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Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
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.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
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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