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Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
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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