’t have that many textbooks around in our field. Was it just the lack of those things around or what drew you to starting to write and had you written any before that?

Susan Salvo:

Well, I had written a little bit. So part of what I did after that massage school was I want to promote myself. It didn’t have a lot of money. So there was a local paper here called lagniappe, it’s actually French for something extra.

And what I would do is I would write an article for the publication and instead of getting paid, I would have an ad. So I started writing things about… Sports massage was really hot in the ‘1980s. So, I would do something on golf and something on tennis and something on swimming and something on running. I did a lot for Lake Area Runners, which is our sporting group here. And then after that, I was starting to teach and publishers would call and say… Actually publishers were Williams & Wilkins. Again, they were later bought in by Lippincott, and they were the first one that contacted me. And it’s so funny because I was already working on my bachelor’s in education. So I’m already thinking about principals.

And before we had computers, we were doing something with readability and only one textbook was out at that time. And I wasn’t a big fan. And the only reason why I wasn’t a big fan was because it was very difficult to read and it’s odd that I’m a writer because I have a reading disability, so I really struggle with reading. So I write for people who struggle with reading.

When I was called by a publisher, they were saying, well, if you could do a better job, show me. It’s like, okay. So, I did two things. I wrote a prospectus and the second thing I did was I took the current book that was out there and I did a readability graph on it. And the way you do that is you take any passage, 100 word passage, and you count the number of syllables and you count the number of sentences and you graph it. And then from that data you can extrapolate if this is the fifth grade, if this is the 10th grade, if this is the 12th grade. And the current book that we had out there was a 17 grade reading level.

Whitney Lowe:

Wow.

Susan Salvo:

How many people do you know who go through massage school that have a master’s?

Whitney Lowe:

Yeah.

Susan Salvo:

So it was a master’s level. So to me, the barriers, we were already exceeding what the culture was in massage. And then there was another publication that came out called The Bottom Line. If you haven’t seen it, you need to check it out. It’s a little newsletter that comes out twice a month and it’s written… I love the word parsimonious. It’s written very lean, all extraneous words are removed. The reading level is appropriate for the average American, which is currently about ninth grade, 10th grade, 11th grade, give or take a few years. And so when I sit in my proposal and I said, I’m going to make it almost like a soundbite, I also use what’s called the BLUF method, bottom line up front, which is-

Whitney Lowe:

I have to tell you, you told me that several years ago, and I have this piece of paper pasted on my wall that says BLUF, right up there, because I thought that was so good. I really like that.

Susan Salvo:

And a person in the military told me that. And so apparently, it’s one of their ethos there. So when I gave the prospectus, I said, this is the current environment of the textbook industry, went too high. Then it was, we need practicality. That was really, really important to me. And integrity was also really important to me and accessibility. So lean, accessible. And then when I sent it in, there was other people competing for the same job. When the person who was my supervisor basically called me back, she says, “You won, but you won because your proposed TOC, table of contents,” and the word she used was meat and potatoes. It was the most basic, simple to understand, not a lot of… At the time we were using the word airy fairy. It wasn’t a lot of energy work, it was just practical, knowledgeable information. In fact, very first book I wrote, the word kinesiology really wasn’t used like it is today. So my very first chapter was muscular nomenclature, skeletal nomenclature.

And it’s been fun for me to watch the evolution of language over time, even in textbooks. The inspiration was we needed more good information that was accessible to a wide range of people. And again, I just had a break. I was lucky. Right person, right time. In fact, what she said, you need a prospectus. I had to look up what a prospectus was. I had no clue. But writing got better. And you probably know this, being a writer yourself, it wasn’t until my third edition that sales really, the tipping point. And so that was when I realized, oh my God, this is serious. Actually go get a degree. So everything, I did backwards. So I got the variety, then I got the education.

The whole process has been phenomenal because I get to rub shoulders with people like you, with people like Benny Yvonne, with people like Celia Bucci and Michelle Renee. And because I wanted the book not just to be my voice, I always have contributors come in and I know we’re going to be talking, hopefully it’s about mentors at some point. I’ve had mentors in every single aspect of my career except book writing.

So what I had to rely on, and I was intentionally not looking at other books heavily because I didn’t want to be influenced. I wanted to have something-

Whitney Lowe:

Right.

