Instructional Design Document
Course Title
Integrative Massage: Addressing Stress with Secondary Complaints
Course Overview
This minicourse is a hybrid, combining both asynchronous online and in-person elements, for licensed massage therapist (LMTs) seeking additional training or continuing education for license renewal.
Massage therapy has been a proven way to improve the body’s emotional, physical, and psychological responses to stress. In this course, learners discuss the known therapeutic effects of massage therapy for stress, and the best application for achieving these effects. In addition, learners practice applying advanced techniques to address secondary client specific complaints, without negating the therapeutic effects of a massage protocol designed to address a primary complaint of stress.
Table of Contents
Evidence of Gap/Need
In most states, licensed massage therapists are required to complete a certain number of continuing education hours within a specified number of years to maintain their license. Most states only accept continuing education that are NCBTMB approved to ensure that the courses offered display the highest professional standards and instruction as defined by the profession.
The state of Arizona requires massage therapists to renew their license every two years. Part of the renewal process requires that the therapist completes 24 hours of continuing education. A minimum of 12 hours must be in a live setting, only 12 hours may be online. Massage therapists from other states may complete this course for continuing education hours if the state follows the NCBTMB guidelines.
Target Audience and Learner Profile
Target Audience
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Massage therapists who need continuing education for license renewal.
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Massage therapists who have an interest in furthering their skill set.
Demographic Information
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Learner ages range from 18+.
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All genders.
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In the United States, massage therapy is a diploma earned from a vocational school, or a bachelor’s degree at most. So while learners are all LMTs, they will have different levels of prior education (GED to some level of college education or professional degree, not necessarily related to massage therapy) which influences literacy level.
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Some learners will have difficulty with reading and writing.
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The degree of experience a learner has will depend upon when they graduated, how long they have practiced and how many hours of massage performed during that time.
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All learners will speak English, but some will be second language speakers.
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Learner comfort with technology, and access to technology, will vary.
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Learners will have various means of employment. Some will be self-employed and own a private practice, others will work for an employer in a spa, chiropractor’s office, or franchise.
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Socioeconomic and cultural backgrounds will vary greatly.
Learning Goals
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Explain the value of therapeutic massage in countering the negative emotional, physical, and physiological effects of stress.
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Demonstrate the application of advanced techniques for secondary complaints in a massage protocol focused on reducing stress.
Prior Knowledge
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Learners must be a massage therapist with an active or expired license, which requires graduation from an accredited school. Consequently, learners will have had the same basic foundational principles.
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Knowledge and skill set will vary depending on length of experience and prior training.
Learning Styles and Preferences
Learning styles and preferences will vary in both the online and in-person.
Online (Asynchronous) - 5 Hours
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To accommodate the various styles, videos, images or visuals with corresponding audio demonstrations will be used online.
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Assessments could include:
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Short quizzes for fact-based aspects of the course.
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Short answers based on course knowledge and personal experience in addressing stress.
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Criteria based assignment: Evaluation of what works, and what could be improved in their current massage practice, based on course content related to protocols or techniques presented in the form of self-reflection.
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In-Person - 16 hours (2 days)
To accommodate the different styles, a combination of visual, auditory, and kinesthetic learning is utilized.
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Lectures are interactive and utilize visual aids such as a skeleton or palpation on a model. Major topics are visually presented using PowerPoint, videos, etc. with corresponding pages in the learner’s manual for notes. Dialogue and questions related to the content are permissible.
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Protocols and techniques practiced in class are visually demonstrated on a model. Learners observe and can move if desired for different viewpoints.
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A handout with the techniques or protocol is provided for learners so they can reference it and take notes during the demonstration, and for future refence during hands-on or personal practice.
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During the hands-on sections, the protocol will be displayed via a projector and the learners will also be led through the protocol verbally by the instructor. More complicated techniques will be redemonstrated on a model as needed. The instructor and a teaching assistant will assist learners individually with the application of the techniques and their body mechanics. The leaners practice the protocol at the same pace.
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A large part of practicing massage therapy is the experiential aspect. This is one of the reasons learners pair up to practice techniques and approaches – they each get to both practice and receive the introduced techniques. During the hands-on sessions, the instructor and teaching assistant also assist in helping the learners practice asking for and giving feedback about what the learner on the table is experiencing so the learner practicing has real-time feedback for improving or adapting. This also provides an opportunity for peer mentoring.
