Professional Practice

Blog 2: Treaty of Waitangi - What does it mean to be a healthcare professional?

Explain the meaning of the articles of the treaty of Waitangi, their historical context and their significance to health practice in New Zealand.

Within the Treaty of Waitangi there are four main areas of concern relating to the healthcare profession, governance, authority, equity and respect.  Directly relevant to each of these areas are the 3 P's: Partnership, Protection and Participation. These elements are key in the development of a fair and equal interpersonal client relationship.

Governance

In Article 1 of the Treaty of Waitangi, it was generally understood by the Maori chiefs that the idea of governance was administration to/overlooking of their land by the English queen.  This idea was misunderstood by the English as implying sovereignty or power over the land given in exchange for the queen's protection. We can apply this concept of governance to our profession as massage therapists by ensuring that we look after our clients and administer to their needs, but do not confuse this with sovereignty or power over them/their decisions in exchange for our protection.  In other words, this does not require them to compromise themselves or their cultural values in any way, in exchange for a massage treatment or other healthcare service.

This also entails the responsibilities we have as healthcare practitioners to the welfare of our client (during the session and afterwards where appropriate).

Lastly, the policy and legislation of the treaty and what this means when applied to all clients is important regarding best practice in the workplace.

Authority

The idea of authority in Article 2 of the Treaty was primarily to do with the difference in perceptions of authority between the Maori chiefs and English representatives of the Crown.  This article related mainly to control of the land; the Maori version indicates that the queen agrees that the Maori chiefs hold rangatiratanga (chieftainship) over the lands whereas the English version appears to imply that the land really belongs to the queen and is being gifted back to the Maori should they wish to retain it.

In the Healthcare profession, as practitioners we are in the position of the governors and the client represents the chiefs.  Therefore we need to ensure that we allow and encourage the authority of the client in an equal partnership.  

Giving the client the opportunity to assist with planning the treatment or modifying it where necessary respects their equal authority within the client/practitioner relationship.  As a rule, clients prefer to be treated as equal beings and this is acknowledging the democratic element that should be present between healthcare practitioner and client.

Equity

Here the words of debate are 'subjects' or 'citizens'.  In the English version of article 3 in the Treaty, it is stated that the queen declares that the Maori will be protected and will maintain the same rights as British 'subjects' - a word which essentially places said 'subjects' on a lower platform to the queen who is located at the top. 

In the Maori version of article 3, the Maori accept the queens governance if the queen offers them the same protection and rights of British citizens (the people of England).  This largely highlights a difference in the cultural views and understandings of the English and the Maori, and how the people in each culture are treated, including the hierarchical systems and their differences.

With respect to Massage Therapy, equity relates to an awareness on the part of the practitioner ensuring that every client receives the most suitable treatment bearing in mind their personal circumstances.  In this way, the treatment is tailored to the individual client and their individual needs, while maintaining an expected standard.  An example would be providing wheelchair access to the massage premises to accomodate disabled clients.  For Maori clients or other clients with integral cultural rituals an awareness and willingness to accomodate these on the part of the therapist is required.  Maori clients may prefer to discuss altering a treatment that involves the head for example, and may take offence at sitting on a table as another example.  The key here is to have the sensitivity to 'read' the client and understand how their cultural customs may affect their response to any part of the treatment.  Specifically for a massage therapist, the best time to discuss cultural differences and protocol would be during the interview process at the start of the massage, when the treatment plan is proposed and negotiated by both parties (therapist and client).

Respect

Only the Maori version of article 4 in the Treaty exists, which was an oral article and was subsequently not added into the written texts.  This may be due to the English intention of assimilation, in which all indigenous religions and beliefs were converted to the main religion of England at that time, namely Christianity. However, the Maori article discusses the 'protection' of the 'Maori custom' by the Governer.  

In terms of healthcare, respect in this case is generally expected and comprises an unbiased deference to the client's cultural values and needs, what they are seeking to achieve as a result of the massage treatment and as an individual.  This is a standard quality that massage therapist's should look at developing if it isn't already inherent in their nature, as it is crucial when operating within the realm of healthcare and in maintaining a positive reputation.

References:

Bachelor of Midwifery/Diploma in Massage Therapy; Treaty Workshop.  May 18th, 2009.

