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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.
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.
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.
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.
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.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
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.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
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.
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).
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
March, 2003, Vol. 03, Issue 03
Working With Clients Who Have Reflex Sympathetic Dystrophy Syndrome
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
My last article on hyperthyroidism prompted some interesting responses. In that article, I mentioned I had an unusually difficult time finding any useful information on alternative treatment options for hyperthyroidism patients who wanted to avoid surgery or radioactive treatments to their thyroids (because of the increased risk of developing hypothyroidism).As usual, you came through in a big way. Here's an excerpt from one of the most hopeful letters I got:
This month's column is dedicated to a condition quite different from thyroid dysfunction. Over the course of my time with Massage Today, many readers have requested some information on a disorder that is not at all well understood, even by the professionals who try to treat it. Reflex sympathetic dystrophy syndrome is a condition involving an initial injury (usually) to an extremity (usually), which results in a disproportionate amount of pain, disability, and trophic (growth-related) changes to the damaged tissue. In some cases the symptoms of RSDS can move progressively through the body and affect areas distant to the original trauma.
In October 1864, a group of doctors compared their observations of Civil War soldiers recovering from gunshot wounds. Their comments were remarkably astute, and constitute a vivid picture of the experience of the condition eventually termed "causalgia" from the Greek kausis (burning) and algia (pain).
Reflex Sympathetic Dystrophy Syndrome: What Is It?
RSDS involves tissue damage, overactive sensory neurons, an excess of pain-sensitizing chemicals, and resulting inflammation followed by atrophy of the affected area. Because it is called so many things, and the criteria for making a diagnosis varies by medical specialty (orthopedists use different methods than general practitioners or internists, for instance), it is extremely difficult to pin down and get any solid statistics on its incidence or demographics.
Part of the confusion around this disorder lies its name. Chronic progressive pain syndromes have many labels, and RSDS just happens to be the one that is most popular at this moment in time. Here is a short list of other labels for this or very similar conditions:
The most conservative discussions of RSDS limit it to problems that begin in the hand or arm. This discussion won't limit the damage to the upper extremity, but please be aware that clients who live with this condition may have learned to call it by a different name, depending on where it has affected them, and what kinds of professionals they work with for treatment.
Etiology: What Happens?
When a person experiences any stimulus on the skin, a sensory neuron carries that information to the spinal cord, where a reflex response begins. At the same time, that impulse travels up the spinal cord to the brain, where the stimulus is interpreted at a conscious or subconscious level. If the stimulus is perceived as something safe and relaxing, it initiates a parasympathetic response; if it is interpreted as threatening or painful, a sympathetic response follows.
In RSDS, as far as it is understood at this point in time, a stimulus initiates a sympathetic, but this response long outlives its usefulness. The affected part of the body goes through a localized cycle of pain, which causes sympathetic responses, which reinforces the pain, which exacerbates the pain response, ad infinitum. The healing processes that would normally interrupt this sequence are unable to break through the vicious circle of pain - stress - pain. Eventually, the physiological changes that occur when a specific part of the body is stuck in a sympathetic loop cause their own kinds of damage - damage that can be irreversible. Tissue that experiences chronic inflammation will become essentially "walled off" from the rest of the body, and develop severely restricted blood and lymph supply. This leads to atrophy, bone thinning, and permanent loss of function.
Although it happens only rarely, this pain cycle also has the potential to spread proximally on the affected limb, to the eyes, internal organs, and even to the contralateral limb.
Signs and Symptoms
Four main symptoms have been observed in most RSDS patients: constant burning pain with little or no stimulus; local inflammation and sweating; spasm of both skeletal and smooth muscle in nearby blood vessels; and chronic insomnia (which can contribute to increased pain perception, as sleep deprivation can disturb neurotransmitter levels).
RSDS can be broken down into three or four loosely defined stages. Overlap of these stages often occurs, so they are useful mainly as a time reference for how long a person has been affected by this condition, and what treatment options have the best chance of interfering with its progression.
Diagnosis and Treatment
Because the diagnostic criteria for RSDS and related disorders vary according to medical specialty, it can be difficult to reach a conclusive diagnosis in the early stages of the disease. This is a problem, because the long-term outlook for someone with this problem is significantly better if he or she can begin treatment in Stage I, rather than Stage IV.
Visible signs and patients' descriptions of symptoms are usually straightforward with this condition. Diagnosis can be confirmed with thermography: a test that measures blood flow and localized heat in the body. X-rays or bone scans may be used to look for signs of osteoporosis at the site of injury.
Stage I RSDS may be treated with simple analgesics: NSAIDs or short-term steroids if necessary. Patients get good benefit from heat, especially moist heat applications like paraffin baths or hot packs. Ice is generally not useful for RSDS patients in any stage. Stage II and III RSDS patients need to be more aggressive with their pain management. Anti-seizure medications and morphine pumps are used with mixed results. TENS machines are successful for some people but not all. Calcium channel blockers may improve blood flow and relieve pain. Eventually, a patient may consider a sympathectomy: the surgical severing of parts of the sympathetic nervous system in order to stop the endless cycle of repeating pain signals. This intervention can be successful, but many patients report that the benefits are short-lived and the pain comes back post-surgically.
Can Massage Help?
This is where it gets interesting. Usually, when I research a particular topic, I look up that subject plus "massage," and get exactly nothing. Then I try that topic and "alternative treatments" and often have marginally more success. But for RSDS, this acutely painful, poorly understood sensory dysfunction, I found much more information about massage than I usually do. I found testimonials of RSDS patients who felt their massage therapists had prevented them from developing contractures in their affected muscles; I found suggestions to use massage to help desensitize over-stimulated areas; and massage is frequently recommended along with some other alternative therapies for chronic pain management. I also got some feedback from therapists who specialize in working with RSDS patients; an excerpt from one letter follows:
The upshot of it all is that although RSDS is a painful, inflammatory, potentially progressive condition (all of these qualities raise some cautions for massage), bodywork can serve a useful purpose in the treatment options (or just coping options) for the person who is affected by this disorder. Exactly what modalities to use, and how to avoid causing more pain than necessary while working to maintain muscular and joint health, will depend on the tolerance of the patient and the skills of the therapist.
This is an excellent example of a condition in which a massage therapist should work as part of a health care team, not as a solo practitioner. For more information about RSDS, I highly recommend the following Web sites:
Next time, I'll discuss another frustrating, chronic, progressive condition, but one that has a generally more hopeful prognosis: adhesive capsulitis, also known as frozen shoulder. Send me your success - and failure - stories, so we can all benefit!
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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