resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
March, 2004, Vol. 04, Issue 03
Clinical Reasoning Skills
By Whitney Lowe, LMT
In the health care arena, assessment is commonly defined as the systematic process of gathering information in order to make informed decisions about treatment. We all do this any time we make a decision about how much pressure to use, which technique to employ, or how to address a particular problem presented by a client.What is different is the degree to which we use these assessment skills. As massage therapists become more involved in treating people, the process of assessment becomes increasingly important. You must be able to distinguish between conditions with similar symptoms and make vital decisions about how to approach a client's condition, or determine whether to treat the condition at all.
There are numerous systems of assessment for pain and injury conditions that share common elements, including the use of specialized orthopedic tests. These tests are used by different types of health care professionals to identify various pathological problems. Since different health professionals utilize the same tests, communication between multiple practitioners regarding the condition of a client/patient is easier. However, while these tests are a valuable part of the assessment process, a common trap can occur when using them. The trap occurs when too much emphasis is placed on using tests over other methods of assessment and evaluation. For example, if a client complains of shoulder pain, and you know about special orthopedic tests for shoulder disorders, it is a common fallacy to run through these tests to see if you can find the nature of the client's problem. This is still a shotgun approach. What is missing is an essential element of the assessment process: clinical reasoning.
When first learning about a subject, the information is often divided into separate facts or concepts. It is only after achieving a greater degree of mastery in the subject that people organize this information into usable patterns. Studies that have investigated the difference between the way experts and novices present information have found that experts put together more patterns of information, while novices tend to gather more separate details, many of which may be irrelevant to accomplishing the final task or skill they are learning. This aspect of learning and processing information is essential in assessment and clinical reasoning processes, and can be well-illustrated in the following example.
When a client complains of shoulder pain and describes the common symptoms, the practitioner must determine what information is relevant and how to proceed in the evaluation process. If the statements are considered separately, they may not lead to essential clues about the nature of the condition. This is often where the practitioner jumps to the use of several tests to see if he or she can hit on the "right condition"; however, the more skillful practitioner will pick up on statements during the initial intake and begin to form patterns. This practitioner will see connections between various signs and symptoms, and the further line of inquiry will almost lead itself in many cases. The art of reasoning is the ability to see these patterns of connection; therefore, the challenge is learning how to perfect those skills and see the patterns.
Consider the job of a detective. When investigating a crime, the detective must pick up on clues and determine which ones are important (and which ones are not). The ability to discriminate between the two can be difficult. The best way to make this choice is through a combination of subject-matter knowledge and experience.
For clinical practitioners, the more we know about various pathological problems, the wider the base of information we can draw from when searching for relevant clues. At the beginning, it will be difficult to know which clues are relevant - this is where experience comes into play. After seeing similar conditions a number of times, we develop an experiential background against which we can see similar patterns and recognize which cases are similar to others we have worked with before. As we combine our knowledge and experience, we are able to more accurately and quickly find the nature of a client's complaint.
The more skilled you become in clinical reasoning, the easier and faster the assessment process will be. Therefore, as you learn about assessment and range of motion evaluations, muscle tests, or specialized orthopedic tests, always think about why you are using a particular procedure, instead of just going through the motions. The more you understand why you are doing what you are doing, the more you will contribute to your ability to see these patterns within the clinical evaluation process, and significantly improve your skills.
Click here for more information about Whitney Lowe, LMT.
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