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Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
May, 2002, Vol. 02, Issue 05
Working with Clients Who Have Spinal Cord Injuries
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article I provided some information on multiple sclerosis - a topic that many readers had requested. I hope that information was helpful and provided some insight into fruitful ways to work with these clients.At the end of the article, I promised to devote my next column (this one) to working with clients who have spinal cord injuries - another frequently requested topic. Then I put out a request for those of you who work with that type of client to share what you do, what works, and what to avoid, so that we all might benefit from your experiences.
Guess how many responses I got? Goose egg. Zilch. Bupkis. To me, this means one of two things: either no one is doing any work at all with spinal cord injury survivors, or no one feels confident enough about what they're doing to share it with others. I know the first can't be true, since somewhere between 183 and 230 thousand people in this country currently live with permanent spinal cord injuries. Surely some of them receive massage!
After considerable research, I finally found a few therapists with experience in this area. In addition, I just finished being a support person for the 2002 Winter Sports Massage Team for the Paralympic Games, so I do have some things to share. I'll proceed on the premise that many of us do have some of these clients, but we feel that we're working in the dark. I'll do my best to shine a little light on this subject.
First, let's look at what exactly happens when the spinal cord is injured.
Spinal Cord Injury: What Happens?
Spinal cord injury (SCI) is a situation in which some or all of the fibers in the spinal cord are damaged, usually by trauma, but occasionally from other problems such as tumors or bony growths in the spinal canal. They fall into one of three categories: concussions, in which tissue is jarred and irritated but not structurally damaged; incomplete injuries, in which only some of the neuron tracts in the spinal cord have been damaged; and complete injuries, in which all the ascending and descending tracts have been interrupted at a specific level or levels.
As long as at least part of the spinal cord is intact, some motor or sensory function may remain in the affected tissues. This factor will determine what kind of recovery a person can expect to achieve. Obviously, the higher the damage, the more of the body is affected. Injuries to the anterior part of the cord affect motor function, while damage to the posterior aspect affects the senses of touch, proprioception, and vibration. Damage to the lateral parts of the cord interrupts sensations of pain and temperature.
An injury that affects the lower abdomen and extremities, but leaves the chest and arms intact, is called paraplegia. An injury that impacts the body from the neck down is called tetraplegia or quadriplegia. Among the SCI patients alive today, quadriplegics slightly outnumber paraplegics.
A person with a newly injured spinal cord goes through a period called "spinal cord shock." During this time, blood pressure is dangerously low, the heart beats slowly, peripheral blood vessels dilate, and the patient is susceptible to hypothermia. A number of secondary reactions may occur in the CNS at this time, including excessive bleeding; edema; free radical activity; scar tissue formation; white blood cell attacks on healthy tissue; and demyelination of healthy cells. These secondary responses can interrupt function up to two full levels above the primary injury, but they can be controlled with medical intervention, so it is vital that the patient receive aggressive care during this window of opportunity. With a new spinal cord injury, the affected muscles may be either flaccid or hypotonic. When the inflammatory process begins to subside (and this can take days or weeks after the initial injury), the muscles supplied by damaged axons begin to tighten, and their reflexes become hyperreactive. Spasticity along with hyperreflexia is a hallmark of spinal cord injury. If muscles stay flaccid and reflexes are dull or nonexistent, the damage is probably to the nerve roots rather than to the spinal cord itself. Injuries to the low back often show this pattern, as the spinal canal is occupied by the cauda equina nerve root extensions from T12 down to the sacrum. Depending on the nature of the trauma, it is perfectly possible to sustain injury to both the spinal cord and the nerve roots simultaneously.
Spinal Cord Injury Complications
Spinal cord injuries can lead to many serious long-term complications, several of which have important implications for massage therapy. SCI patients invest a lot of time and energy in working to prevent, minimize, or recover from these secondary problems.
Spinal Cord Injury Treatment Options
New treatment options for SCI patients are being developed daily. Some SCI patients may have electrodes implanted in muscles that are controlled from an external computer. These implants can provide pinching and gripping capabilities for people who otherwise would not have the use of their hands. Surgical transfer of healthy tendons can also be helpful. For some people, the triceps muscle may be paralyzed, while the deltoid is not. Surgically extending the posterior deltoid tendon and attaching it to the olecranon can provide these people with the power it takes to use a wheelchair.
Treatment for SCI survivors is targeted at providing them with the skills to live as fully as possible. Physical and occupational therapists specialize in helping these patients gain the skills they need to function; mental/emotional therapists are also critical, especially for those who are adapting to their paralysis as a new way of life. Ultimately about 90% of all SCI patients are able to live independently with these new skills.
Spinal Cord Injuries and Massage
With all these complicated processes going on, and all these potentially dangerous problems that may develop, could it ever be appropriate for an SCI survivor to receive massage? Absolutely. In fact, the range of massage therapy modalities that can be successfully used with SCI patients is exactly the same as that for any other clients. As long as threatening complications like blood clots, pressure sores, and infections are not present, massage therapists can apply their skills with compassion and imagination to the great benefit of their clients.
Some bodyworkers specialize in energy and light-touch work with their SCI clients: this approach, which could include therapeutic touch, craniosacral therapy, and any number of other modalities, can be especially powerful in achieving "incorporation"- that weaving together of the whole body that many SCI patients lose.
Other approaches address the mechanical challenges of being confined to a wheelchair. The spasticity that SCI patients live with is a chronically progressive situation. This progress can be slowed or even halted with a carefully applied program of exercise and stretching-massage is certainly appropriate in this setting. Further, some of the spasticity and contractures that SCI patients experience seem to be a function of myofascial binding as much as loss of enervation. One therapist I spoke to described how exciting it was to work with an elderly patient's gnarled and claw-like hand, and see her gradually relax and be able to regain some control.
As SCI patients' muscle tone changes, they are likely to experience postural distortions that can be quite painful. Massage can help to limit this process and reduce the pain associated with it. As long as sensation is present so the client can give accurate feedback about how the bodywork feels, massage can be a powerful tool in keeping these changes at bay.
Finally, many SCI patients have to cope with chronic tendinitis and overuse syndromes in their hands, wrists, elbows and shoulders. In these cases it's not only appropriate, but essential to receive bodywork that can help to restore function as quickly as possible.
Practical questions such as how to position clients on a table, or whether to use a table at all, can only be answered on a case-by-case basis. At this year's Paralympics, the 2002 Winter Sports Massage Team had hydraulic tables that could be raised and lowered to make getting in and out of a chair as easy as possible. This is a good investment for therapists who work with any clients who might have movement difficulties. Plan on using bolters extensively, and be sure to accommodate for urinary catheters and/or colostomy bags. Ultimately, the best service we can offer is simply to ask, "How can I make you most comfortable?"
I'd like to conclude this article with excerpts of a reflection written by Jan Fields, a member of the 2002 Winter Sports Massage Team, after he had worked with a Paralympic alpine skier with spina bifida:
So, readers, what's next? Give me some ideas of topics you'd like to see discussed in "Dealing with Pathologies: What's on Your Table?" Otherwise, I'll just make some up of my own!
Ruth Werner, LMT, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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