Ministry of Health (2002) He Korowai Oranga: Maori Health Strategy.  Retrieved on the 15th June 2009 from:

http://www.moh.govt.nz/moh.nsf/0/8221e7d1c52c9d2ccc256a37007467df/$FILE/mhs-english.pdf

My own thoughts

Research Methods

Reflection on the Collaborative Task Process

Due: 5th June 2009

Overall I feel that my contribution to the collaborative research project has been sufficient, and the journey taken has been personally enlightening.  Below I have listed my:

Contribution to the group:

- Created the google doc for the group to use as the format structure for the group proposal

- Coordinated the meeting of the group on two occasions, but this was generally a mutual consensus

- Provided 5 references and intuitive ideas regarding the research question

- Was present at most group meetings and actively involved with the process

Contribution to the references: 

- Information on ethics and data analysis relevant to our group proposal: Cohen, Manion & Morrison (2007)

- The effect of massage on the parasympathetic nervous system and the resultant relaxation effect, and how this would assist Chronic pain clients: Marieb (2004)

- The presence of chronic local adaptation syndrome in clients suffering from chronic pain: McQuillan (2008)

- Descriptions of chronic pain symptoms from an anonymised client, potential link between chronic pain and emotional/psychological trauma, referral of chronic pain patients to massage therapists by other healthcare providers: S. Farrimond, personal communication (2009)

- Links between neurophysiology/peripheral nerve pathways and chronic pain from a medical perspective: McQueen, personal communication (2009)

My Interpretations of the Topic:

At the conclusion of this group collaborative research proposal, I feel there is a strong link between chronic pain and emotional disorders, oversensitivity of the peripheral nerve pathways and chronic pain syndrome fits the profile of an individual prone to anxiety and depression.  I feel that due to the lack of research to date conducted in the field of chronic pain there is a potential area for further exploration into the phenomena that is chronic pain syndrome.  Our research indicates that massage therapy would play a viable role in the control and treatment of chronic pain symptoms, on both a physical and emotional level.  

So far, the medical system has attempted to treat chronic pain (e.g. with the instigation of pain clinics within hospitals nationwide (McQueen, personal communication, 2009)), but due to the lack of research and therefore lack of knowledge of this condition and its fundamental nature, the healthcare profession continues to be mystified by chronic pain sufferers and the syndrome itself, placing it in the 'too hard' basket.

I feel this offers an area of research particularly relevant to the Massage Therapy profession to explore in the future and the vital role massage could play in the treatment process.

My engagement with the group:

Initially, I attempted to act as coordinator for the meeting of our group, but as a result of the progression of the task I found myself leaning toward the editor style role, editing and culling the information rather than adding further research.  

I enjoyed this editing role more so than the role of researcher or coordinator, as I felt it suited my aptitude with language and writing.

I was a present force at most of the group meetings, continually engaging with the others and the task at hand.

My involvement with the workload:

I feel I contributed an acceptable portion of the references required, assisted with arranging group meetings and liaised with the other group members in a concerted manner throughout the group task.  I believe I was appropriately involved with the journey taken by the proposal, from its initial formative stages through to its completion and presentation as a google document.

As a result of this collaborative group task process I have become interested in the role that massage therapy may play in the future, in relation to undefined/seldom researched health conditions.  I have also discovered my strengths (and passions) lie mainly within the realm of the written word and editing, rather than in management or as a researcher with regards to this group project.

References:

Grinlinton, T., Howley, H., Marks, S. & Steven, S.  (2009) Collaborative Research Project: How Many Massage Sessions Does it Take to Reduce the Sudden Onset of Chronic Pain Symptoms? Dunedin: Otago Polytechnic Massage Therapy School.

My own thoughts.

Professional Practice

Blog 1: Scope of Practice as Defined by Massage New Zealand

'Does the Scope of Practice as defined by Massage New Zealand fit with the legal requirements under the Healthcare Practitioners Competence Assurance Act and does it accurately reflect our scope of practice as Massage Therapists?'

I strongly believe that to have a defined industry standard regarding the level of competency and professionalism required to call oneself a massage therapist is critical to the recognition of massage therapy as a viable healthcare profession. However this portends some positive and negative aspects.

In favour of defining a scope of practice within Massage Therapy, is the corresponding faith in the massage industry by the public, recognition by the government and therefore eligibility for ACC funding and access to MT by low income families via the public healthcare system (McQueen, personal communication, 21st May 2009) and academic recognition in the realm of research.

