resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
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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