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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.
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.
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.
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.
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.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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?"
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 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.
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."
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.
September, 2003, Vol. 03, Issue 09
We Get Letters & E-Mail
Beginning this month, letters that were not published in the print version of Massage Today will appear online.
Readers can respond to these letters via e-mail at .Please write "WGL Online" in the subject line.
Editor's Note: Some letters have been edited for clarity.
Colorful Reaction to 'Shades of Gray'
Regarding your editorial in the April 2003 issue ("Shades of Gray" www.massagetoday.com/archives/2003/04/14.html), one more point of contention for your list: How to design these laws so that a massage education does not become a requirement for a touch modality in which it is not needed?
For example, a massage education is not necessary to practice Polarity Therapy safely and effectively, yet some massage school owners and national associations continue to try to use state law initiatives to force all touch therapists through their programs, for the obviou$ rea$on.
Little wonder that non-massage folks continue to resist the state-law movement.
John Chitty, RPP, RCST
Multiple Perspectives on 'Who Owns Manual Therapy?'
Editor's note: The following letters are in response to Cliff Korn's May editorial (www.massagetoday.com/archives/2003/05/10.html).
I would suggest that you take the time to understand [the Chiropractic] profession's point of view before writing an editorial about something [of which] you obviously know very little.
Chiropractic is the greatest supporter and promoter of massage therapy, and yet here you are biting the hand that feeds you. I think you need to ask some questions before you will understand.
My barber spends a few minutes after every cut, massaging my shoulders and neck. It feels good! This is technically a chair massage!
As a profession, how will you respond if every barber were given the opportunity to take a three-day seminar, which would then allow them to offer chair massage as a service? Give it some thought. Take your time and ask a few questions before shooting your mouth off and creating a problem where none existed before.
Print this as a response to your editorial and I suspect your readers will respond in favor of my point of view. Notice that I am a licensed massage therapist in Texas and not just a chiro.
Paul McLemore, RMT, BS, DC
I am a licensed massage therapist in Connecticut, and nationally certified. I am blessed with a diverse practice in which I hold office hours in a chiro clinic two days a week, do spa work two days and have a (primarily) sports-based clientele in my home office the balance of the time.
Your observations are spot-on regarding the lack of recognition of overlapping scopes of practice. I have had a DC tell me "Just worry about the 'soft stuff'; I'll handle the healing." This, in the case of a patient who was so heavily armored it was not possible for the doc to perform an effective adjustment. The implication was that if I were able to significantly relax the musculature, he would be able to facilitate the healing process. How's that for embracing the holistic model?
Another interesting story came from my contact with a principal in a principal in a physical therapy group. She had arranged a meeting for me to explore the possibility of adding massage therapy to her business. Several of her patients, most of whom were referrals from orthopedists, had specifically requested massage in addition to PT. She stated she "... didn't really get it, but if they wanted some 'fluffy stuff' to make them feel better, she'd be happy to charge them more to cover [my fee]". When I suggested to her that massage was not just "fluffy" but proven to be therapeutic, she snickered and said, "If that were the case, you or your colleagues would be on staff working in hospitals already"! Swallowing some pride, I decided it would be best to encourage her to find another LMT, wishing her good luck in the process.
It continues to amaze me that there is an enormous dialectic between healing arts and the health care industry. If the whole point of offering "health care" is to facilitate the healing process in individuals (or to assist in maintaining wellness) then the only logical viewpoint is from the holistic model.
All around us are volumes of evidence, both anecdotal and empirical, which argue there is an unmistakable, if indescribable, link among the mind, body and spirit. To presume to "treat" any one of these aspects solely is folly. How many times have your heard someone say, "I've been to several doctors and not one could tell me what was wrong, let alone help me"? Enough to suggest that there may not be anything wrong with the doctors; but the system sure is sick?
Where does the responsibility rest in reconstructing the paradigm? With those of us who perform the work every day and have the ability and opportunity to educate the public at large, and our colleagues in health care. For most of us, it will be on a one-on-one, face-to-face basis. For others, the public forums are the way. Seems to me there is some truth in the observation that no one "owns" manual therapy...we all do, whether trained on a doctoral level or just a guy who bumps his elbow walking through a doorway and rubs it himself, just to make it feel better.
Neal Delaporta, LMT
While I don't claim to speak for anyone else, I don't think Chiropractic in general is trying to contain or eliminate the massage therapy profession.
