resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Science of Stretching
In 1986, Rob DeCastella set a course record by running the Boston Marathon in 2:07:51, just 39 seconds off the world record.
Remembering Clarence Gonstead and 50 Years of the Gonstead Clinic
Dr. Clarence Selmer Gonstead (1898-1978) took chiropractic practice from back-alley bone setting to an understandable biomechanical science. His life was dedicated to clinical competency.
Physical Exam 101: The Hands
I am sure you are familiar with the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Fibromyalgia: Put the Pain in Its Place
While some fibromyalgia patients respond favorably to regular chiropractic care, others experience minimal relief. Unfortunately, many of these patients must rely on pharmacological management to relieve their constant pain.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
By the Numbers: 3 Common Financial Mistakes With Major Consequences
Warren Buffett is on record for sharing the hidden art of becoming wealthy and making it simple enough for anyone to grasp.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Coding for the Subluxation: ICD-9 vs. ICD-10
When I attended chiropractic school, I was taught that chiropractors approach health care differently than the traditional medical establishment.
Are You a Bad Chiropractic Patient?
My father was a great DC. In fact, as you might expect, he was the doctor of chiropractic I measured all other doctors against. Sadly, he died at age 61 when I was in my early 30s.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Curbing Label Overwhelm
For the average consumer, reading a food package can be overwhelming: natural, organic, non-GMO, gluten free, free range ... you get the picture.
Why You Should Include the Single-Leg Stance Test in Every Patient Assessment
The single-leg stance (SLS) test, also known as the single-limb stance test, unipedal stance test or one-legged stance / balance test, is often used in the geriatric population to assess static postural and balance control.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Vaccines and Chiropractic: Evidence-Based Medicine or Medical Dogma?
Right or wrong, the chiropractic profession has historically been against vaccinations. However, a growing trend within the profession is seeking to reverse this position.
Immunizations by Colorado DCs: Really?
You probably didn't hear about it, but back on Nov. 21, 2013, the Board of Directors of the Colorado Chiropractic Association (CCA) adopted "immunization authority" for Colorado DCs as its No. 2 legislative goal.
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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