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News in Brief
Northwestern Student Honored for Addressing Concussions Head-On; Northwestern Announces New CFO; Life U. to Provide Unique Opportunity.
Specialized Pro-Resolving Mediators: 21st Century Inflammation Fighters
Specialized pro-resolving mediators, or SPMs, are a portion of the omega-3 fatty-acid spectrum that have been shown to have a powerful effect on reducing inflammation.
The Value of Melatonin in Breast Cancer Prevention and Adjunctive Treatment
Although melatonin (MLT) is best known for its sleep-aid properties and as a natural remedy to prevent jet lag, extensive experimental studies suggest it possesses anticancer activity through several biological mechanisms.
Identify & Adjust the Apex Posterior Sacrum
Low back pain involving an apex posterior sacrum (+θX-axis misalignment) typically presents with signs of lumbosacral joint impingement or facet syndrome.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Day in the Life of an Advanced-Practice DC
Can you tell us a little about your background in the profession? Why did you want to become a DC? I studied at Boston University from 1968-1972 as a pre-med student majoring in biology.
F4CP Launches New Social Media Campaign
The Foundation for Chiropractic Progress has launched a new service to help member doctors: a social media campaign called "Accelerator."
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Designing a Fitness Plan (Part 4): Blending Pain Relief With Healthy Aging
Pain relief is still the No. 1 reason patients come to my office. However, most of my patients have other goals as well, such as: "I want to lose 10 to 20 pounds"; "I feel old and want to slow down the aging process"; "My doctor says I am becoming a diabetic and need to exercise"; or "I'm tired and want more energy."
Misconceptions & Opportunities With Medicare
As I speak around the country on how to properly document Medicare patient encounters, I get questions regarding opting out of Medicare. There are many misconceptions about opting out of Medicare, including just what it means to opt out.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Let's Streamline Your Front Desk
Your front office can be your greatest source of efficiency or a constant bottleneck. Increasing the productivity of this area without sacrificing the quality of patient interaction can be a little tricky.
Excited to Share the Science of Chiropractic: An Interview With Dr. Heidi Haavik
Dr. Heidi Haavik has become known in the circle of chiropractic researchers as not only a rising star, but also one willing to do research that can have a major impact in the scientific world and how chiropractic is perceived.
How Many of Your Patients Have Sarcopenia?
Figure 1 demonstrates the typical appearance of sarcopenia in the paravertebral muscles. Have you considered evaluating your patients for this problem? Sarcopenia is the progressive loss of skeletal muscle mass and function that affects the older population.
An Alarming Lack of Accountability
Accountability seems to be a lost quality today. The simple act of taking responsibility and doing the right thing just doesn't happen as often as it should. Maybe it is the litigious nature of our society.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
February, 2004, Vol. 04, Issue 02
Orthopedic Massage vs. Medical Massage: Are We Using the Correct Terminology?
By James Waslaski
Several weeks ago, after discussing my mother's "medical" condition with her surgeon, I realized how vital it is for our profession to establish the differences between medical and orthopedic massage.My mother had a critical medical condition called a dissecting aortic aneurysm, in which she exhibited low back pain symptoms, similar to someone with a tight iliopsoas. The medical doctor expected kidney problems, but - through divine intervention - an MRI discovered the massive aneurysm near the bifurcation of the femoral arteries, and it was ready to burst. I thank God each day that she did not go to someone minimally trained in medical or orthopedic massage, because an attempt to release her iliopsoas would have ruptured the aneurysm, and she likely would have died on the massage table.
However, a year prior to discovering the aneurysm, my mother had an "orthopedic" condition called iliotibial band friction syndrome that presented as lateral right-knee pain; through the release of the gluteus maximus, the TFL, and other tight muscles around the knee, surgery was avoided, and she is pain-free one year later, thanks to proper stretching techniques.