Susan Salvo:

Because I was already in college, I drew heavy on the way history books and the way psychology books were formatted. This is another reason why you see in my books, you see a lot of quotes from historical figures because of the history influence in my background. And you see a lot of biographical information because in psychology books, they talked a lot about, this is the people who really helped shape the profession. And I liked that. I wanted that feel to the textbook. So it felt inclusive and it felt respective to other cultures and historical- and history.

Whitney Lowe:

And I think you did a great job with that too in terms of getting the… You’re introducing the voices of many of the professions’ luminaries to the new students, which is a great service and it’s a wonderful process of things that you’re doing there. So I think it’s been a great way that you’ve done that. I want to go back for a moment to something that you were saying earlier because this idea struck me, and I never ever really thought about it this way before, but when you’re talking about the readability issue, as practitioners in our field of manual therapy and massage and things like that, many of us don’t have traditional academic degree training programs, and yet, we’re doing a lot of things and we’re encouraging people to read medical textbooks and read medical journals and things like that, which are notoriously poor in their readability levels. So I’m curious if you’ve had any ideas or thoughts on how to improve access to those kinds of things for people who have readability difficulties with some of the really heavy intense science writing that’s in a lot of those medical textbooks or journals.

Susan Salvo:

Well, it is a struggle, and I will tell you a couple of stories about this. I can remember being in my master’s level education and our professor was reading us a paper and I was watching the classroom and one person said, “Why is this so hard to understand? Why is it written for us?” And then the teacher said, “Well, it’s written for academics.” It really made me realize that academic papers is not written for the general public, it’s written for academics. This is a secret, then when I went through my own dissertation program, knowing that my background is vocational school, so you have to remember that, I’m an academic, but I live in vocational school, so we had to have these seminars about how to write a dissertation. And they ask you… No, they don’t ask you. They… part of what you’re expected to do is right at a 16 grade level.

And I already knew about grade level and how to not do it and how to do it, but I hated writing like that and I hate reading a paper like that. So I actually didn’t do it on purpose. And so I wrote mine at 11th grade reading level and my profession’s going, “Oh, this is the best paper I’ve ever read.” Going, “Well, yeah, because you could read it.” So that was the one thing that I do.

And another thing that I do is we could talk about health literacy in a second because I think that we need to touch on that. When I’m writing my textbooks, I intentionally use words that are accessible. That’s the term I like to use a lot. We’re doing that a lot at the MBLEx which I’m very, very excited about, and health literacy is basically a concept that if you’re writing information for the general public, a pamphlet, a brochure, even an intake form, you must write to the reading level of the average patient. And actually, it has dropped one letter grade since COVID. So now, we’re at sixth or seventh grade level for the average reader in the United States. And when I talk about documentation like I did, when you or I were at the Oregon meeting, we touched on this concept and if you Google health literacy, there is a way for you to look at, instead of using the word this ascertained, use the word know. And so you can go through all your papers and find words that are not appropriate for your audience and find better words.

And we just did that with the MBLEx. So we’re going back over, and I love this so much, because it’s about accessibility. That way, you’re really… Is the person taking the test, are you grading them on their understanding of difficult terminology? And sometimes, and you and I have been in those meetings where it’s SMEs, subject matter experts writing these items, but we always have to remember who the candidate is. And I think sometimes, that’s been overlooked. So we’re going back and we’re looking over every single MBLEx question, different committees, and we’re looking at every single word. And also, we’re shortening the sentences. So instead of having a paragraph now, we’re trying to make it three lines to again BLUF, to get the very essential things in an item. And then we’re looking at each individual word, and I think it’s going to improve pass rates.

Whitney Lowe:

Yeah. That’s really good to hear because I think that’s one of the big challenges that happens for a lot of people in the test process. And then of course, difficulty understanding that stuff leads to test anxiety, and then you start having uncertainty about what you’re doing and then you become anxious about the readability of those things that impacts your ability to think well and do well on those exams. So that’s great that you’re working on those things. I think that’s very needed.

So I want to also go back to a second. There were so many things in your initial bio discussion that we had, and I’ve tried to make some notes here, some things I wanted to go back to. But you had mentioned also that you’re doing a lot of work with legal cases as expert witness. And a lot of people I think, don’t even know that this whole thing exists, of the whole process of legal cases that happen in the massage world and what happens, how do you find expert witnesses? Tell me a little bit about how that came about of doing expert witnessing, and what things do you end up doing with these legal cases?

