Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
December, 2001, Vol. 01, Issue 12
Working with Central Nervous System Dysfunction
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article, I asked (on behalf of a massage therapist who had contacted me) if any of you have experienced working with a client who has a shunt to route excessive fluid from the brain to the abdomen.I got some wonderful responses, which I passed along to the inquiring therapist. It also raised an issue worth examining in more detail: What are some cautions related to working with clients who have injuries or diseases that interfere with central nervous system function?
The range of people who fall into this category is surprisingly broad. Young clients with cerebral palsy or spina bifida; survivors of head or spinal cord injuries; people with brain tumors or cysts; older clients with a history of stroke, Alzheimer's or Parkinson's disease - all of these people experience significant loss of CNS function.
I'll address the shunt situation first. Shunts are flexible tubes inserted into the brain to drain excessive fluid created by tumors, cysts or other disorders. (One reader told me about a client with hydrocephalus, for instance). The tubes run subcutaneously down the neck and into the thorax; they eventually drain into the peritoneal space. Clients with shunts may be able to lie prone or supine, but not on the side that is shunted, for fear of creating a blockage. Headaches and neck pain are likely to be present, and massage may be an effective treatment option, as long as great care is taken not to disrupt or interfere with the shunt in any way. Of course, in these situations, no massage therapist should be working alone. Communication with the client's health care team, especially his or her general practitioner and neurologist, is an important safety measure. (This communication cannot happen without written client consent, however, so be sure to have your paperwork in order.) Possible risks include a creating a kink or blockage in the tube, or physically disrupting the tube, either of which could precipitate a seizure (depending on the nature of the original dysfunction). These risks can be avoided with careful positioning and sensitivity to the presence of this foreign structure under the skin in the neck. Massage has a lot to offer these clients, if it is done with understanding and awareness. So get to work!
To address the issue of working with clients who have CNS disorders more generally, three situations demand specific kinds of attention from massage therapists: the client's ability to communicate; the presence of numbness; and the consequences of living with chronic degenerative disorders.
Communicating with Clients Who Cannot Speak
Put yourself in this position: you've been invited to a nursing home to do chair massage with some of the residents who have advanced Alzheimer's disease. You make eye contact with your first client and softly explain what you're going to do. You get no particular response to your words, but as you lay your hands on this gentleman's shoulders and let him become aware of your presence, you feel him take a deep breath, and some of the tension in his neck begins to subside. Great! you think, as you proceed into some gentle strokes, and maybe even kneading of his tight, contracted shoulders. His breathing becomes slower and more regular; he may shift in his wheelchair as his muscle tension changes. Perhaps by now you are busily working on one of his upper arms, where his deltoid is hard and wiry. Almost imperceptibly, he has begun to withdraw from you. Because your hands are no longer on his trunk and you are standing behind him, you don't notice that his breathing has all but stopped and his eyes are wide and worried. While you are happily thinking about all the good you are doing, your client, disoriented and frightened, cannot tell you to stop. Did you do something in particular to make him feel so threatened? Probably not, but that's not the point. He got scared, and his therapist did not appropriately read the signals. The session cannot possibly proceed.
Can you see how easily this could happen? Working with clients who cannot vocalize means that therapists must be ever-vigilant with nonverbal communications. This sensitivity points to the difference between working with clients and working on clients. When we work with clients, we enlist their participation in the process. We pay attention to this through all kinds of signals, verbal and otherwise: breath rate, facial expression, muscle tension, skin temperature, energy flow: all of these can provide nonverbal cues for how our clients are processing the stimuli that we provide. This is the beautiful dance of massage: stimulus, response, adjusted stimulus, new response, all with the goal of improved health and well-being, no matter what state we begin in.
