Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
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.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
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.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
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.
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!
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
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.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
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.
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.
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.
Melatonin: A Promising Natural Agent in the Prevention of ALS
A number of years ago, experimental studies suggested melatonin could block key steps in the development of Alzheimer's disease, primarily by acting as a brain antioxidant and inhibiting the build-up of beta-amyloid plaque in the brain.
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
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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