Susan Salvo:

Okay. So let me tell you about my very first one. So it was a case actually in Lafayette, where a massage therapist was injured in a car accident. And the person who was working on the case, it was working with the automobile insurance company. And they were saying, well, you can’t do massage anymore. So I had to discuss the physicality of massage. So from a exertion standpoint, standing, sitting, leaning over, so many clients a day, stamina, all these things. And so I’d never written an expert report before. I had no template to look at. So at the time, my daughter was working for an attorney and I said, “Give me an example of what one looks like.” And so she gave me three and one medical, one physicist, because for certain car accidents, you need that physics part. And one was an accountant because sometimes, accountant has to calculate lost earnings and surgeries and medical and over lifespans. It’s so interesting how they put all this data together.

And I read them and the first thing that hit me was you have to establish your expertise in the very beginning. And I will tell you, years of experience is not enough because anyone who’s been doing massage for 20, 30 years could call themselves an expert. What makes an expert an expert is the deepening of knowledge. Systematically deepening knowledge. But one of the things stood out at me, and this was right about the time the NCBTMB was struggling, and that’s not the right word, but deciding on what to do next, not do national certifications. What was the next thing we should do? And it was board certification. In every single one of those reports, that was part of their ascertain of… That was their desire to promote their level of expertise was I’m board certified. And it was like I went, oh my gosh, this is the language attorneys and judges understand. So I couldn’t get board certified fast enough, and it was the year that it came out, ‘2013, I believe.

So that was really important to me. So that was my very first one, but it taught me a lot. And that case I was also deposed. That taught me a lot about depositions. Then once you get a case, you must be put on, don’t laugh, the word list serve, right? I think you put on a list server or something because then I started being asked more often. But what happens in massage is if someone alleges, listen to the words carefully, that they’ve been injured, they could file a lawsuit for you. It doesn’t mean you’ve done anything wrong, it just means now someone has got to look at the case and determine if the term that they use is substandard care. You did not provide the standard of care, different scope of practice. So usually, both sides have their own experts. So it’s fun because it’s not a big pool of us that do this. So oftentimes, I know the other side and sometimes, you’re working for the plaintiff and the plaintiff… I had to look this Latin word up, it needs to complain.

So with the person who files a lawsuit, oftentimes it’s the client in the case of massage lawsuits, and then the defense is the person who allegedly caused the harm to the plaintiff. And I’ve worked for both sides about 50/50. And so then typically, you get the documents that you have to review, and then you read the depositions of both sides. And sometimes, they’re giving depositions of not only the client, the therapist, but the bosses, the managers, the COE of the company depend on what they’re trying to look for.

And then you have to look at the facts and then determine if the therapist did practice with this standard of care. And for a case to win, three things have to happen. Number one, we have to establish what the standard of care is. So typically, what I go to is I go… It’s tacky to quote your own book. So I go to your book, I go to Sandy’s book, I go to Reese’s book, I go to other textbooks that are out there in the industry, and I cite those sources. And then I also cite content outlines. Big, big important thing for the industry. I look at NCBTMB has a content outline. COMPTA has a content outline, and then the federation has a content outline. So I use those to establish there is the standard. And people say all the time, oh, there’s no consistency. I’m going, oh yes, there is.

There’s more consistencies across curriculum and content than there is inconsistencies. So that has to be established, number one. The second thing I have to establish is that the therapist reached the standard of care and sometimes, they didn’t. But that has to be established through that first process and then I have to say, the breach and standard led to the injury. So if you don’t connect those three dots, you don’t have a case. And there’s all kinds of things. And yes, I have not taken cases because I’ve read the depositions and I’m saying, “You don’t have a case here.” Because I typically only take cases… Now when I say win, please understand, no one wins. It’s costly, it’s stressful, and even though it’s not the therapist’s fault, someone was injured.

And so those are the things that you have to grapple with. My funnest cases are the ones that I have to… And I always go into it not knowing what I’m going to find. Because I think it shows more integrity. I don’t go, I have an opinion or I’m going to find things that supports that opinion. That’s not the way to do it. It’s the opposite. I don’t know what’s going on. So I’m going to read it and see what emerges. What pictures emerge. The latest, most interesting case, they’re all interesting, was it was on a cruise ship and it was a therapist who did not speak English, it was a second language and a woman was in a wheelchair, and the client claimed that the therapist, this is going to sound very odd, but this was in the demand letter, the complaint. It was that the therapist drug the client off the table and dropped her on the floor.

Whitney Lowe:

Wow. Okay.