The drawbacks of defining an enforceable Scope of Practice are the resultant limitations placed on the massage therapist with regards to techniques used, staying within their personal scope of practice and qualifications required to practice as a healthcare professional (it may be that a qualification at diploma level is required in order to be recognised as such). 

Standardization of qualifications and the course framework will therefore become routine, and the expansion of massage therapy as a developing profession may be limited.  There are concerns over placing such definite boundaries around healthcare professions due to the HPCAA and the consequences of this: "The resulting legislation is complicated and undermines professional functioning. Its effect may be exactly the opposite of its intention.." (Briscoe, 2004).

There is currently no portion under either scope of practice defined by Massage New Zealand which specifically addresses the use of the title 'massage therapist' by practitioners who do not hold the relevant qualifications.  This would be legally enforceable under the HPCAA, but may not discount other related words such as 'bodyworker' being used by an unregistered massage practitioner.

Confusion may ensue if say, some practitioners have only completed some weekend courses in relaxation massage and proceed to advertise themselves as masseuses/masseurs, whereas other registered practitioners holding the requisite qualifications defined within the HPCAA are advertising themselves as massage therapists. 

The problem here lies with the terminology used: the general public particularly the older demographic, may need to be re-educated about the difference between these terms as some may not know a difference exists. For example, it is not likely, common or even legal in current society for an individual to advertise themselves as a doctor without the requisite medical qualifications and rigorous training. According to Gilbey (2008) if an individual attempts to portray themself as a doctor to the wider public but are not a registered healthcare professional, they are liable to be fined up to $10,000 under the HPCAA. 

For these reasons, a practitioner of massage would need to ensure that they were not breaching the terms of the HPCAA by incorrect use of title (e.g. massage therapist) according to what is outlined within the HPCAA, providing massage therapy is included the next time the Act is amended.

The Scope of Practice for both a Certified Massage Therapist and Remedial Massage Therapist is detailed thoroughly by Massage New Zealand, and fits with the current legislation defined under the Preliminary and Key Provisions 8: 'Health practitioners must not practice outside scope of practice.' (HPCAA, 2003) Essentially, the scope of practice outlined by MNZ applies mostly to the "delivery of soft tissue therapy" and basic client assessment. This places us securely within the defined scope of practice for massage therapy and hardly encroaches onto the turf of other healthcare disciplines.

I feel it is beneficial to have these boundaries in place as this will ensure that the research within the defined scope of practice is more thorough and that we may delve deeper into the profession of soft tissue manipulation and therapy, rather than spreading our focus over many other healthcare disciplines. We are massage therapists, therefore our main focus should realistically be on soft tissue manipulation.

Since the area of myofascial release has not been claimed as a main method of therapy by any other healthcare discipline (with the possible exception of osteopathic medicine (Ward, Hruby & Jerome, 2002)), it is most likely that massage therapy can claim this as a developing area of expertise directly relevant to the scope of practice within this field of study and research, as it is a manipulation of the fascia (soft tissue).

As a result of this proposed academic exploration into the sphere of massage therapy, we would be in a better position to achieve our desired goal as defined under the MNZ Code of Ethics: professional image.

Within the MNZ scope of practice, there also appears to be a glaring absence regarding practitioner competence, fitness to practice and quality assurance of the goods and services provided (in this case massage), which may also bring up legal issues concerning the Consumer Guarantees Act (1993). The intention of Section 3 in the HPCAA was to ensure the safety of the public, exclusion of practitioner liability and confidentiality of client and practitioner records except in special circumstances. This is important in terms of setting an industry standard that is reliable, professional, legally watertight, and protective for massage therapists as practitioners. As a result, the inclusion of this clause is crucial to the perception and reputation of massage therapy as a professional practice among clients, other healthcare practitioners and the general public.

Cultural competence also appears absent from the scope of practice defined by MNZ, however there is some vague mention of refraining from prejudicial behaviour and discrimination.  This is particularly unprofessional in New Zealand as all other spheres of healthcare (eg. midwifery, medicine, physiotherapy, etc) currently include a section on this and the relevance of the Treaty of Waitangi. 