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Assessments are more focused on actual ability to demonstrate the skill set and could include the ability to demonstrate:
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Communication with their partner using open-ended questions to solicit feedback.
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A Swedish flow promoting the feeling of connectedness for the client.
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The integration of advanced techniques into a Swedish flow without negating the intended effects for a massage primarily designed to reduce stress.
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Motivations and Challenges
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Personal and professional enrichment, and continuing education hours will be the motivation for the learners.
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Learning challenges include, undeveloped skill sets, lack of anatomical knowledge and time needed away from work or other responsibilities for the in-person training. Since the learner demographic is vast, accessibility and comfort with technology will vary among learners.
Technology Proficiency
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Basic technology proficiency is necessary. Learners must be able to access the online course in the LMS using a tablet, or computer.
Accessibility and Inclusivity
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Consider various levels of literacy and experience in the written content. Assessment of tasks or skills must allow for unique adaptations that accommodate the leaner’s ability, but still meets the desired outcome.
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Specific means for assisting learners with visual, hearing or learning challenges need to be considered for the online and in-person courses.
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Some individuals may present physical challenges or unique physical attributes that may call for adjusting or amending protocols, but all participants must be able to participate in the in-person course to receive continuing education hours. Individuals who cannot, or who have a contraindication that prevents them from receiving the work, need to be directed to find a different type of course.
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Cultural or religious beliefs must be considered, particularly in the in-person course as some individuals may not fully disrobe, may need to partner with the same sex, etc.
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Language and images must be representative of diverse populations and should not perpetuate stereotypes.
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Marketing should be straightforward and written using professional terms but should consider the broad literacy levels of the learners.
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Steps for receiving a certification for continuing education must be clear and everyone must accept those terms prior to enrolling (A requirement for receiving continuing education hours is that participants must be present, and physically able to participate during the scheduled time. Participants who fail to attend the scheduled hours, or who cannot physically participate, cannot receive a certificate of completion of continuing education for submission to their state board.)
Feedback and Iteration
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Solicit ongoing feedback from peers who offer continuing education.
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Review NCBTMB requirements and submit course for approval upon completion.
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Once the course is approved, solicit feedback using surveys to the learners after every course to revise and improve.
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Review data from assessments or feedback in the course to revise.
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Research information for evidence-based practice, research on massage therapy and evidence demonstrating support for application as an intervention to stress, and trends or changes in the industry to keep the course current and marketable.
Course Type
Course Type
Informational
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Conveys knowledge about stress and the physiological impact of stress on the body.
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Presents specific types of massage application can help reduce the effects of stress on the body. (Primary complaint)
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Presents advanced techniques can be utilized in a massage whose foundational goal is stress reduction, to address a secondary complaint.
Step-by-Step
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A protocol is presented that provides a step-by-step process for stress reduction as a primary complaint.
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Additional protocols are presented for adapt advanced techniques into the protocol to address secondary complaints without exacerbating stress.
Audience Analysis
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LMT learners will have the same basic foundational principles since accredited massage schools must cover specific content. However, knowledge and skill sets will vary depending on emphasis of massage school, length of experience in practice, capacity for learning higher-level content in detail versus generally (ex: anatomy/physiology) and any additional prior training.
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This course would be considered low-intermediate since the premise of the course should have been covered in their basic training.
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At minimum, learners should understand the general correlation between stress reduction and massage therapy and have a functional understanding of anatomy. Some learners may have more in-depth knowledge.
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The basic massage protocol will reinforce a Swedish flow for connectedness, body mechanics and draping – individuals in a continuing education course show various degrees of aptitude with these but may not be open for suggestions for improving (feedback for improving body mechanics is most likely because they have discomfort or pain from how they currently practice).
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The integration of advanced techniques will be easily attainable, even if the modality is new to the learner, as they will be generally applied within the basic massage protocol introduced.
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Individuals interested in enrolling in this course will likely be LMTs with an infinity for Swedish massage, but LMTs interested in the introduction of advanced techniques or modalities will look forward to that part. Being able to receive a massage is always a strong motivator for LMTs because they don’t get enough bodywork, so the experiential aspect of this course, with full-body and specific protocols, is of particular interest.
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Most learners prefer a degree of learning through observation and "doing" for kinesthetic application. So, the online aspect, which is self-paced, that presents the “lecture” or information aspects of the course, and the in-person course primarily created around practicing and receiving, will be of high interest.
