resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
May, 2003, Vol. 03, Issue 05
Adhesive Capsulitis: Freezing, Frozen, Thawing Shoulders
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
My last column on reflex sympathetic dystrophy syndrome (RSDS) seemed to hit a chord. It seems many of us work with clients who live with chronic pain - clients who feel they have limited options in the mainstream medical community.While massage is unlikely to be a curative for this frustrating and potentially debilitating disorder, it is clear we have some benefits to offer. The following is an excerpt from a letter I received from Cynthia van der Smissen, RMT, who achieved some success in treating a client with this condition:
As the title promised, this month's column is about another painful and frustrating condition, but one that has a much brighter outlook than RSDS: adhesive capsulitis, sometimes called "frozen shoulder."
Adhesive Capsulitis: What Is It?
Adhesive capsulitis is the currently accepted term for one of several disorders grouped under the umbrella heading "frozen shoulder." This group includes any combination of shoulder conditions that contribute to reduced range of motion (ROM) at the glenohumeral joint, including arthritis; bone spurs; bursitis; rotator-cuff tears; and impingement syndrome. These problems occasionally lead to secondary adhesive capsulitis, but require different types of intervention for complete resolution.
Adhesive capsulitis is an idiopathic (of unknown cause or origin) problem with a peculiar and unique presentation. It typically has a long, slow, painful onset ("freezing"), followed by a period during which pain is reduced, but function is severely restricted ("frozen"), and finally, a period during which all pain subsides and function is fully or nearly fully restored ("thawing"). The entire process can take anywhere from a few months to well over a year.
Adhesive capsulitis can afflict anyone at any age, but it is seen most frequently among women in their 50s. Some researchers suggest that it affects as much as 2 percent to 3 percent of the population at some point, and somewhere between 10 percent and 15 percent of those patients may have it bilaterally.
Etiology, Signs and Symptoms
Because the shoulder joint has less supporting connective tissue than most joints in the body, it has unparalleled mobility and a huge normal range of motion. Even the capsular ligament that links the humeral head to the glenoid fossa is looser than most joint capsules. This increases mobility, but it leaves the shoulder vulnerable to a number of injuries other joints typically don't face, because they're better protected.
Stage I: Freezing
When the process of adhesive capsulitis starts, the joint capsule begins to adhere to the humeral head. Sometimes, this process is secondary to another injury that limits shoulder use, but it also can occur without any discernable trauma or trigger. This time frame, during which the adhesions between the humerus and the capsular ligament progress and worsen, is the first of three stages, sometimes referred to as the "freezing" stage. The first stage of frozen shoulder can last for two to four months, and is acutely painful in both active and passive movements of the shoulder. Typically, range of motion is lost in medial rotation first, but may progress to all directions.
Stage II: Frozen
The second or "frozen" stage of adhesive capsulitis lasts anywhere from four months to a year. During this time, the joint capsule thickens and essentially glues itself to the humeral head - particularly the anterior portion. Although range of motion is severely limited during this time, much of the pain usually subsides.
Stage III: Thawing
Perhaps the most mysterious thing about adhesive capsulitis is that after many months of severely limited movement in the shoulder, and progressive formation of connective tissue adhesions between the joint capsule and humeral head, the condition begins to resolve spontaneously. The joint capsule becomes free, pain is eradicated and movement is restored. This process may take a long time; a year or more is not unusual. If completely untreated, it is likely that range of motion at the shoulder joint may not be fully re-established, but the percentage of lost function (again, this is usually in internal rotation) is often not significant enough to warrant further interference. The goal of many treatment options is to ensure that when the adhesions begin to melt, the fullest possible range of motion is recovered.
At this time, no single factor has been identified as a direct cause of adhesive capsulitis. Certain statistical relationships have been traced, however, that raise interesting questions. People with diabetes have a higher risk of developing this problem than the general population. The same is true for people with chronic fatigue syndrome; people recovering from heart attacks or strokes; and people with hypo- or hyperthyroidism. Adhesive capsulitis has been investigated as an autoimmune disorder; however, while some immune cell abnormalities occasionally have been observed, this does not seem to be a universal situation. If there is a single reliable causative factor for adhesive capsulitis, it has yet to be identified.
Generally, adhesive capsulitis is diagnosed based on patient history and clinical tests. The end-feel of the joint is firm, but not as hard as joints with a bony end-feel. Its pattern of progression is predictable enough that it can be identified without a specific blood marker or diagnostic test. X-rays and MRIs may be conducted to rule out other possible scenarios (bone spurs, osteoarthritis, tumors, tuberculosis, etc.), but they are not diagnostic for frozen shoulder. Arthrograms (tests in which a contrast medium is injected into the joint space), give useful information; not only do they show where adhesions may have developed, they also reveal how much fluid the affected joint can accommodate. A healthy shoulder will accept 20-30 mL of dye for an arthrogram; a shoulder with adhesive capsulitis will only be able to take in 5-10mL.
The results of various treatment options for adhesive capsulitis are not exactly cause for celebration. Studies of various interventions show that while they may be successful at restoring full, or nearly full, range of motion, they may not shorten the process. Indeed, overly aggressive physical therapy and exercise, while being painful, also increase inflammation and prolong the freezing or frozen stages. Interventions for adhesive capsulitis typically start with NSAIDs or other anti-inflammatories, then progress to home exercises, physical therapy and perhaps surgery. Cortisone injections may be prescribed to limit inflammation, and allow for the possibility of manipulation under anesthesia to detach adhesive material. This treatment can improve range of motion if successful, but the possible complications are serious: fracture of the humerus; rupture of the joint capsule or subscapularis muscle; and neurovascular or cartilage injury. Surgery to mechanically separate adhesions also can improve ROM, but carries the risks associated with surgery, and significant postsurgical pain.
Can Massage Help?
As always, this is where things get interesting. Nothing in the literature suggests massage can directly affect any of the tissues in which pathological changes are taking place. After all, we can't friction the inside of a joint capsule to reduce adhesions. Furthermore, passive stretching, while important to reduce the risk of permanent loss of ROM, is painful and may exacerbate symptoms if overdone.
So, if you have a client in any stage of adhesive capsulitis, what are your options? A few readers sent me some interesting suggestions. All of them deal with the secondary restrictive effects of adhesive capsulitis, but that makes sense, since muscular restriction reinforces joint restriction, leading to the vicious "use it or lose it" cycle of immobilization.
Kathleen Beruman of Bar Harbor, Maine, wrote the following about working with a client diagnosed with adhesive capsulitis and chronic fatigue syndrome:
Terry Solomon of Los Angeles, Calif. contributed these suggestions:
While neither of these stories can function as a fully performed research project, they do point out the fact that just because the "common wisdom" about frozen shoulder predicts pain and limitation for one year or more, doesn't necessarily mean that's what a client has to endure. Thoughtful, educated, sensitive, imaginative massage therapists are finding ways to "break the rules" with intractable disorders all the time. If you're one of them, I hope you'll share your story with the rest of us.
The topic for my next column is again your choice. Would you like to read about severe acute respiratory syndrome (SARS) - the "new flu" that is spreading rapidly in Asia and somewhat more slowly in the U.S.; various types of depression; or something entirely different? Let me know what's on your table, so we can share it with everyone.
Until then, blessings,
Ruth Werner, LMP, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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