Finally, there is a large amount of energy concentrated on ensuring that untoward sexual advances are not made by the massage therapist, and client relationships stay strictly professional.  This is over emphasized under the Code of Ethics reminding others of the earlier association between massage therapy and the sex industry, and while this is definately part of the history of massage, it is not wise to give it so much emphasis if our goal is to appear professional.

Overall, I feel that the Scope of Practice defined by MNZ is incomplete in places and too superficial in others and so does not fit with the legal requirements of the HPCAA.  In order for Massage Therapy to be included in the next amendment of the Act, a greater emphasis on legal, cultural and educational competence is vital and there must be clarity on why these are necessary.  

However, with recognition as a healthcare profession under the HPCAA, we must realise that our Scope of Practice will be limited as a result.

References:

Briscoe, T. (2004). New Zealand's Health Practitioner's Competence Assurance Act: A missed opportunity for improvements to medical practice, The Medical Journal of Australia, 180 (1), p. 4-5.

Gilbey, A. (2008). Use of Inappropriate Titles by New Zealand practitioners of acupuncture, chiropractic and osteopathy, The New Zealand Medical Journal, 121 (1278), p. 1.

Massage New Zealand. (2009) Certified Massage Therapist: Scope of Practice. Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/scope-of-practice-cmt/

Massage New Zealand.  (2009) Code of Ethics.  Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/code-of-ethics/ 

Massage New Zealand. (2009) Remedial Massage Therapist: Scope of Practice. Retrieved on the 20th May, 2009 from: http://massagenewzealand.org.nz/about-us/scope-of-practice-rmt/

Ministry of Health. (2008) Health Practitioners Competence Assurance Act 2003. Retrieved on the 21st May, 2009 from: http://legislation.knowledge-basket.co.nz/gpacts/public/text/2003/an/048.html

Parliamentary Counsel Office of NZ. (2008) Consumer Guarantees Act 1993. Retrieved on the 21st May, 2009 from: http://www.legislation.govt.nz/act/public/1993/0091/latest/DLM311053.html

Ward, R., Hruby, R. & Jerome, J. (2002) Foundations for Osteopathic Medicine. USA: Lippincott Williams & Wilkins, p. 1034.

Pathology: Condition 1

Pathology: Musculoskeletal
Condition 1: Osteoporosis
Final due: 5th June, Peer assessment: 19th June 2009.

Description:

Osteoporosis is defined as a systemic skeletal condition in which the bone tissue deteriorates faster than it is being formed, leading to thinning and weakness of bones. It is not possible to cure osteoporosis (Laroche, 2008), which is an irreversable, degenerative disease of the bone. According to Nevitt (1994), prevention is the best form of cure, as the loss of bone strength that occurs as a result of the loss of bone tissue is permanent. The risk is greatly increased in the elderly due to the slowed production of bone and the heightened possibility of falling and therefore fracturing bones. The best prevention is to build up stronger bones during childhood/adolescence when metabolism is at its peak, in order to reduce the likelihood of osteoporosis occurring later in life.

Etiology:

Osteoporosis is a standard part of the ageing process, and can occur as a secondary condition alongside other systemic diseases and endocrine disorders such as hyperthyroidism and diabetes (Sweet, Sweet, Jeremiah & Galazka, 2009).
It is characterised by loss of bone density and greater fragility of bone tissue, which is exacerbated by various etiological factors, such as a family history of osteoporosis, regular smoking and alcohol consumption and insufficient sun exposure, resulting in low vitamin D levels (Morgan & Kitchin, 2008).  A diet low in calcium, certain medications (e.g. glucocorticoids) and low oestrogen levels also increase the likelihood of this disease (Sweet et al, 2009).
In women, the onset of osteoporosis appears most commonly after menopause, in anorexics, and otherwise hormonally or nutritionally deficient individuals (Morgan & Kitchin, 2008).

Signs & Symptoms:

According to Premkumar (1999) bone pain and stress fractures may be present in the initial stages but as the progression is so subtle, the condition may go unnoticed until the event of a fracture, by which time the disease is in its advanced stage and acute damage has occurred. As osteoporosis is a subtle condition that gradually appears during the later stages of the client's life, there is no way of identifying the exact date of initial bone deterioration, and due to its irreversable nature it may require the remainder of the client's life to reach the peak of its expression.  Loss of height and bone deformities such as kyphosis of the spine can indicate that the acute stages of the disease are present in the spinal bones (Holt, 2008).

