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Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Code Connection: Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
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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