Susan Salvo:

The table was unreasonably high. That was part of it. And the lotion was unreasonably slippery. So those are the three little things that I had to play with. And I intentionally read the therapist’s deposition last because I wanted her voice to be the last thing that I read, given all the other pieces of the puzzle. And now reading this, and she saying things like her legs. They go crazy. She fell out. She fell out on me, and I’m going, “I know exactly what happened. She fainted.” She experienced what you and I know was orthostatic hypertension.

So I went back and I shared that there’s a ton of evidence for it. And the therapist even said in her deposition, they’re very methodical on the cruise ships. They have this certain routine that they do and they don’t deviate from it. And even she said, and it was a couple’s massage that the other therapist said the same thing, that after the massage they’re required to, the massage is over, get up slowly… All the little ritual. As she was saying this to the client, the client was getting off the table on her own, but she still stayed in the room watching this unfold. And then she runs over to try to grab her and then she fells on the floor. Well then the client…

Oh, one more thing. I was able to find a study, going back to reports and research. I was able to find a study that said the people who have the greatest degrees of orthostatic hypotension, which is a drop in blood pressure, so the greatest drops in blood pressure have something called symptom impairment. They don’t realize it’s happening. So I cited that source and talked about that the therapist really acted within the standard of care, which is to help the client. She saw the client in trouble. Of course, humanity’s going to rule and she’s going to try to help the client. She’s not going to let her fall on her own. And I was able to protect the therapist in that case.

Whitney Lowe:

Yeah. Are there any situations where, let’s say you’re hired by one side versus the other, either the plaintiff or the defendant’s side, and you read the materials and let them know, this doesn’t look good for your side. Would they keep you on as an expert witness in that instance if you’re telling them like, this doesn’t look good for you?

Susan Salvo:

No. No, they don’t. There was one case where the therapist had done… Now what I thought originally was a straight leg stretch, and that’s actually orthopedic assessment and it irritated a herniated disc. So that was what I was looking at and I said, “Yeah, you probably have a case.” But when I read the therapist’s deposition, she bent the knee. That was not disclosed to me when I agreed to take the case and I said, you don’t have a case anymore. She did the right thing, by bending the knee, you’re protecting the back. And that report did not get used.

Whitney Lowe:

Yeah. Right.

Susan Salvo:

But again, but I do, going back to my mantra is integrity. I won’t lie. I won’t give false evidence. If I think therapist did something wrong, I will say. Like the whole concept of anterior neck massage, that has been case after case after case that the court has ruled in the favor of that, this is substandard care because this is a well-known, well-established endangerment site. Another interesting story. So I’ve worked on now four cases of anterior neck massage. One was carotid artery dissection, and three were brachial plexus injury. In fact, I quote one of your articles, by the way, just thought you’d know that, about brachial plexus injury. And in the weekly depositions, oftentimes a therapists talks about trigger points in the Scalenes and trigger points in the SCM, sternocleidomastoid, and that’s what they were doing in the anterior neck, and they always quote Travell and Simons’ book.

So I said, “This is fascinating.” I said, “Because when I was in the massage school in the early ’80s, we didn’t talk about doing the anterior neck massage. We just knew that it was an endangerment site.” But then it started happening. And then Travell’s book came out in ‘1983 and so on and so forth. So there was a little bit of a shift there. So I thought, I wonder what the book says about it. And she doesn’t recommend manual therapy at all on these trigger points. She just recommends injection therapy and spray and stretch. Again, for some reason, in this profession, we are teaching students to apply pressure on this area. It’s causing harm. And it’s because they have quoted the reference wrong. And it’s like, guys, wake up. Read the sources you’re citing and see what they say.

Again, so that’s been something that has really been mind-blowing to me is… And one of the experts in the cases said, “I teach this stuff.” And they even took the therapist in this case and the other expert said, “Do on me what you did to the client that allegedly caused the incident.” And then he says she’s doing it right. And I’m going, dude, number one, you’re biased because you teach it. Number two. I said, but you have to know the anatomy. That’s what the thing… I know you’ve heard this argument before, and I was able to say and win this case that no amount of anatomy knowledge changes the fact that these structures can be damaged by manual pressure.

And so it’s just been such an eye-opening experience for me to look at things from so many different angles. And I’ve been in the rooms where the cardiologist and the neurologist are listening to these cases and they’re going, “What are you massage therapists doing working on these areas?” So even they say, don’t do it, but we don’t really talk about that enough in massage schools. But cases have taught me so much, and that was just a fascinating thing about, again, substandard care. And did the substandard care lead to the injury in those four cases I was able to prove, yes.