Morphology:

A deficiency in the minerals that form bone tissue, particularly calcium and phosphate, can force the body to extract these from the bones in an effort to achieve homeostasis. This leads to accelerated osteoclastic resorption (Laroche, 2008) which results in the bone tissue presenting as demineralised, brittle and fragile, breaking easily with little stress (Premkumar, 1999).

Incidence:

1.3 million bone fractures per annum in the overall population have been caused by osteoporosis in the United States (Cooper, 1999). Within this population, 1 in 8 men will suffer from an osteoporotic fracture in their lifetime as will 1 in 2 white women (Sweet et al, 2009).

Indications for MT:

Exercise, gentle massage particularly excercising caution over bones and bone structures, light to medium massage pressure over stiff neighbouring muscles using the fingertips in a circular motion or alternatively, the palm of the hand (Salvo, 2008).

Contraindications for MT:

Deeper massage over bones and greater stroke pressure. Deep tissue massage techniques near the site of osteoporotic bone are also contraindicated as these may aggravate the progression of bone fractures and so must only be used with necessary caution by a qualified practitioner (Leidig-Bruckner et al, 1997).

References:

Boschert, S. (2002) Risk Factors Don't Always Predict Osteoporosis. San Francisco: Internal Medicine News. Retrieved on the 16th May, 2009 from: http://www.internalmedicinenews.com//article/PIIS109786900271086X/fulltext

Cooper, C. (1999) Epidemiology of Osteoporosis. Southampton: Osteoporosis International. Retrieved on the 16th May, 2009 from: http://www.springerlink.com/content/865w7gj0t4496n1p/fulltext.pdf?page=1

Holt, E. (2008) Osteoporosis. Retrieved on the 16th May, 2009 from: http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm

Laroche, M. (2008) Treatment of Osteoporosis: All the Questions We Still Cannot Answer. The American Journal of Medicine, 121 (9), p. 746.

Leidig-Bruckner, G., Minne, H., Schlaich, C., Wagner, G., Scheidt-Nave, C., Bruckner, T., Gebest, H. et al. (1997) Clinical Grading of Spinal Osteoporosis: Quality of Life Components and Spinal Deformity in Women with Chronic Lower Back Pain and Women with Vertebral Osteoporosis. Journal of Bone and Mineral Research, 12 (4), pp. 663 - 675.

Morgan, S. & Kitchin, B. (2008) Osteoporosis: Handy Tools for Detection, Helpful Tips for Treatment. The Journal of Family Practice, 57 (5), p. 313.

Nevitt, M. (1994) Epidemiology of Osteoporosis. San Francisco: University of California. Retrieved on the 16th May, 2009 from: http://www.ncbi.nlm.nih.gov/pubmed/7984777

Premkumar, K. (1999) Pathology A - Z: A Handbook for Massage Therapists. Calgary: Lippincott Williams & Wilkins.

Salvo, S. (2008) Mosby's Pathology for Massage Therapists. New York: Elsevier Health Sciences, p. 112.

Sweet, M., Sweet, J., Jeremiah, M. & Galazka, S. (2009) Diagnosis and Treatment of Osteoporosis. American Family Physician, 79 (3), p.193 - 200, Table 2.

Assessment task 1 - Blog 4 - Evaluation of Research Findings, Tessa Grinlinton.

There is a large amount of unintentional ambiguity within the article 'Unravelling the Mysteries of Fascial Unwinding' which simply serves to confuse and frustrate the reader.  This ambiguity reinforces the intuition that the writer may not entirely know about or understand the topic of which he is attempting to depict and explore.

The paragraph related to 'forcing the tissue in some directions' suggests that the author/s have not fully explored the area of myofascial release in which either direct or indirect methods for unwinding the tissues are employed. The ambiguous word in question is 'forcing', we are never forcing the tissues in a harmful way, but in direct myofascial release and unwinding, we may be deliberately guiding them with slight 'force' against the areas of most restriction in order to encourage release in those areas.

