Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
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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