I read your editorial yesterday with much interest. I became aware of Kansas SB 225 after receiving a survey from one of the massage professional associations that seemed to indicate licensure of massage therapists was being contemplated by the Kansas legislature. I conducted a search on the legislature's web site and SB 225 was returned. I contacted the massage professional association to express my extreme concern regarding this bill. The response I received indicated that the association's legislative monitoring group would follow and report on the bill. Alas, they did not.
SB 225 alarmed me because "therapeutic massage" is specifically mentioned within in the scope-of-practice for physical therapists and, although language in the bill provides an exclusion for massage therapists, that exclusion seemed to me to be overly restrictive.
Here is the pertinent exclusion text:
Kansas SB 225 Section 10.C.18:
While I have no difficulty with the second portion of the above ("no drugs"), [the phrase] "Relaxation, muscle conditioning or figure improvement" is, in my opinion, an extremely limited description of a massage therapist's scope-of-practice.
This bill was signed into law by Gov. Kathleen Sebelius on April 11, 2003, despite the lobbying done by Kansas chiropractors. I do not know if any massage therapists lobbied for or against the bill. I would hope that any massage therapists would have lobbied against this bill, as chiropractors did. I naively relied on the professional association to monitor and report on the bill's status. I will not make that mistake again. Kansas currently does not have licensing requirements (or even registration) for massage therapists, therefore there is no other scope-of-practice definition for massage therapy in Kansas statutes.
Your editorial focuses on Kansas chiropractors attempts to usurp some of the massage therapy scope-of-practice and ignores the excessive limitations on massage therapy's scope-of-practice being imposed by the state legislature.
I wholeheartedly agree with your editorial's suggestion the various professions should be working together to arrive at overlapping scopes of practice. It is clear that Kansas legislators need an enormous amount of education regarding massage therapy. However, it seems to me that the general massage community would have been better served if your editorial illustrated the need to be much more vigilant in monitoring pending legislation rather than accusing the chiropractor's of attempting to grab power. These accusations seem to be designed to vilify chiropractic as a profession rather than to encourage massage therapists to partner with chiropractors and physical therapists in providing the much needed education to our lawmakers.
Cim Roesener, NCTMB
Just wanted to drop a quick note to tell you how important your "Who Owns 'Manual Therapy'?"article is to all practicing somatic therapists.
When my articles were released last year [in Massage magazine], I figured I would get some flack from some fringe "watchdog" group of Chiropractors. Sure enough, immediately after the first installment hit the stands, the magazine received a biting letter to the editor complaining that I was teaching massage therapists bone work and that they alone had legal rights to any mobilization of bones. He slammed me for referring to bodyworkers as "manual therapists" throughout the article and scolded me for not simply referring to my reading audience as "massage therapists."
I wrote back a very nice response, but in the next issue Gregory Lawton, DC, president of the Medical Massage Association wrote a nasty letter back to the chiropractor essentially reminding him of how the AMA had treated them, and how it made them feel. Essentially stating what your piece said, except not as eloquently. The letter was so harsh, Massage magazine had to edit much of it.
This practice among healthcare professionals of "drawing the line in the sand" has to go. We should all be working toward a common goal of educating our public in all forms of manual therapy technique in the best ways we know how.
Erik Dalton, PhD
I am a chiropractor and bodyworker with my own clinic. I am also one of the pathophysiology instructors at Bodymechanics School of Myotherapy and Massage. After reviewing your editorial, it seems you have made some assumptions about the chiropractic perspective on who should have the ability to adjust patients. The tone of the article makes us all seem like a very insecure bunch of doctors and I need to clarify that I am not, and neither are most of my colleagues. That said, you do have some good points.
First off, it seems the legal wording of the law in Kansas as you quoted it is far too broad and doesn't seem to fit the definition of chiropractic as we are taught in chiropractic college. It certainly covers the scope of practice of a chiropractor, but it is not a good definition of chiropractic. The key defining factor, theoretically, that sets chiropractors apart is the high velocity low amplitude thrust (HVLA) to specific spinal segments and joint complexes. That can be argued when looking at chiropractic and osteopathic joint manipulative techniques, but that's the main idea
The Kansas law does seem to override common sense when it comes to comparing chiropractic, as they have defined it, with existing professions, such as osteopathy, physical therapy, and massage. All those profession utilize the mobilization of tissues. Not to mention that a classic definition of chiropractic would exclude any electrical modalities. Chiropractic means "by the hand." I just don't see how that can be defensible in court and I wonder how it was passed into law in the first place.
