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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.
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.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
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.
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
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.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
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.
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.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Fish Oil: A Key Component to 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?
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
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.
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!
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Peaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
April, 2002, Vol. 02, Issue 04
Scope (Not the Mouthwash)
By Cliff Korn, BS, LMT, NCTMB
"Scope of Practice" is a term that, like many others, seems obvious, but means different things to different people. Strictly speaking, a scope of practice is the legal limit of practice options available to a regulated practitioner.However, in common usage, associations develop scope-of-practice guidelines for professionals in a field independent of regulation. A practitioner's scope of practice is predominantly measured by definition, and definitions change depending on who is doing the defining. Laypersons and regulators may define terms we use internal to our work differently than we do.
An example of this can be found with the term "massotherapy." From a school website comes this definition: "Massotherapy is a scientific method for treating disorders of the human body through manipulating the soft tissue, by hand or other modality, to affect relaxation, relieve pain, increase range and mobility of joints and ligaments, reduce certain types of edemas, affect blood and nutrition, improve metabolism, promote circulation, and beneficially influence the nervous system." Another school's site defines the same term as: "Massotherapy is a hands-on application that consists of a number of techniques executed on living tissue with the objective of promoting a general well-being. This type of therapy has an effect on the skin, muscles, tendons and ligaments (referred to sometimes as soft tissue) and aims for a physical as well as a psychic well-being since the last two are closely related." Yet a third defines it as the following: "Massotherapy is massage therapy or a systematic and scientific manipulation of the soft tissues of the body."
They all make the term seem pretty synonymous with "massage," don't they? My favorite choice for definitions is Webster's New World College Dictionary, Fourth Edition. My copy defines massotherapy as "a physical therapy by means of massage." My guess is that individuals looking to initiate state regulation/licensing of massage would get fewer objections from the physical therapists if they studiously avoided Webster's definition!
Individual state regulators can and do choose how they wish to define terms and scopes of practice. This can drastically affect a scope of practice from one jurisdiction to another. A classic example of this is colon hydrotherapy, which until recently was (in one state) not allowed in a licensed massage establishment, while in a different state required those performing colon hydrotherapy to also be licensed massage therapists. In another state, a practitioner of massage may treat temporomandibular joint dysfunction only if a physician has directly referred the patient in writing for such treatment. One state allows the application of non-prescription topical substances on the body within its scope of practice. This has led massage therapists there to offer facial massage, which really irritates the estheticians, who consider the word "facial" to be theirs alone.
Certainly massage therapists deal with overlapping scopes of practice all the time, but regulatory definitions, scope limitations and educational requirements make it particularly difficult within the broad umbrella of massage therapy. Many well-meaning massage boards have developed broad massage definitions so that other professions aren't able to exclude massage therapists from the conduct of emerging advances in the field. A side-effect of this is that many people get swept up in the regulations that feel like they don't fit a definition of massage. Reiki practitioners in all but the most hard-nosed jurisdictions have been able to exempt themselves from most massage definitions. Other methodologies, which frequently wish to opt out of massage regulation, are reflexology and polarity. They make strong cases for not fitting the definitions of massage in many instances, but my trusty Webster's defines reflexology as "a practice involving the use of acupressure or massage of the hands or feet to relieve pain in other parts of the body, reduce tension, etc." The International Institute of Reflexology also lists itself as approved for continuing education by both the Florida Board of Massage and the NCBTMB. Do you think a regulator or layperson reading that definition and noting those approvals would see the merit in granting reflexology an "out"?
Similar difficulty with structural integration, Bowen technique, Asian bodywork, Trager, watsu, CranioSacral Therapy, etc., stems from differences in definition. One I found humorous was Webster's definition of Rolfing. It states, "service mark for a form of painful massage intended to relieve emotional tensions by relaxing and repositioning the muscles." My guess is that the Rolf Institute's public relations team will soon be petitioning Webster's publisher for a definition change!
The differences in state-by-state definitions and scopes of practice are particularly stressing to massage therapists. As a group massage therapists tend to be a mobile lot and the ability to cross state borders relatively seamlessly should be a boon. An organization had been in place to attempt to find common ground in regulatory language. Unfortunately, the National Alliance of State Massage Therapy Boards is all but dead. It has no leadership and no plans to meet again. Perhaps there can be a grassroots effort to get it re-established.
Thoughts on scope of practice are always affected by definitions. Here are a few (from Webster's, of course!) to ruminate on when next you are discussing the benefits of accepting or rejecting regulation, embracing or delaying continuing education, or contemplating whether you are a professional or a hobbyist in massage:
My high-school biology teacher used to use a phrase that still stays with me: "Ontogeny recapitulates Phylogeny." It refers to life cycles of individual organisms affecting the life cycles of groups of organisms. When we choose to define our scopes of practice, we affect more than just ourselves. As that teacher was alluding to with his jargon, what happens to one is indicative of what happens to many!
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be published in a future issue of Massage Today. Please send all correspondence by e-mail to , or by regular mail to the address listed below:
Former editor of Massage Today, Cliff is owner of Windham Health Center Neuromuscular Therapy LLC. He is nationally certified in therapeutic massage & bodywork and is licensed as a massage therapist by the states of New Hampshire and Florida. Cliff is a member of the International Association of Healthcare Practitioners; a professional member and past president of the New Hampshire chapter of the American Massage Therapy Association; a certified member of the Associated Bodywork & Massage Professionals, Inc.; and a past chairman of the board of directors of the National Certification Board for Therapeutic Massage & Bodywork.
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