Whitney Lowe:

Yeah. We seem to have had such a long string of lineage education and massage where one person learned this and they opened a school and they taught people, and those people taught people. And it doesn’t seem like there’s a really good strong body of evidence for this kind of stuff in terms of learning some of these really more crucial fine points because there is a pendulum swing too where you can go overboard and say like, “Well, don’t touch anybody’s anterior neck region at all.” And there’s a big difference between touching with a very light finger touch and doing some myofascial type things as opposed to putting significant pressure on there. What do you think is the best way, especially since you’re a textbook author, what do you think is the best way to teach about some of these more significant potential endangerment sites that people may not know about, but also not freak everybody out at the same time and make them not do anything?

Susan Salvo:

I’ve often wanted to do a class called alternatives to anterior neck massage. But anyway, so what I would recommend is, and I love to have these conversations because we had these allotted conferences, and so we all get a chance to banter back and forth. So the question comes up, what is safe pressure? And two things about that. The first thing is that question will never be answered because an IRB would never approve a study because it’s a harm study. But I also say the second thing is that there has never been an adverse event related to manual lymphatic drainage. And because they typically use five grams of pressure, so I can’t tell you how much pressure, what’s the threshold, but I can say five grams of pressure does not cause adverse events. So I think I can comfortably back that up with research, but I think that anything more than that, mm-mm. And we’re really talking about skin stretching. Tracy Walton does a really good job in her pressure scales. Have you looked at her stuff?

Whitney Lowe:

Oh, yeah.

Susan Salvo:

Okay. Because she actually talks about things like are you using the weight of your body, the weight of your hand? Are you displacing tissue? So I think she really gets more of an objective way to think about pressure. So I’m comfortable saying skin stretching, but nothing else.

Whitney Lowe:

Yeah. And one of the points that I try to make with people is that there’s alternative ways to get to some of those deeper tissues that you want to treat if you understand some more about kinesiology and mechanics without having to push harder into them. And a lot of this has to do with understanding what those muscles do and what their actions are and how to do various other types of techniques with them. So hopefully, that’s something that will just grow a body of knowledge maybe over time. Which made me think about this as we were talking about, maybe you need to start creating a database of information that comes out of these legal cases that will help us pool together a good understanding of what are some of these more significant types of injuries that occur.

Because there’s an issue that I think comes about a lot, which is that some of these cases, some of these instances when they’re bad, do end up coming into a legal case because somebody sued somebody or there’s something that really happened. But there’s a lot of people who will say, “Well, this treatment technique is not bad because I’ve never heard anybody. Nobody’s ever said anything to me.” And I’ve always asked the question, if somebody gets hurt, where’d they go? Who do they tell? Because I’ve had a lot of clients come to me over the years and tell me they were hurt by other practitioners. And I asked them, did you do anything about it? And they said, “Well, no, what do you do? Who do you call?” And so I don’t think there’s really a good system in place for reporting some of these kinds of adverse events. And so maybe the worst ones or most significant ones end up coming into the legal case arena like the things that you’re doing. But I think there’s a lot of stuff hovering around underneath the surface of injuries that happened that don’t ever get reported.

Susan Salvo:

Yeah. And you really are hitting a sweet spot here, because two things I want to mention. Always two things. But the first is in the legal cases, if you don’t tell the client the possible risks, that actually invalidates consent. So it is fun to watch the depositions of anterior neck massage debate because a good attorney will say things like, “Did you tell the client that you were in an endangerment site?” Because most therapists have heard of the term, yes or no. It’s usually no. So did you tell them the possible injuries? Because in my textbook, and I think Sandy’s is too, we list the case reports and then the question always comes up, risk versus benefits? Is there another technique that you could have done, like what you just said, that could have been equally effective, but not put the client at risk for harm? That’s when the therapist gets busted, right there.

Whitney Lowe:

Yeah.

Susan Salvo:

Because the answer’s almost always, yes. But going back to what you said about the database is, when I am writing a case report, I have to use evidence and I will always use, I’m sorry, a expert witness report. I have to use case studies. Case reports in my report. So what happens when you get a case report about a harm study, anterior neck massage, quad artery dissection, brachial plexus injury, it’s a physician who had a patient who writes the report, who submits it to a medical journal. That’s all we got. Typically, in my very first case, which was a quad artery dissection, I do remember realizing that this case was going to be forgotten unless the physician agreed to write a report and submit it to a scientific journal. So I called. He said he didn’t have time.