Course Modality: Hybrid
Learner Preferences
Most individuals are drawn to kinesthetic learning in massage therapy, so learner preference leans more to in-person learning. Hands-on skills are easier to learn this way, and easier to assess by the instructor. However, the online aspect is a convenient option to learn knowledge and review skills at one's own pace and does not require an LMT to schedule time away from work.
Interaction Levels
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Online interaction is low. Learners progress at their own pace to learn. Since learners often sign up for a continuing education course within a week of it being offered (often around their license expiration date), synchronous learning would be difficult to get a full cohort.
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In-person interactions are high. Learners interact with each other to practice the skills they have learned, to provided and receive feedback on the experience on what works and what does not, how the techniques and approaches feel and how this translates to a client.
Accessibility
Online
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Video content will utilize closed captioning.
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Transcripts will be provided for videos.
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Alt text will be utilized for images or graphs.
In-Person
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Learners with visual challenges may audio record the lecture and demonstration. During hands-on, instructors can provide individual coaching to a visually impaired learner for applying techniques.
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Individuals with learning challenges will be able to receive coaching from the instructor or teaching assistant during the hands-on aspect of the course.
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Learners with hearing challenges will be able to receive individual coaching from the instructor or teaching assistant. The course will be sequential, and all visual materials will complement the flow of the course.
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Different learning styles can be easily accommodated, and learners can select with whom they pair up with in the course, to encourage peer-to-peer learning.
Technical Requirements
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Basic technology proficiency is necessary for the online course. Students must be able to access the online course in the LMS using a smartphone, tablet, or computer.
Course Learning Outcomes
Upon successful completion of this course learners will be able to:
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CLO1: Apply characteristics of the therapeutic relationship for creating a healthy foundation for a client-centered approach.
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CLO2: Evaluate client health history to determine if massage therapy is indicated or contraindicated for the client's current state of health.
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CLO3: Describe the emotional, physical, and physiological responses to stress that occur in the body, and the resulting symptoms, to a client in a therapeutic setting.
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CLO4: Explain the benefits of massage therapy at an appropriate health literacy level for a client.
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CLO5: Design a client-specific massage protocol to address the complaint of stress with secondary complaint areas and relative contraindications. (in-person portion)
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CLO6: Perform a full-body massage that emphasizes connectedness, but appropriately integrates advanced techniques to address secondary complaints based on client-centered protocol. (in-person portion)
Weekly Learning Objectives, Learning Activities and Assessment Strategies
Week 1
Module: Effects and Benefits of Massage Therapy
LO4.1: Describe the physiological, physical, and mental changes that improve with massage therapy.
LO4.2: Communicate known benefits of massage therapy in layperson’s language to help a client see the benefit of receiving massage and justify a proposed protocol. (health literacy)
Activities
Video
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health benefits of massage (proven vs. anecdotal)
Readings
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effects of massage on body systems
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effects of specific massage
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strokes/techniques
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benefits of massage seen in medical community
Assessment Strategies
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Discussion Question: Science (EBP) vs. Anecdotal Evidence, significance and purpose of both. (peer discussion)
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Assignment: Create a personalized reference tool (chart) that lists proven effects from massage, the benefit to the client and identifies a massage technique that will produce that result.
Week 2
Module: Stress and the Body
LO3.1: Describe physical and emotional complaints in the body correlated with stress during each phase of adaptation.
LO3.2: Describe the components of the cycle of stress and identify the significance of each.
Activities
Video
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phases of stress.
Readings
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benefits of massage for addressing symptoms of stress
Module: Contraindications and Client Considerations
LO2.1: Distinguish between indication and contraindication.
LO2.2: Define the terms systemic, relative/local, absolute, and relative as they apply to contraindications for massage therapy.
LO2.3: Determine absolute and relative contraindications based on health and medical history provided by a client.
Activities
External resources from AMTA and other creditable sites to support course content.
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contraindications and precautions.
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indications
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client-considerations
Assessment Strategies
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Discussion Question: Describe manifestation of stress in Alarm or Resistance phase, propose massage technique effective for that stage. (peer discussion)
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Discussion Question: Discuss how to address undisclosed conditions that are contraindications. Share strategies to prevent this from occurring, how to approach and ensuring client safety. (peer discussion)
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Assignment: Utilize personalized reference tool (chart) form Module 1. Evaluate client history. Detail client reported symptoms typically associated with stress. Identify and describe condition making it a contraindication and determine if relative, phase-specific, or absolute contraindication.
