resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
April, 2005, Vol. 05, Issue 04
How Should We Teach Assessment?
By Whitney Lowe, LMT
Musculoskeletal disorders (MSDs) are some of the most commonly occurring causes of pain and disability in this country. They are treated by a wide variety of practitioners, and many people with them seek the care of someone other than a physician.Consequently, massage therapy is frequently used to address this wide array of pain and injury problems.
Proper treatment of any MSD begins with identifying the underlying problem. It is only then that we can determine if we should even be working on this client. If the practitioner has determined that a MSD exists for which massage treatment would be helpful, s/he must then determine which techniques or approaches to use with the client that should be helpful. The way to make this determination is through proper and accurate assessment.
Information may be gathered in many different forms, systems or structures yet they all have several elements in common. A thorough assessment includes detailed information from the client history, observable characteristics of the client and his/her condition, as well as specific methods of physical examination.
Some practitioners shy away from any organized framework for their assessment process, stating instead that intuition guides them. Others may state they do assessment solely through what they feel in their hands. While these are very important skills and may work well for basic relaxation massage approaches, they don't provide information necessary to make appropriate clinical decisions about treating MSDs. If I had an illness or injury and went to see a physician, I wouldn't want that doctor to evaluate me based on intuition or palpation alone. Likewise, many MSDs are complex and we must engage in a more comprehensive process when evaluating them.
There are some misconceptions about what assessment entails. Some feel it is just evaluating a client's range of motion. Evaluating range of motion is important, but you must know more than your client has a limitation in a certain motion, such as abduction of the shoulder. You must do what you can to find out why that limitation exists. Others state that assessment is mainly the use of special orthopedic tests like the Phalen's test for evaluating carpal tunnel syndrome. Memorization and use of various orthopedic tests is helpful, but only when used in their proper contexts. Simply memorizing these tests does not make you effective at assessment any more than memorizing the alphabet makes you a writer.
Assessment and Learning Theory
Learning theorists have developed classifications of how we learn that describe increasing levels of complexity. One of the most common classifications still used today is Bloom's Taxonomy of Educational Objectives, first published in the mid-1950s. In this classification, Bloom and his colleagues described six levels of increasing cognitive complexity: knowledge, comprehension, application, analysis, synthesis and evaluation.
The lowest levels, knowledge and comprehension, involve rote memorization. While memorization has its usefulness, it should not be the primary goal of our educational objectives. Unfortunately, most educational environments do not go past this level and assume that "learning" has occurred because an individual is able to achieve a specific score on a test that emphasizes rote memorization and, too often, little else.
The problem with this approach is that it doesn't reflect clinical reality at all. In the clinic room, the practitioner is faced with situations where memorization of facts still leaves you pondering as to what your client's primary complaint really is. In order to get past this point you must use the higher levels of the taxonomy - analysis, synthesis and evaluation. These abilities are developed through practical application of clinical reasoning activities in the learning process. Assessment is a complex procedure of clinical reasoning that has to use these higher cognitive functions in order to be even minimally effective.
Consequently, if we want to teach assessment skills in the way they will be eventually used in practice, we have to radically alter the way they are initially presented. In order to do this we have to get away from trying to have students find the "right" answer all the time. In many cases there isn't one "right" answer. There are several different paths and they each take us in different directions that may produce a good clinical reasoning process. Therefore, to accomplish this goal we must create educational activities that encourage a degree of cognitive uncertainty and encourage the practitioner to go through the reasoning process to figure a problem out. It is only through this kind of practice that these skills are developed.
So, when learning assessment, don't get stuck on trying to memorize a large group of special orthopedic tests or performing range-of-motion evaluations and call that your assessment. You must look at the entire picture of gathering information from the client's story and physical examination, process the importance of what you have found out, and construct a model for explaining your findings. When you can do this, you have moved into the higher levels of cognitive complexity, used advanced assessment strategies, and performed a much more thorough service in seeking care for your clients.
Click here for more information about Whitney Lowe, LMT.
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