resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
The Visual Error Scoring System: A Concussion Tool
Postural stability and oculomotor function are the most easily recognized physical indicators of neurologic motor dysfunction associated with concussions.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
January, 2001, Vol. 01, Issue 01
By Kate Jordan, NCTMB
Many massage therapists are confused and uncertain about the appropriateness of accepting pregnant clients who are in high-risk pregnancies. Who can be harmed? Can massage therapy and bodywork be useful and beneficial in a high-risk pregnancy? Are there techniques to avoid?
A high-risk pregnancy is one in which the mother or baby has a greater chance of injury or death.About 5-10% of all pregnancies in the U.S. fit in this category.
Prenatal care for women in this situation may include more extensive testing, more frequent prenatal visits, medications, and bed rest.
A woman may be identified as high risk because of her age (under 15 or over 35), family history, medical condition, or complications that develop in her pregnancy. Therapists should include a question about risk status in intake forms for pregnant clients, or in initial phone contacts. If a client indicates that she is considered to be high risk, it is essential to communicate with, and secure a release from, her prenatal health care provider, who will be a doctor, nurse-midwife, or lay midwife. Such a release asks the health care provider to approve massage therapy, and also list any precautions or limitations in massage procedures. I find it easiest to fax a release form to the doctor's office, or ask my client to hand-deliver it on her next prenatal visit.
When working with a high-risk pregnant client, it becomes even more important to observe basic precautions and contraindications for bodywork in pregnancy. Some clients may have been restricted by their health care providers in the positions they are allowed to take. This can include no sitting or prone or supine positioning, or lying on either the left or right sides. When no specific restrictions have been given, side-lying positioning is the safest, offers the greatest comfort, and increases blood flow to the heart. Side-lying is also the most common position a high-risk client on bed rest will be asked to assume.
Therapists should also modify bodywork modalities used on the legs in pregnancy. Fibrinolytic changes in pregnant women's blood makes blood clots more likely to develop. These clots can develop in both superficial and deep veins in the legs, and are not always detected by common tests. Therapists should avoid using techniques that involve deep pressure and friction on the legs. This includes, but is not limited to, deep acupressure, shiatsu, cross-fiber friction, deep tissue massage, and all percussive movement. In addition, all techniques on the legs, except for the lightest effleurage, should be directed toward the heart, since hormonal changes in pregnancy weaken the valves in veins.
Therapists should restrict abdominal massage with high-risk pregnancies to light touch, and should avoid touching the abdomen entirely in the first trimester. Since 80% of miscarriages occur in the first trimester (1-13 weeks), it is wise for a therapist to avoid even the appearance of possible contribution to the loss of a baby.
When a mother knows that her pregnancy is high risk, or develops a complication that puts her in that category, she may experience anxiety, fear, and guilt. This increased stress can further endanger the successful outcome of her pregnancy.
Massage therapy is especially appropriate for the high-risk mother, since it promotes relaxation, reduces anxiety, supports the physiology of the pregnancy, and can relieve the discomfort and muscle strain that develop when a mother is placed on bed rest. Recent research has shown that massage in pregnancy decreases the incidence of prematurity or other complications in labor.
When in doubt about the appropriateness of specific techniques for a high-risk pregnancy, therapists should consult experts in that modality, or err on the side of caution. Observing guidelines on client positioning and use of modalities will enable the therapist to provide the high-risk pregnancy client with a safe, enjoyable, and therapeutic bodywork experience.
There is a need to understand and address the unique health concerns of women. This column will continue to explore issues of particular interest in massage therapy and bodywork for women, including reproductive health, sexuality, body image and eating disorders, pain syndromes, osteoporosis, and aging.
Click here for previous articles by Kate Jordan, NCTMB.
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