So you’re right in that these cases, like you just said, we do have data in the case report system that talks about it. If they’re there, I’ll site them in my textbook. But a lot of it goes under reported. Completely agree. But we do teach, I’m going to argue this. We do teach safe practice procedures in school. What happens is, I want to call this a rogue instructor. Let me tell you another story. So I’m in Minnesota, I’m talking about some of these studies, anterior massage, some the case work I’m doing, and this little girl raises her hand in the front, she says this, Ms. Susan, Ms. Susan, I know this is great what you’re saying, but I’m in massage school and that’s in our curriculum.” And I went, “Really?” I said, “You’re wrong, but I’ll tell you why you’re wrong.”

And then I go into the spiel about there’s three pillars of education. The first pillar is curriculum, the second pillar is instruction, and the third pillar is evaluation. I said, all right, curriculum, and curriculum comes from textbooks and it comes from content outlines like the MBLEx and such. Anterior neck massage is nowhere in that curriculum. What’s happening is instructors may be exposing students to things that are not in the curriculum.

Whitney Lowe:

Yeah. Well, and I know one of the ways which this has happened, because I’ve seen it happen and been part of seeing those transitions happen over the years, is certain practitioners, especially on the continued education circuit, who may be endeavoring to give new, fancy, really mind-blowing techniques of doing this really challenging type of work, and they’ll teach something like that. I remember being taught in a continuing education course, some anterior neck work in the late ’80s that I thought was dangerous. Taking and displacing the trachea to put deep pressure on the longest colon, is just like, wow.

And then instructors go to some of these courses and they think, this is really cool. We’re going to teach this in our curriculum. And they bring it back and start teaching it in the school as an entry level program. And especially challenging when they’re teaching that to people who don’t really have a very good understanding of anatomy yet, nor the really specific palpation skills to be doing these kinds of things. And I think that’s again, a lot of the reasons and the ways in which this stuff gets promulgated through our education systems without having good standards of content in some of those educational institutions.

Susan Salvo:

Absolutely agree. But it’s a challenge that I think that we’re going to be struggling with. But I certainly hope that therapists who listen to this program err on the side of caution and advocate for patient safety or client safety. For sure.

Whitney Lowe:

Yeah. I want to shift gears a little bit now because we’ve been talking about learning things, and you’ve mentioned a couple things in our conversations about the importance of mentorship, and I hear that word talked about a lot. Tell me a little bit about your experiences with mentorship and how you think that is a good strategy and idea for people to be pursuing.

Susan Salvo:

Well, I love being mentored and I love mentoring. And my very first mentors I would have to give credit to my massage school instructors. Even to this day, they’re such wealth of information. Charlie Brown, Robert Stevens, Carol Kresge, Patricia Lorenzi, just dynamite people. And so they really helped shape who I became as a massage therapist. And later on, CE classes were another big, big important thing for me. Taking Trager was hugely important to me. Infant massage training, it taught me how to work with people non-verbally because they’re babies. I liked the work of Hakomi, which is Ron Kurtz, more of a body-centered psychotherapy. I loved Harold Dull’s work with Watsu. So those to me are the mentors from a postgraduate developmental. From educational standpoint, I would say that you and Benny Vaughn have been huge influences for me on looking at good models, good delivery systems, good assessments. So that has been… Thank you for that. It’s really shaped because known you since, like I said, since the ’80s. And I want to say I went to a class you did with Benny and Baton Rouge or something.

And then for my CE class… Okay. So what happened was I didn’t really hit the CE world until after I sold the massage school, and I went to my very first conference. That’s how Ednet started. But that’s a whole nother story. I went to my very first conference. And I booked three the first year, ‘2013, and I had some amazing conversations with Eric Stevenson, taught me so much about the big picture with CEs. In fact, he’s the one that turned me onto the book, The Courage to Teach, Parker Palmer, a great book. And then Felicia Brown, who’s probably my second mentor as far as the CE circuit goes, she really taught me a finesse and strategy and working a class. So I owe her and Eric and Benny a tremendous amount of appreciation for what you guys have done. But I do believe in when you’re called, you step up to the plate.

