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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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
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.
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.
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?"
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.
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."
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.
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.
May, 2005, Vol. 05, Issue 05
Spotlight on Research: Trager Approach Shows Promise in Treating Chronic Headaches
By Michael Devitt
This periodic column keeps you abreast of the latest research documenting the benefits of massage and bodywork. Published research is summarized, with references to the full study text provided; abstracts of research are reproduced with minimal edits.If you would like your research abstract or summary published in Spotlight on Research, please contact us at .
Named after an Illinois medical doctor, the Trager approach is one of several mind-body techniques used frequently by massage therapists in the course of care. A combination of massage, mobilization and relaxation, the Trager approach relies on gentle, rhythmic rocking motions and stretching techniques that promote easy and free movement and sensations throughout the body. A typical Trager session can last from between 60 and 90 minutes, and includes not only stretching and movements, but also a form of mental exercise called "Mentastics" that helps clients remember and recreate the experiences felt during the actual Trager session.
The Trager approach is usually employed to treat musculoskeletal conditions such as low back pain. In a study published in a recent issue of Alternative Therapies in Health and Medicine, however, scientists looked at the role Trager could play in the treatment of another debilitating condition: chronic headaches. The study found that the Trager approach reduced both the frequency and duration of headaches, with the added benefit of helping people cut back on the amount of drugs they needed to treat headache pain.
In the trial, 29 men and women were randomly assigned to either a medication/Trager group, a medication/attention-control group, or a medication-only control group. All of the subjects had been diagnosed with some form of chronic headache, and all were taking some type of headache medication to relieve the condition.
Patients in the Trager group were treated by a Trager practitioner once a week for six weeks. A typical Trager session lasted approximately one hour and consisted of three parts: 1) a brief, current patient history; 2) a series of movements performed by the practitioner with the patient lying on a padded table, on joint and soft-tissue areas of the patient such as (but not limited to) the head, neck, upper back and shoulders, designed to increase range of motion, ease tension, and encourage both site-specific and general relaxation; 3) teaching the client simple movements designed to help recall and recreate the movements achieved while the practitioner worked on the client, and encouraging the client to practice these movements between treatment sessions.
In the attention control group, subjects met with a physician once a week for approximately 20 minutes, during which time the physician examined the person's head and neck and recorded any pertinent findings or changes. The physician also discussed any headaches the subject experienced in the past week, and asked about medication intake, headache changes and overall well-being. Patients in the medication-only group had no scheduled visits with a health care provider during the six-week treatment period.
For two weeks prior to the start of the study and throughout the six-week treatment period, participants were required to keep a headache diary that documented the frequency, duration and intensity of headaches, and use of headache-related medications. Each participant also completed a modified headache quality of life (HQOL) questionnaire.
Compared to the attention and medication-only groups, patients in the Trager group experienced significant mean decreases in the number of headache episodes per week. Trager patients reported a 27.5 percent reduction in weekly headache frequency, while attention patients experienced only a moderate (3.7 percent) reduction in headache episodes. In the medication-only group, however, the frequency of headaches actually increased by 13.5 percent.
Significant differences were also seen in the area of headache duration. In Trager patients, the length of headaches decreased an average of 0.6 hours; in attention patients, average headache duration decreased 0.3 hours. As with headache frequency, headache duration for patients in the medication-only group increased by an average of 1.3 hours per week.
Perhaps most strikingly, "statistically significant differences" in medication use were seen between groups. In the Trager group, biweekly medication usage decreased an average of 44 percent per patient from baseline through the treatment phase of the study. Medication use among patients in the attention group decreased an average of 19 percent. Patients in the medication-only group, on the other hand, showed an average 25 percent increase in biweekly medication use.
Each of these factors appeared to have an impact on the participants' quality of life. Not surprisingly, patients allocated to the Trager group "showed a significant improvement in HQOL," a result the researchers deemed "encouraging." Interestingly, improvements in headache quality of life scores were similar between patients in the attention and Trager groups. While these scores were not significantly different, the authors noted, "[the] improvements for each of these groups were significantly better than the control group."
The investigators admitted some limitations to their study design, most notably the small number of participants (33 randomized subjects, including four people who withdrew prior to completing the treatment phase). They also observed that while the attrition rate for their study was relatively low, dropout rates of other headache trials have approached 50 percent, a situation that must be taken into account when planning future studies. Finally, the authors noted that different participants took different types of headache remedies. "In the ideal situation," they wrote, "the medication used by all participants would be the same pharmaceutical preparation, and a clearly defined increase or decrease of specific drug type would be measured."
Limitations notwithstanding, the scientists suggested that the improvements seen in headache patients given the Trager approach "support the potential efficacy of Trager in treating chronic headache."
They also recommended that the results of the current trial be used as the framework for a larger, more ambitious study. As the scientists wrote in their conclusion: "In this first randomized trial evaluating the efficacy of Trager in treating chronic headache, we have demonstrated that the Trager approach decreased both headache frequency and medication usage, and that both Trager and physician attention improved the HQOL measurements in chronic headache patients ... the patient improvement in frequency, HQOL, and medication usage while under the care of the Trager practitioner implies that properly focused attention, combined with Trager's manual approaches, is an effective and promising treatment for chronic headache.
"... Demonstration of equivalence between the Trager method and the attention control group in a randomized, controlled, pilot study such as this, is the first step in scientifically assessing the efficacy of alternative treatments. Thus, this pilot study has provided data for the design feasibility of a larger, phase III multi-site trial."
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