Your client, now in his 20s, survived a high-school football injury in which he lost most spinal cord function at C5. He has limited use of his arms, but no feeling or function below his waist. He comes to see you because he has developed a shoulder tendinitis that makes getting around in his wheelchair a terrible trial. As you begin to explore his back, shoulder, and arm musculature, you realize that he has areas in which sensation is intact; areas in which he has muted sensation; and other areas in which he is entirely numb. Obviously bodywork that has the intention of kneading or stretching tight muscles is inappropriate in areas in which your client has no sensation, but does that mean you can't touch him there at all?
The contraindication for massage and numbness exists because when a client is numb, he cannot report whether the bodywork he receives feels good or is harming him. One of the complications of spinal cord injuries is the development of spasticity: muscle fibers become progressively tighter, more brittle, and more bound up with connective tissue. Any attempt to "fluff" up these contracted areas would only damage the tissue. The general rule I offer in classes and workshops that address spinal cord injuries is, "if they can't feel it, you shouldn't try to change it."
On the other hand, one of the benefits of massage is that we can increase our client's sense of "incorporation": literally, in-corpus, or "putting the body together." If we rub here, skip there, stroke here, jump over that numb spot, we do the opposite of incorporation; we reinforce a sense of detachment and disintegration. Instead of being woven into one beautiful and beloved whole, the client's body-sense falls to pieces.
In short, the rule for massage and numbness is that any touch conducted over a numb area must be done with the understanding that the client cannot give accurate feedback about whether it feels good or not. Therefore, it is not a good idea for massage therapists to try to change the quality of that tissue, although light strokes and gentle pressure is certainly appropriate. I have had letters from therapists who have found successful ways to stretch this rule, but it must be done carefully, slowly, and with the client's full and informed consent.
There is much more to be said about working with spinal cord injury survivors. Their condition carries many challenges and situations that massage may impact, for better or worse. If you are interested in learning more about massage and spinal cord injury survivors, or if you have stories of failures or successes dealing with this population, let me know, and I'll devote a future column to the topic.
Living with Chronic Degenerative Diseases
Some clients have nervous system disturbances that are not related to injury, but instead are the result of chronic, progressive, degenerative disease. Alzheimer's, Parkinson's, multiple sclerosis, amyotrophic lateral sclerosis (Lou Gehrig's disease), and several others fit under this heading. A diagnosis of any of these diseases means that although someone may find ways to slow its progress, the disease will probably lead to an eventual loss of nervous system function, and possibly to death.
Where does massage fit in this picture? We can't reverse the memory loss seen with Alzheimer's disease, and we can't restore the brain tissue that is lost in Parkinson's. What we can do is address one of the most debilitating complications of chronic disease: depression. Imagine being told that you can look forward to a future that holds virtually no hope for a cure, only the vague possibility that some new treatment options might reach the experimental stage within your lifetime. A natural result of this kind of event is the development of clinical depression: a combination of chemical and emotional stimulants that lead to sadness, grief, loss of interest in friends and loved ones, and a sense of hopeless doom. Sadly, the effects of depression, including poor sleep, a tendency to eat badly, and dissociation from people who could be supportive, can exacerbate the symptoms of the original disease.
Massage is a excellent way to interfere with this unfortunate process. Massage improves the quality of sleep, reduces stress and stress-related hormones, and provides a time when patients can focus on how good they can feel, and how wonderful their body is. Massage, along with other appropriate measures, can often help to ameliorate the effects of depression, which may be more debilitating, at least in the short run, than other symptoms of the original disease.
I have barely scratched the surface of what is involved in working with clients who suffer from central nervous system dysfunction. But if we begin by making accommodations for these three aforementioned issues -- the ability (or lack thereof) to communicate; numbness; and the debilitating effects of depression -- we will be miles ahead of where we started.
As background to composing one of my next articles, I'd like to take a poll: What would you like to see discussed?
I am eager to hear from you. Let me know what kinds of conditions your clients are dealing with, and how you've found massage influences that process. Therapists all across the country can benefit from hearing about your experiences, so bring 'em on!
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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