So when I have an opportunity to mentor, I often do. And in fact, I never turned anybody down, whether it’s a Facebook question or a email or a phone call or a conference tea. And when I’m giving my end of the year graduation commencement speech, I always try to leave them three things. And having a support system and a mentor before they graduate, before they launch their practice is something I really encourage them to do. Carol Kresge taught me that. She says, “Don’t be afraid to ask some of the big guys.” In fact, she was the one who contacted Jack Meagher and he already had written his horse equine massage book, and she was the one that said, “This is good stuff. I want to learn from you.” So she went to his place around Boston I think is where he lived, and said, “You need to be doing this to humans.” And so later on, a few years later, he wrote Sports Massage, but it was because Carol Kresge knocked on his door and said let me in.

Whitney Lowe:

Right. I remember a scene similar to that back when I was on the teaching staff at the Atlanta School of Massage, and this would be about 19, maybe ’89 or something like that. And I went to the Continue Education director, and I had just discovered Leon Cheetos, what everybody called the Blue Book, one of the very first ones. He came out with a soft tissue manipulation book. And I was just blown away by the content and the information in there. And I went to the CE director. I said like, “We got to get this guy here.” She’s like, “He’s in England. He’s in the UK. How are we going to get…” I said, “Just reach out to him.” And I think this, it turned out to be I think, one of his first US tours on the CE circuit, and we got him over to our massage school, and I was just like, it was astounding.

The room was of course, packed, standing room only of people that had come in there, but it was a great opportunity to do exactly like you said, which is, reach out to these people and connect with them. And most of them really want to talk to people and really want to share things and do stuff. So it’s a great opportunity to find people who can really take you places. And a lot of times those things come somewhere down the pike and you never know who they’re going to be, when they’re going to be that. It’s just like I didn’t really know that much about who Benny Vaughn was when the school set up a workshop with him to come in there and the teaching staff at the school said, “Hey, would you help with logistics for this course? We’ll give you a free spot in the class.” I’m like, “Sure, I’ll do that.”

And when I went in the classroom, it’s like, oh my God, this is where I live. This is where I want to be. And that started our very long relationship for many years of doing that. So I would agree that the mentorship thing is just so valuable for many-

Susan Salvo:

We’ve got the internet and Zoom.

Whitney Lowe:

Yeah. Yeah.

Susan Salvo:

It’s easier to reach out to people and connect with them.

Whitney Lowe:

Yeah. And speaking of the internet, I want to know just a little bit, you mentioned this a moment ago, a lot of people may not know what Ednet is and that it exists. I’ve turned a lot of people onto that. Can you tell us a little bit about what Ednet is and how that came about?

Susan Salvo:

Sure. So ‘2013, so I started the lecture circuit and I really was putting a lot of emphasis on teacher in services and creating more resources for them. We had just moved away from CDs and computer-based learning to online learning, and that was a whole… So much has happened since then. And so I wanted to have a platform for teachers, because what I would do when I would go to a convention is I would always offer a free CE teacher in service to get all the classroom people together and talk about things, like we did with the school summit, but on a smaller scale. And I would always do it for free just to have a networking opportunity for us. And I said, “We need to start a Facebook group.” And I originally did not want to do it on my own. I approached the Alliance, and at that time, ignorance talking, at that time, I did not understand the difference between a Facebook page and a Facebook group. They’re different.

So they said, “Oh yeah, no problem. We’ll use our Facebook page.” Well, it’s not a place you can share. Only the administrators can share. It’s not like Whitney can ask a question or Harry can ask a question or Benny can ask a question. And I went, “No offense, but no, thanks.”

Whitney Lowe:

Yeah.

Susan Salvo:

So I said, let’s just start one. And I wanted it sharp. And so we started Ednet and we maybe had 20 members at first, and then it started getting bigger. And then Ed Bursh who I just adore, joined in, and he’s been a great administrator. And we have some rules, no self-promotion, and it’s just a place to ask a question or share a resource or an idea, share lesson plans, videos that you find helpful. I love the group, and I just find it extremely respectful.

Whitney Lowe:

Yeah, it is. Absolutely. With so many really challenging Facebook discussions and things like that, that is one place where you’re not going to get bashed and you’re not going to get into argumentative discussions with people. It’s just a really good group of people that are over there. So I would encourage anybody who is doing anything relating to massage manual therapy education to come on over to Ednet E-D-N-E-T. You can just put that in your Facebook search when you search for groups, and you’ll find that, and it’s a wonderful, wonderful service that you’ve created and put together for that. Because I, as you know, love, hanging out over there and sharing educational resources and asking questions and finding things over there too.