Orthopedic massage involves therapeutic assessment, manipulation and movement of locomotor soft tissue to reduce pain and dysfunction. Restoring structural balance throughout the body allows us to focus on both prevention and rehabilitation of musculoskeletal dysfunctions. I hope for this to be one of many articles on the differences between orthopedic and medical massage so that there is more consistency within the profession on the use of the terms. It is my strong opinion that misusing the term "medical massage" will build a wall between massage therapists and other health care professionals who spend many years studying medical conditions that are quite different from orthopedic conditions. After spending almost 20 years in a trauma center, I have seen thousands of medical and orthopedic conditions. As massage therapists, there are several potential dilemmas we face when we claim to perform medical massage. For example:
I am concerned about organizations that claim to "certify" massage therapists in medical massage in as few as three days. Doctors - especially chiropractors - frequently ask me how a massage therapist with as little as 300-500 hours of training can become certified in assessing and treating medical conditions in one weekend. I tell them that many educators and therapists in our industry misuse the term "medical massage" because it is the current "buzz word." In other words, it sells seminars and sounds very clinical when used in practice and on business cards. But there are longer, more comprehensive massage programs out there that train students in medical settings and discuss the signs and symptoms of various medical conditions, and if you are already trained as a nurse, doctor, or in another medical specialty, you can see the big picture much more clearly.
In my opinion, orthopedic massage is much more appropriate when we are treating musculoskeletal pain conditions or sports injuries. Its objectives are to restore structural balance in the muscle groups throughout the body, and decompress arthritic or painful joints. Muscle groups shorten, due to prolonged poor posture or repetitive motions, and shortened muscle groups need to be stretched out or they will pull bones onto nerves and blood vessels, and cause or contribute to all sorts of orthopedic conditions. I believe that conditions like joint arthritis are symptoms that result from tight muscles around a joint; thus, thoracic outlet and carpal tunnel syndrome are actually orthopedic conditions.
In thoracic outlet, our goal is to lengthen short muscle groups, such as the anterior and posterior scalenes, the pectoralis minor, and any supporting muscles that compress nerves in the neck and shoulder and cause weakness and radiating pain into the arm or hand. Carpal tunnel can often be effectively treated by lengthening the pronator teres and the flexors of the wrist, and assuring the carpal bones are in alignment. Achilles tendonitis would be best addressed by lengthening the gastrocnemius and soleus muscles. In my opinion, it is truly orthopedic massage when we work to restore range-of-motion, balance out muscle groups surrounding the joints to treat pain, and work to prevent and rehabilitate injuries that involve muscles, bones, tendons and ligaments. Orthopedic massage is also great for performance enhancement.
However, medical conditions can mask and/or complicate orthopedic conditions. For example, a woman in her third trimester of pregnancy may have excessive swelling in her wrists, adding to the tight muscles and tendons in the wrist area requiring medical assistance, perhaps also requiring the use of a diuretic (if not contraindicated) or lymphatic drainage to reduce inflammation. There are functional assessment tests that can determine most orthopedic conditions and outline a treatment plan using multiple modalities. These assessment skills better align you with other orthopedic experts, including orthopedic surgeons, chiropractors, physical therapists and osteopaths.
I also believe that combining multiple disciplines allows better results. One patient may respond better to CranioSacral Therapy, while another requires lymphatic drainage, and the next needs a combination of myofascial release, neuromuscular therapy and stretching. (I will touch more on a multidisciplinary approach in a future article.) Lastly, patients need to be actively involved in their own treatment by perhaps changing the ergonomics of the work environment, watching their posture, using good body mechanics, and doing specific stretches and exercises between treatments.
I would briefly like to address one other concern about the current state of the massage profession. I came from Florida and trained with many of the leaders in our industry. I also took college courses in pathology, biomechanics, anatomy and physiology, then took years of workshops to prevent "tunnel vision" into any one discipline from occurring. In Florida, the base training starts at 500-600 hours and becomes more advanced.
In Texas (where I now live), a person can be a practicing and certified massage therapist with 300 hours. I recently attended a great insurance billing seminar here in Texas; what frustrated me, however, was that many of the attendees had only 300 hours of training. Even if these therapists learned to use the insurance billing codes properly, it is unlikely that after only 300 hours of training, they could ethically support their treatment and billing claims without additional training. I also see claims to "certify" these therapists in medical massage without administering a written and practical exam. No wonder the medical community looks down on us!
I hope I have put a bit of fear into massage therapists that may still have a long way to go to understand that all medical conditions do not fall under plain and simple treatment protocols learned in a basic medical massage training program. As a profession, I suggest we work to distinguish medical conditions from orthopedic conditions to better align ourselves with other medical experts.
I look forward to seeing how the National Certification Board for Therapeutic Massage and Bodywork defines an advanced-level therapist, once it moves to a higher level of certification, and is confident that the process includes a large panel of experts in role delineation and item-writing processes. I also hope that more schools and educators can agree on whether we should call our work clinical massage, orthopedic massage or simply an all-inclusive term like medical massage.
Click here for previous articles by James Waslaski.
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