resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
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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