Susan Salvo:

Well, I enjoy your questions and I hope more people start conversation.

Whitney Lowe:

Yeah.

Susan Salvo:

Meaningful conversation.

Whitney Lowe:

Yeah. And I think for a lot of early on massage educators, it can feel intimidating because most of us, probably 95% of us weren’t trained as educators. We became the accidental educator because somebody put us in the classroom and said, “Here, you go teach,” or want to go teach. But we never really learned much about education. So it’s a great opportunity to be able to do that in that group.

Susan Salvo:

Yeah, I love it.

Whitney Lowe:

Yeah. So we’re winding down here now, but this is one of the overall themes that I wanted to touch on. We were talking about lessons learned over the years that we’ve been doing. And you’ve been doing this for so long and with so many different things that you’ve been doing. I’m curious to hear if you have any… Some of the most significant or unexpected lessons that you’ve learned over the course of your career, whether it’s through your publishing processes, teaching, legal work, clinical practice, what have been some of the most interesting or unexpected lessons you’ve learned over that time?

Susan Salvo:

The only overarching lesson would be when I’m doing textbook writing or when I’m doing legal writing, I always try to get outside my comfort zone. I always try to get another person’s perspective. I like to use the word triangulation. So that’s been my big lesson, is that I want to be able to look at it from at least two, hopefully three points of reference. I think triangulation is a navigation term, like where am I in relationship to two other points of geographic contact. So when I’m making a decision, I just don’t look at it from a massage therapist standpoint, I look at it from an educator standpoint. I look at it from a healthcare provider, physician standpoint, PT standpoint. And I think that we as a profession need to do more of that, is to pull other people to our tables and show us our blind spots.

We should have had board certification years ago. Years ago, and we didn’t. We elected on a inappropriate term. It’s a term we used, which was national certification, board certification would’ve been the better term even back then. But I think we were shortsighted. And again, I think that’s probably what I want to leave you and your viewers with, is to really be thinking about what is it you want to create? The vision. Where do you want this profession to go? And be the change you want to see in the world. Become more active in the classroom, become more active in the profession, volunteer more with the different organizations because we need more vision and participation so we can guide this where we want it to go.

Whitney Lowe:

Wonderful. Well, you are certainly an inspiration for so many practitioners, just all the wonderful things that you’ve done, and I hear everybody raving about the materials that you continue to produce and improve. And so I just want to say thank you for your timeless and selfless contributions to our field over the years. It has been certainly an invaluable thing that’s been moving us forward. So again, really loved getting a chance to talk about this. And this is another one of those instances where you and I have had a couple of sit-down conversations where we just got deep into the weeds on online education and educational theory and all that stuff. And I love having those kinds of discussions. So thanks again so much for putting that effort into it and sharing things with us. If our listeners want to find out anymore or reach out, what’s the best way for people to contact you?

Susan Salvo:

I have a website called Massage Passport, and they can just use the contact page or they can friend me on Facebook. I’m very responsive.

Whitney Lowe:

Okay. And we’ll make sure to put a Massage Passport link in the show notes as well. So yeah, so find it on Facebook. And also if you’re interested in education stuff, come on over, join the Ednet group and have some discussions with us over there. So wonderful. Well, again, thank you Susan, so much for sharing some time with us today. It’s been great having you here and always good to catch up with you.

Susan Salvo:

Thank you, Whitney.

Whitney Lowe:

Yeah. And do remember The Thinking Practitioner Podcast is supported by ABMP, the Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you, a package including individual liability, insurance, free continuing education, and quick reference apps, online scheduling and payments with Pocket Suite, and much more. And ABMP CE Courses podcast and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including those from both Til and me. Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking. We want to say a thank you to all of our listeners and to our sponsors of course, as always, and to you for taking time now to listen in with us today. You can stop by our sites for the video, show notes, transcripts and extras. You can find that over on my site at academyofclinical massage.com and over on Til’s side at advancedtrainings.com.

If you have questions, comments, things you’d like to hear us talk about, just record a short voice memo on your phone and you can email that to us at [email protected] or just send us a text message or text email over there as well. You can also find us on social media under our names, under my name @Whitney Lowe and also under Til Luchau. You can find Til’s over there as well. And if you will, rate us on Apple Podcast, it does help other people find the show, and you can hear us on Spotify, Stitcher, Google Podcast, or wherever else you happen to listen. So please do share the word and tell a friend. And thanks once again so much for listening and we’ll see you next time.

 

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