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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."
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
Knee Pain From the Kinetic Chain
As practitioners of manual medicine, chiropractors often treat patients suffering from knee pain.
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.
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.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
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.
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.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
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.
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.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
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.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
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.
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.
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.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
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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