The whole idea of a "turf" war about protecting the HVLA thrust as a technique that should be exclusive to chiropractors seems to be a big misunderstanding on your part (which may be propagated by politicians). Anyway, both chiropractors and osteopaths have been utilizing HVLA type techniques since the onset of both of those professions. The reality is not a factor of wanting to "own" a technique -- the issue is safety.
The 500-1000 hours of most massage therapy programs is no where near sufficient to learn the physical skill and clinical knowledge to know how to adjust, when it is appropriate to adjust, and, especially, when it is not appropriate to adjust a patient. The issue is similar with physical therapists, as their education is essentially a masters level education. The knowledge base is simply not enough to be able to gather a full clinical picture of whether a patient is safe to adjust with an HVLA technique.
Chiropractors have approximately 5,000 hours of education in chiropractic college, and I know that osteopaths have a similar education. Some people may feel that 5,000 hours is not necessary, but I have seen a number of patients that have been hurt with an HVLA type thrust from both massage therapists and physical therapists, as have many of my colleagues.
My purpose in writing this is not to attack your article. You made some good points, but I hope you have seen mine as well. Chiropractic and massage together make an great pair in helping patients recover much faster than either alone. I know there are a number of doctors in the American Chiropractic Association that took offense to the picture you painted of the chiropractic perspective. We should be working hard to make a positive environment for maximal patient benefit, not putting out fight songs.
Michael W. Neely, DC
Questions About Sports Massage
Editor's note: The following letters are in response to Michael McGillicuddy's July article, "The Art and Science of Pre-Event Massage" (www.massagetoday.com/archives/2003/07/11.html).
I was pleased to see your article about pre-event massage. I am a massage therapist in PA (prior to that I was in Tampa). My business provides sports massage to college athletes. I read the part of you article that stated: "A pre-event massage administered too close to the start of an event that requires an athlete's instantaneous response can actually interfere with the start." We provide pre-event massage at swimming competitions. How much time do you recommend between the massage and the start of a swimmer's race? I appreciate you feedback -- thanks again for the good article.
Michael McGillicuddy responds:
The first person I heard talk about not doing pre-event massage on swimmers was Benny Vaughn. He stated that they noticed that their swimmers starts were just a little bit slower when they received pre-event at the swim site before competing. They would do pre-event massage at the hotel where the team was staying, but not at the site.
You must watch your athlete's response to pre-event massage. If they are a fraction of a second off on the start, you could be doing them a disservice. Not all athletes respond the same; however, if you notice the start times are not as quick as they should be, do not administer pre-event massage close to the competition.
I enjoyed your article regarding pre-event sports massage. Since the first day of massage school, I wanted to focus most of my attention on athletes. However, getting into that field has seemed more complicated than expected. I was just wondering how you might suggest focusing more on sports massage and getting the clientele or applying for a position with a sports team.
Rochelle Beirmann, CMT, NCTMB
Michael McGillicuddy responds:
When I got out of massage school, I knew I wanted to do sports massage. I joined the Florida State Massage Therapy Association sports massage team, and we worked a sporting event almost every weekend. I also took every workshop I could related to sports massage. By being seen at events and educating myself as much as I could on sports massage, I began to develop a reputation in the community as one of the best.
After awhile, the athletes know who has the best hands and does the best job, and they seek you out. You can always get involved in your community by volunteering at events; most high schools need help with their teams. If you work on the student athletes, you get to know their parents and the other medical people who work with the teams. That is how your reputation will grow. Continue taking courses on sports massage and be sure to read everything you can on the subject.
"Positive Results Using Reflexology"
I just finished reading your column regarding working with stroke victims (www.massagetoday.com/archives/2003/07/12.html). I enjoyed it, particularly the photos.
I just wanted to share that there is (at least) one other specific modality that is effective in helping stroke victims. I specialize in reflexology with my work, and have had very positive results using reflexology with people who have suffered strokes (both minor and extreme), as well as other conditions arising from disturbance within the body's nervous systems.
Because reflexology speaks so directly to the central nervous system, it has the ability to override previous information that the CNS believes to be true (i.e. paralysis), and thus assists the body to restore motor function.
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