resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
March, 2005, Vol. 05, Issue 03
We Get Letters and E-Mail
By Editorial Staff
Massage Today encourages letters to the editor to discuss matters relating to the publication's content. Letters may be edited for space and clarity, and published in a future issue or online.Please send all correspondence by e-mail to or regular mail to:
The following two letters are in response to Janine Ray's article, "Updating Texas Massage Regulation" (Nov. 2004, www.massagetoday.com/archives/2004/11/04.html).
"Please stop pushing for more hours"
Why stop at 500 hours? Why not create an Associate's Degree in Massage Therapy Services (ASMTS) or better yet, a Bachelor's Degree in Touch Therapies (BSTT), then a Master's Degree in Specialized Touch Therapy Techniques (MSTTT), and eventually a PhD in Healing Arts (Dr. of HA)! If professional massage therapists wish to be doctors or physical therapists or other specialized healers, by all means go to college or get the education you need to be better and more validated. There are certainly unending opportunities out there. But please stop pushing for more hours and more continuing ed hours and more regulation within our industry.
I have been a "professional" massage therapist for over 10 years. I graduated with 500-plus hours. I could do a great massage before I ever went to school - the only thing the school did for me was give me the documentation required to sit for the licensing tests. My massages are soothing, relaxing and healing not because I am well versed in massage techniques and anatomy, but because I do not try to fix anything. I don't need more massage education (especially CEUs) even though I do seek out information and classes that I am interested in or feel may help me be better at what I do.
Yes, I want to help my clients feel better and I know that massage therapy can often do more to provide relief for many ailments than doctors, medication, psychotherapy, physical therapy, etc. It also complements other healing arts; however, I think too many massage therapists are playing doctor now.
CEU credits are a joke and a rip-off. Either you pay $300 or more for a class that teaches some "new," "revolutionary," or "simple" technique that will stretch, release, relax, fix and repair, or you opt for the cheapie $99 or under anything-you-can-get-to-qualify-as-six-CEUs-with-the-massage-licensing-board-class that doesn't really provide anything but a piece of paper to validate the time spent in class. Point being: There are some excellent training classes out there; I think it's great that massage therapists want to improve their skills - I certainly want to improve mine - but I don't want to be required to do so, and I don't think it is necessary.
Those who wish to accept personal injury and workers' comp claims and "treat" their clients' ailments are the ones who need to do whatever it takes to make that an option in their practices. I certainly don't want to get involved with insurance claims. Nor do I want to be involved in litigation because I performed services outside my scope of practice, which is happening too much in our industry.
Specialization and diversity in scope is wonderful. CranioSacral, Esalen, medical massage, visceral manipulation, myofascial release, and multitudes of techniques ad infinitum are expansions of practice and all require extended educations. Bravo! You go ladies and gentlemen, but leave those of us who want to practice a simple relaxing massage to our own devices. I have a thriving business of clients who don't want me to fix anything. Perhaps if more massage therapists could give a good basic massage instead of trying to dazzle 'em with BS, there would be a lower attrition rate.
I don't think these are issues at all. They are contrived excuses for people who want to tell others how to run their businesses - people who feel a need to demonstrate their competence and abilities and who want to eliminate as much competition as possible. What do you get out of micro-managing our industry? Bah humbug to committees and coalitions promoting required increased hours for massage therapy licensing in Texas. Best wishes to those who wish to be better and do better in their chosen areas of massage - go for it. Just leave the rest of us alone.
Editor's note: The following letter was sent to Janine Ray and copied to Massage Today. It appears with permission of the author.
I am ashamed of the TAMT [Texas Association of Massage Therapists]! Ashamed as you should be for distorting the original intent and misrepresenting Texas massage therapists as an officer of the TAMT. Why should I, a Florida LMT, be ashamed of the TAMT? Who am I to say how the TAMT should be acting for its members? Because I am the founder of the TAMT, that's why! I started the TAMT to oppose the AMTA - not to sleep with it! The TAMT is supposed to represent all massage therapists, not just its school-owner members. More training at the basic level provides benefits for one group and only one group, massage schools.
To say that "The existing education requirement is limited because the current law specifies that the schools can only require a maximum of 300 hours of training in their entry-level programs" is a lie, pure and simple. There are schools that offer advanced courses beyond 300 hours. If so many RMTs wanted these courses as the poll suggests, they would have waiting lists of RMTs applying for them. Instead, very few schools offer them because they are not in demand. Of course RMTs are going to say that they need more anatomy because that is what they have been told by their schools. That's what I believed when I graduated from a Texas school. I then got my wish when I had to return to school to get my Florida license. I haven't had to use that original 75 hours of A&P yet, never mind the additional 150 hours I took here. A total waste of time and money! The fundamental truth is that you do not need any anatomy to be a qualified, safe and effective massager.
The leadership of this organization has sold out its members. It's time for the members to start voting with their feet. I encourage everyone who is sick and tired of the same lame arguments to leave their association and build another one, one that will truly represent all touch therapies and not just an elite few.
Talking Trigger Points
Although the majority of the article, "Medical Massage for Jaw-Joint (TMJ) Disorders" (Dec. 2004, www.massagetoday.com/archives/2004/12/05.html), by Boris Prilutsky was quite well written and informative, his information about trigger points was far from correct. Actually, it was offensively incorrect to anyone who has studied Travell & Simons, who are, without question, the experts on the subject.