The author contradicts themself in the ambiguous description of "sometoemotional release... again here we only deal with physical unwinding". By simply reading the term sometoemotional release we assume that a large portion of this will involve emotional and somatic releases, therefore we are not purely dealing with physical unwinding (which cannot be seperated from emotional or somatic phenomena, as they are all interconnected in the field of myofascial unwinding) but an infusion of all three. This would suggest that again the writer of this article has only investigated the topic from a limited set of viewpoints and has yet to see the whole picture. If they are however attempting to insinuate that pure physical unwinding has purely somatic and emotional effects they are still not linking the three bodies which are essentially part of this holistic field, and the ambiguous nature of the statement leaves the reader confused.

In the article 'Unravelling the Mysteries of Fascial Unwinding' the researchers have compiled a very relevant list of specialised articles related to myofascial release and the ideomotor effect (in which the subject makes movements unconsciously facilitating said release). Neuromuscular therapy, craniosacral therapy and bodywork journals boost the quality of reference sources, an article in the new scientist appears from the heading to be representing a skeptics point of view regarding the phenomenon of fascial unwinding: 'Greatest Myth of All'.  However on close inspection of the article in question, we discover that it relates in fact to the unconscious processes of the brain related to perception and action.  Again, the ambiguity of the reference heading may reflect an ambiguity in the article itself, reflecting an ongoing theme of ambiguity projected by the author.

The 'Healing ancient wounds: the renegades system' article is one of the main articles seeming to suggest that fascial unwinding and indeed tense fascia may have a psychological, subconscious and even spiritual connection, transcending original science based theory and simultaneously linking with it. There are also extensive references to neurobiology, the medical side of fascial unwinding and ideomotor reflexes, lending a scientifically proven base to these findings.

Overall, the writer seems to have attempted to isolate and detach the phenomenon of fascial unwinding as a seperate event in order to portray it in a conventionally scientific format, unfortunately this has not worked in his favour due to the inherently holistic nature of fascial unwinding.  He has utilised many quality reference sources, namely peer reviewed journals, but his downfall lies in his communication of these findings in what should have been an academically rigorous manner.

References:

Halligan, P. & Oakley, D.  (2000) Greatest Myth of All.  New Scientist 168 (2265), 35 - 39.

My own thoughts.

Terra Rosa Bodywork E-News.  (2008) Unravelling the Mysteries of Fascial Unwinding.  Retrieved on the 26th April 2009, from: http://74.125.95.132/custom?q=cache:5ptBtbTPEsoJ:www.terrarosa.com.au/articles/Terra_News2a.pdf+unraveling+the+mysteries+of+unwinding&cd=1&hl=en&ct=clnk

My Search Process: Memo

I am really enjoying the spontaneous way in which our group arrived at its hypothesis, using a largely intuitively guided process.  The qualitative and quantitative elements are neatly combined within the format of the question, allowing for a greater scope of analysis and possible "avenues for further investigation" (Cohen, Manion & Morrison, 2007, p.483) into the subject of chronic pain.

The difficulty I face is with the foreign terminology that comes with the territory of research methods and analysis, providing an immediate obstacle to overcome before I can delve deeper into the potential methodology and different research perspectives (e.g. triangulation).  The concept of hypothetical questions and inference are equally difficult for me to familiarise myself with due to the challenge of understanding abstract theoretical concepts over concrete specific objects (as in the field of massage therapy, e.g. anatomy).

I notice that the polytechnic as an environment in which to commence this collaborative research assignment is indeed a good choice due to the close proximity of necessary resource facilities such as the Bill Robertson library, and within walking distance to the Medical and University libraries.  The mood around this research site is both contemplative allowing for spontaneous intuitive expression to occur in relation to the collaborative research process and intellectually stimulating, encouraging deeper exploration and thought into the stages of said process.

So far, the group dynamics have been cohesive, collaborative and relatively intuitive during the initial phase of formulating a research question and delegating the tasks required to investigate this more thoroughly.  However due to the round table nature of our group, all members are perceived as equal and this has resulted in an equal distribution of the workload, and tasks.  The positive aspect of using this system is that the organically different viewpoints of each researcher regarding each task area will result in a greater diversity of data and information, as seen in triangulation.

This is the stage of the research process in that the use of mixed methods is particularly beneficial as the differing observations of each group member will allow for greater precision and deeper comprehension of the research question.

The value of time is fundamental to the quality of the research process, as deeper theories and intuitive possibilities cannot properly be expounded without ample time to posit questions and rework these to a refined hypothesis. Inevitably however, these many possibilities need to be narrowed down into "general and specific points" (Cohen et al, 2007, p.487) relating to the original research question so that our process may evolve successfully.  This will then lead on to the next stage of the collaborative research process requiring more direct research and specific analysis than abstract theory.