Week 3
Module: Client-Centered Approach
LO1.1: Discuss the importance of the therapeutic relationship.
LO1.2: Develop strategies for cultivating a therapeutic relationship in private practices to ensure a client-centered approach.
Activities
Video
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characteristics of therapeutic relationship
Readings
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professional guidelines for therapeutic relationships
Assessment Strategies
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Discussion Question: Explain importance of therapeutic relationship and how a massage therapist can proactively cultivate a therapeutic relationship. Discuss the role of personal responsibility and foundational values that guide interactions with clients to ensure client-centered care remains a top priority. (peer discussion)
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Summative Exam.
Subject Matter Expert and Resources
I will be the subject matter expert for the is course. Here are the resources that I will use for informing the content when designing this minicourse:
Green, E. (2013). The psychology of the body (2 ed). Jones and Bartlette.
MBLExGuide. (2024). Massage contraindications & precautions every therapist should know. Retrieved from https://mblexguide.com/massage-contraindications-therapists-should-know/
MBLExGuide. (2024). Massage areas of caution and endangerment sites. Retrieved from
Instructional Design Model
Understanding by Design (UbD)
UbD is the foundational instructional design model used to develop this hybrid course, with both online (foundational knowledge) and in-person (learner demonstration and peer-teaching), as it is very much learner-centered. The design of the course is driven by the overreaching learning outcomes directly needed to address the identified need. Assessments are directly defined by determining how the learning outcomes should be measured to determine transferability of skills to real-life, and learning experiences are developed that align with the learning objectives and assessments.
Aspects of the Problem-Based Learning (PBL) model will be integrated to create opportunities for learners to identify their gaps and then research, collaborate and critically think to solve practice-based problems they have or may encounter as an LMT in practice.
Learning Theories
Primary Theory: Andragogy
Andragogy is the primary learning theory for the proposed minicourse. The design supports creating a learning process that is flexible and relevant to adults. It also focuses on applying information into practice for the LMT.
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Considers needs and common characteristics of LMTs in the learning process to make learning relevant and emphasizes flexibility, peer-collaboration, and applying the course information into their individual practices.
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Emphasizes that adult learning is not the same for everyone.
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Assumptions do not apply equally to all adult learners since they are diverse with a wide range of experiences.
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Assumptions do not apply equally to the individual all the time.
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As a result, the discussion questions and assignments have a large degree of latitude so individuals can draw from their own experiences and private practices, but the response must be consistent with the standards of practice and ethics governing the profession as well as known evidence.
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Additional Theory: Connectivism
Connectivism is used to ensure learning experiences are multifaceted, and the design of the activity ensures there is a focused learning objective but also requires the learner to construct meaning and systems of meaning as the LMTs review and apply concepts into hands-on application.
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Activity elements include problem-solving, exploration, questioning and connections to personal interests related to private practice, which encourages intrinsic motivation.
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Learning is contextual. Activities are connected to what is going on in the real world related to massage therapy.
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Learning experiences account for and incorporate the learner’s application of personal and unique knowledge, persona, beliefs, etc.
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In-Person: The instructor models techniques and protocols. ZPD is utilized during the hands-on exchange between learners.
Additional Theory: Behaviorism
Behaviorism is used to ensure desired skills and concepts related to facts, best practices and industry standards have measurable and observable learning outcomes. Application of this theory ensures content is presented sequentially, there is a relatable standard for the diverse perspectives so that real world application, while unique for each learner, is based on expected standards of practice.
Digital Media
Digital Media Evaluation Checklist - Chapter 5: Stress
CLO2: Describe the emotional, physical, and physiological responses to stress that occur in the body, and the resulting symptoms.
Massage: Benefits, Indications, Contraindications
Digital Media Checklist: MT Benefits
CLO1: Evaluate client health history to determine if massage therapy is indicated or contraindicated for the client's current state of health.
Xen Education Group - Course Flyer
Digital Media Checklist - Flyer
Course descripiton.
Digital Media Checklist - Video
CLO2: Describe the emotional, physical, and physiological responses to stress that occur in the body, and the resulting symptoms, to a client in a therapeutic setting.
Digital Media Checklist - Animation
CLO3: Explain the benefits of massage therapy for stress reduction at an appropriate health literacy level for a client.
CLO4: Design a client-specific massage protocol to address the complaint of stress with secondary complaint areas and relative contraindications.