The trigger point is not usually found in the area of greatest pain to the patient. A major characteristic of trigger points is that they refer pain to another area. This is well documented and has been understood for many years. Travell & Simons first book was published in 1983, and this fact was stated in that volume. In fact, the trigger point causing the pain is elsewhere 70 percent of the time. This type of information is the major reason why many people think that trigger point therapy is not very effective. Massage therapists are constantly getting incorrect information such as this. They are being taught part of the picture of what trigger points are [and] how to effectively treat them. My other point is that ischemic compression is no longer the standard form of treatment.
In Myofascial Pain and Dysfunction (Vol. I, 2nd ed., pg. 140), Simons states that TrP pressure release is much preferred to IC: "The pressure release approach seems to be equally or more effective and is not likely to produce appreciable additional ischemia."
As a certified myofascial trigger point therapist, I feel that you should be more careful about allowing people without proper training to speak about techniques that they don't know enough about.
There is an entire organization of people who are well trained in trigger point therapy, and studied from the Travell & Simons medical text. Please contact the National Association of Myofascial Trigger Point Therapists; I'm sure that you could find someone there to write articles with correct information about trigger points.
Mary Jo Smiley, CMTPT
Boris Prilutsky Replies:
Thank you very much for giving me the opportunity to respond to Mary Jo Smiley's comments. I'm glad that Ms. Smiley believes "the majority of the article was quite well written and informative."
Ms. Smiley: You stated that my "information about trigger points was far from correct." More than this, you felt "it was offensively incorrect to anyone who has studied Travell & Simons, who are, without question, the experts on the subject." I am familiar with Travell & Simons' book. In my article, I introduced the readers of Massage Today to a protocol of medical massage that was developed by Drs. Sherbak, Glezer and Dalicho. After extensive research, they published their first book, Medical Massage, in 1955 - a text written for massage therapists, physical therapists, and other physical rehabilitative specialists who utilize medical massage in their treatments.
Medical massage procedures consist of skin mobilization techniques, periosteal massage, connective tissue massage, trigger point therapy, muscular mobilization techniques, and post-isometric relaxation techniques. Incidentally, in many of Dr. Travell's papers that were published in the 1960s, she referenced the works of Sherbak, Glezer and Dalicho.
To your comment that "a major characteristic of trigger points is that they refer pain to another area," I would like to refer you to Travell & Simons, page 16, paragraph eight. It describes the trigger point as a pinpoint localization of a sharper level of pain. You can find a similar definition of trigger points within my article.
To your comment that "this type of information is the reason people think trigger point therapy is not very effective" and teaches "part of the picture of what trigger points are [and] how to effectively treat them," I again refer you to my article where I highly recommend discovering all trigger points and eliminating them. It is true that some acute, active trigger points can refer pain to other areas, in which case, satellite trigger points (which are on the pathways of referring pain) must also be treated. Latent/sleeping trigger points that respond to palpation in a higher sharpness of pain but do not produce pain unless compressed, must be palpated (discovered) and eliminated by ischemic compression, as well. Patients can develop acute active points, which can potentially (but not always) have satellite trigger points as well as latent/sleeping trigger points. Detailed explanations of how to perform ischemic compression can be found in my article.
To your other point, "ischemic compression is no longer the standard form of treatment," I ask you to refer to Travell & Simons, page 34, and look into descriptions of morphology of trigger points. On page 86, you will find an explanation of mechanism of ischemic compression. Furthermore, under the sentence "Travell 127," you will find that only ischemic compression applied by our own hands allows us to eliminate trigger points. Your reference to Vol. I, 2nd ed., pg. 140, contains a description of TrP pressure release, which parallels my article description of proper ischemic compression. These same descriptions of ischemic compression were first written by Sherbak, Glezer and Dalicho in the book I referenced above.
You suggest to the editor of Massage Today "to be more careful about allowing people without proper training to speak about techniques that they don't know enough about." Ms Smiley, I am the fourth generation of a family of physical rehabilitative specialists who extensively utilizes medical massage therapy. I graduated from two professional schools and have more than three decades of clinical experience. I think that I am entitled to have my professional opinions based on research, education and clinical experience.
I could refer you to another text, not less reliable than Travell & Simons, but because you have sworn by this text, I have decided to use it. The pages that I referred you to are from the 1983 edition. I can assure you that trigger point therapy alone is not enough to achieve consistent results in cases of support and movement system disorders, as well as inner organ disorders.
If you carefully read the explanation in my article on post-isometric relaxation techniques, you will understand the way in which development of trigger points in muscular tissue occurs and the necessity of utilizing other modalities in addition to trigger point therapy.
Our bodies do not carry myofascial tissue. We have an alliance of fascia and muscles. We as massage therapists have to take into consideration that the fibers of fascia have no capability to contract, but the fibers of muscles do have this ability. In order to release tension in the muscle-fascia alliance, we must apply connective tissue massage followed by muscular mobilization. This is another reason why we should apply more modalities in addition to trigger point therapy.
Ms Smiley, you call yourself a "certified myofascial trigger point therapist." If you perform trigger point therapy by hand and you are not a physical therapist, chiropractor or medical doctor, to me you are a massage therapist. For the last 30 years, I have been a massage therapist. My grandfather, who was an MD and PhD, used to be very proud to personally incorporate medical massage in his treatments. Believe me, we have many good reasons to be proud of being such practitioners. In these days of massive recognition of massage therapy by the general public, as well as the medical society, we should stop creating new alternative names for massage therapy. I am very proud to be a massage therapist, and so should you be, as well as all of us who practice massage therapy.
Boris Prilutsky, MA
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