At this point in time, I am simultaneously interested in the domain of research methods and the basis/structure of this and confused by the abstract nature of the subject which is largely intellectual and relies on the theories of individuals, which in its very essence will be reasonably diverse.  In conclusion, I look forward to the continuing challenge posed by research methods and the resulting expansion of my own intellectual knowledge.

Reference List

Class notes

Cohen, L., Manion, L. & Morrison, K.  (2007) Research Methods in Education.  New York: Routledge, p. 483, 487.

My own thoughts

Pathology of Tennis Elbow (lateral epicondylitis)

Etiology:

Tennis elbow is a repetitive strain injury caused by recurrent twisting and jarring movements through the lateral forearm and elbow. Unlike its name suggests, it is not necessarily caused by playing tennis (O'Young, Young & Stiens, 2002). These initial movements cause minute tears in the muscular tissue and tendon fibres which have a cumulative effect resulting in pain from chronic overuse. Tendinitis is the initial inflammation of the forearm extensors and lateral epicondyle, which then develops into lateral epicondylitis (Shultz, Houglum & Perrin, 2005) as described below in Pathogenesis.  Risk factors for the development of tennis elbow/lateral epicondylitis include middle age groups (30 - 50 year olds), professional athletes who use a racquet, bodybuilders and occupations such as construction and carpentry (Kraft, 2009).

Pathogenesis:

Once the tears have occurred, the continued repetition of jerky movements aggravates this tissue damage, resulting in inflammation through the radial portion of the forearm, restricting movement and causing pain (Cyriax, J., 1936). The radial tendon continues to rub against the inflamed periosteum of the lateral epicondyle, and according to Davies (2006) causes further swelling, pain when resting, restriction of movement and weakness through the affected forearm in the long term.

Morphology: 

Once lateral epicondylitis has been triggered off by the initial tendinitis, morphological and histological changes occur.  The fibroblasts and collagen fibres produced as part of the body's healing mechanism in response to injury, lay down a new extracellular matrix to knit together the tendinous tissues (Shultz et al, 2005). The collagen fibres then strengthen and harden into a tougher matrix of granulation tissue containing more fibroblasts, blood vessels, collagen and fibrinogen leading to 'scar' tissue (Wikipedia, 2009) at the site of the lesion.

Epidemiology: 

Incidence - Tennis elbow/lateral epicondylitis affects 4-7 individuals per 1,000 patients as seen by a GP annually (Selby, 2004).

Prevalence - As indicated by research conducted by Allander (1974, cited in Pecina, 2004), tennis elbow/lateral epicondylitis was found to exist in 1 - 5% of a population of 15,268 individuals within an age range of 31 - 74 years.

References:

Cyriax, J. (1936) The Pathology and Treatment of Tennis Elbow (Electronic Version). The Journal of Bone and Joint Surgery, Inc., 18, pp. 921 - 940.

Davies, C. (2006) Self-Treatment of Tennis Elbow, Golfer's Elbow, Lateral Epicondylitis, Medial Epicondylitis, Elbow Tendinitis, Elbow Bursitis: The Trigger Point Therapy Workbook. Retrieved the 30th March, 2009 from: http://www.triggerpointbook.com/tennisel.htm

Kraft, J.  (2009) Tennis Elbow Isn't Just for Athletes.  Retrieved the 30th March, 2009 from: http://www.aopeoria.com/edu-art3.shtml

O'Young, B., Young, M. & Stiens, S. (2002) Physical Medicine and Rehabilitation Secrets. Philadelphia: Elsevier Health Sciences, pg. 267.

Pecina, M. & Bojanic, I.  (2004) Overuse Injuries of the Musculoskeletal System.  Florida: CRC Press LLC, p. 88.

Selby, M.  (2004) Clinical General Practice.  USA: Elsevier Health Sciences, p. 15.

Shultz, S., Houglum, P. & Perrin, D. (2005) Examination of Musculoskeletal Injuries. Illinois: Human Kinetics, p. 280.

Wikipedia. (2009) Wound Healing. Retrieved the 30th March, 2009 from: http://en.wikipedia.org/wiki/Wound_healing