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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.
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.
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!
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."
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.
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 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.
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.
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.
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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
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.
June, 2001, Vol. 01, Issue 06
With Legislative Intent
By Keith Eric Grant, PhD, NCTMB
I take on this month's topic with the "slight" hesitancy characteristic of following my two sons into an unheated swimming pool in winter. There are few issues that can polarize massage practitioners as quickly as that of licensing and regulation. Not coincidentally, there are also few issues that could benefit from dialog and critical reflection as much as this one.
Massage is a profession seeking credibility, a useful scope of practice, and freedom from the vagaries of local regulations. We habitually seek such goals within the realms of state occupational regulation (OR). Such regulation has been the most successful strategy for wresting control of massage from local agencies. However, local laws may apply even in states with licensing, unless the state's statute specifically forbids this.
In many states, the practice of medicine is defined so broadly that there is no unclaimed area of health care practice.8 Under such definitions, only professions that have their scope of practice carved out by a licensing law are free from the potential of prosecution. An alternative approach, recently taken in Minnesota and under consideration in California (SB577), is to redefine the business and professions code to specifically allow the unlicensed practice of noninvasive complementary methods.
The Legislative Intent of Occupational Regulation
For most states, the motivation for OR is to protect the public from harm that is recognizable and not remote. Without likely harm, there are fundamental rights for a person to be free to choose a profession.5,7 Motivations of legitimizing or recognizing the credibility of a profession are notably missing from state statutes defining the purpose of OR. So the key question becomes, what is the likelihood of harm occurring at a level of practice that licensing would prevent?
In 1997, the Georgia Occupational Regulation Review Council concluded that there was minimal potential for harm from massage.3 Recently, the British Columbia Health Professions Council concluded that there were no massage practices that warranted being declared as restricted acts.1 These conclusions, coupled with extremely low liability insurance rates, indicate that harm from massage is remote. Massage licensure would have rough sledding in states with sunrise (review) acts.5,7 and such states, like Florida, that currently regulate massage, would be much less likely to do so if the regulation were newly proposed.2 The assumption that unlicensed massage results in client harm is a dog that won't hunt.
Standards and Quality
Licensure is often promoted on issues of standards and quality, yet when closely examined, these are far from clear. When quality is measured by client satisfaction and availability of service, the relationship between licensure and quality is often weak.4,5,8
Measures of quality based on hours of education have been driven more by eligibility requirements for federal financial aid9 than by the need for specific training. In contrast, massage school owner Ramona Moody6 provides one of the few starting points that is based on examining the training needed to achieve minimum competence:
I participated in a task force initiated by the BPPVE [Bureau for Private Postsecondary and Vocational Education], which legislates massage schools among others. The purpose of the task force was to decide what the absolute minimum requirements should be for massage training. The massage schools, owners who participated in the task force decided that rather than develop a curriculum for the 250 hours suggested by the Bureau representatives as a minimum, we would discuss what knowledge we feel the students really need, and how many classroom hours it realistically takes to impart that knowledge. It was a really interesting discussion, carried out over several meetings, and the conclusion we came to was that it takes about 200-300 hours in the classroom to impart to students the minimum education we felt they really need in the marketplace. This included more than one massage modality, along with health and safety, anatomy and physiology, business practices and ethics, as well as communication skills. We felt this would make the student competitive in the marketplace, as well as no danger to the public.
Similar to massage, piloting a plane requires both kinesthetic skills and technical knowledge. Piloting, however, is much less forgiving of incompetence. The FAA requires 250 hours of flight experience to issue a single-engine commercial pilot certification.10 Coupling this FAA requirement with Moody's observations, it seems clear that minimal training requirements for massage are being significantly overestimated. It is incongruent to advocate integrity for the profession of massage when we have not assured the integrity of our own claims for licensing. If we are truly committed to improving the delivery of massage services, we need to take account not just the hours, but the modern teaching concepts and the social fabric for increasing the availability of massage.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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