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TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Avoid Random Treatment of Trigger Points (Part 2)
We must acknowledge that the fascia, which surrounds literally everything in our bodies, including every muscle fiber, is more than just a covering.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Help Update the LBP Practice Guideline
The Council on Chiropractic Guidelines and Practice Parameters has announced the release of an updated Clinical Practice Guideline for Chiropractic Management of Low Back Pain for stakeholder review and comment.
Impacting Chiropractic's Future With Technology
When it comes to electronic health records (EHR), Robert Moberg and Dr. Steven Kraus are two of the leading industry experts on the topic.
Expanding Access, Branch by Branch
The big news coming from Capitol Hill isn't merely the recent introduction of a pair of bills designed to expand chiropractic services in the Veterans Affairs and military health care systems; after all, similar legislation has made its way through Congress before, never reaching the Oval Office for presidential signature.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
B Vitamins Improve Memory, Prevent Brain Atrophy
The 2010 OPTIMA study showed that the accelerated rate of brain atrophy in elderly with mild cognitive impairment could be slowed via supplementation with homocysteine-lowering B vitamins, which included folic acid, vitamin B12 and vitamin B6.
Atypical Femoral Fractures and Bisphosphonate Use: What to Watch For
Bisphosphonates (BP) are popular drugs, with more than 8 billion in sales in 2008; however, profits have declined as patents began expiring. Nonetheless, BP remain the most commonly prescribed drugs for patients at risk of osteoporotic fractures, with several million prescriptions written every year.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Primary Spine Care: Addressing Concerns & Criticisms
The Dec. 1, 2013 issue of Dynamic Chiropractic included an article describing the implementation of a training program for primary spine practitioners (PSP) within a metropolitan region and supported by a large BC/BS plan.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Interpersonal Skills 101: Enhancing the Value of Our Patient Interactions
Recently, I read an interesting article in our local newspaper titled "The Value of Human Interaction." The article presented comments from a senior editor for Fortune magazine who discussed "Civility in the Business World."
Low Back Pain: Posture and Movement Analysis
When performing static and dynamic movement analysis of the lumbopelvic hip area, begin with standing visual posture analysis of the pelvis, and then perform lumbar range of motion and assess what you might see during normal versus abnormal lumbar flexion motion.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
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 more information about James Waslaski.
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