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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."
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."
A Reality Check – and a Chance to Educate
Imagine working in the public relations department of nutrition retailer General Nutrition Corporation (GNC) and reading the The New York Times announce...
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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
April, 2001, Vol. 01, Issue 04
A Comparison of the Somatosensory Effects of Therapeutic vs. Medical Massage, Part II
By Gregory T. Lawton, DN, DC
Editor's note: Part I of this article appeared in the March 2001 issue of Massage Today.
Mechanoreceptors and nociceptors are somatic receptors that act as biological sensors in response to physiological stimuli.The nociceptors respond to abnormal stimuli and transmit this information, most often as pain signals to the higher neurological centers. Mechanoreceptors respond to normal stimuli and transmit this information. Each of these two types of biological sensors tends to dampen or inhibit the other.
Nociceptors are found in the skin and throughout the musculoskeletal system. Nociceptors have been found in almost all connective tissue, with the exception of joint cartilage, synovial membranes, and certain parts of the inner vertebral disc. Nociceptive stimulation due to noxious stimuli has dramatic effects on the nervous system, and has been shown to promote segmental responses such as muscle spasm and increased sympathetic activity. Nociceptor stimulation can also stimulate suprasegmental activity that affects the hypothalamus and can cause sweating, nausea, weakness, pallor and dizziness. A commonly recognized problem in chronic pain is the continuing stimulation of nociceptors.
Mechanoreceptors respond to normal tissue environment and report this homeostatic activity to the central nervous system. Mechanoreceptors appear to respond to weak mechanical signals, gentle movement and pressure, and normal range of motion activities of the joints. Mechanoreceptors do not respond to noxious stimuli and are in fact inhibited by nociceptive input.
The two previous paragraphs, regarding nociceptors and mechanoreceptors are vitally important in understanding what constitutes effective medical massage therapy. Rather than basing our understanding and application of massage therapy technique simply on the theories or pet techniques of a few massage therapists, or upon inaccurate models of physiological function, we should seek to understand the scientific literature that reveals the deeper secrets of physiological function as it pertains to connective tissue therapy.
Based on what is scientifically known about mechanoreceptors and nociceptors, we can suggest the following principles as applied to medical massage therapy:
The above eight principles provide the medical massage therapist with both a mandate and an outline for delivering medical massage therapy. In addition, the medical massage therapist can use the scientific evidence from studies on mechanoreceptors and nociceptors to judge and evaluate massage therapy technique. Clearly, the scientific literature supports manual therapy technique that promotes responses in mechanoreceptors and any technique or activity that dampens or inhibits nociceptors. Four aspects of clinically effective treatment can be identified from the eight principles outlined above:
Therapeutic massage techniques (or any system of massage therapy) that stimulates nociceptor activity via painful and improper technique, will retard and delay the healing of injured connective tissues. Specifically, techniques that are improperly applied such as trigger point therapy and periosteal or deep tissue techniques will stimulate nonciceptive input, muscle spasm, pain, sympathetic hyperactivity, and supra-segmental physiological responses.
It should now be clear that the proper application of medical massage technique should include the avoidance of technique that stimulates nociceptive responses in the nervous system. This stimulation has a negative effect on the outcome of the treatment and the patient's healing process. From this viewpoint, pain is not gain. The massage therapist who wishes to apply the principles presented here in the clinical application of massage therapy technique probably needs to make subtle changes in manual technique. These changes include the following:
Medical massage therapy is a scientifically based method of manual therapy. Medical massage seeks a clear understanding of the scientific principles of physiology that affect connective tissue healing and treatment. Many currently utilized therapeutic massage techniques unnecessarily inflict patient pain and exacerbate the patient's condition, due to a faulty and erroneous viewpoint regarding biological sensory input and "proproceptors." This material is offered to all massage therapists, to clarify this issue and to offer more effective treatment methods. The next time you see an article showing (r a massage instructor demonstrating) trigger point therapy with the elbow buried an inch into the levator scapula and trapezius, consider the nociceptive stimulation this technique is provoking and reconsider the value of this type of technique.
Regardless of what we call or label the manual therapy techniques that we apply to clinical cases, we must, as massage professionals, recognize the need to thoroughly investigate current scientific research regarding connective tissue pathophysiology and reconsider our technique and treatment protocol based on this knowledge. For those massage therapists who prefer to practice general relaxation massage in recreational settings, while they may voluntarily choose not to practice medical massage, they must also recognize and understand the higher mechanisms of connective tissue rehabilitation and the ability of the medical massage therapist to treat connective tissue pathology.
The pet techniques of the massage therapist should not determine the patient's treatment. Treatment should be based on the findings, diagnosis, causation and symptoms of the patient's presenting problem or condition.
The allied medical professions and the chiropractic profession can also benefit from a detailed education in medical massage technique and protocol. The application of non-exacerbating technique directed at the primary area of pathology in most musculoskeletal disorders, the joint complex, is of profound value to medical massage therapists, chiropractors, physical therapists, occupational therapists, nurses and physicians who treat connective tissue disorders. Medical massage therapy may effectively become the pivot point where many of these health care practitioners come together in a common understanding of massage therapy.
References and suggested reading:
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