resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
June, 2005, Vol. 05, Issue 06
Medical Conditions in Massage Practice: Intake Forms and Questions, Part I
By Tracy Walton, LMT, MS
Whether massage therapists call it "medical" massage, "therapeutic" massage, or "relaxation" massage, we work with people with many complex medical conditions. No matter which setting we work in - spa, private practice, sports or medical settings - we see a range of health conditions that ask us to investigate appropriate contraindications.
In this three-part series, I'd like to offer my thoughts on interviewing for those contraindications.The purpose of this series is twofold: to support therapists in their work with people and to invite dialogue in the field. I'll begin this installment with observations of the intake process for massage therapists then offer a sample question for the health history. Each subsequent article will feature one or more health history questions and ideas for how to use the client's answers.
In my work with therapists with different backgrounds and working in different settings, I've discovered a common theme: most are much more comfortable providing the massage than interviewing clients for contraindications. When I ask why this is, most tell me the language of their hands is their chosen language. After using my hands for 15 years in massage practice, I must agree. My hands engage in wordless, soundless and sometimes sacred exchanges with clients. The interview, in contrast, can seem like mere business.
But massage therapists tell me there's more to this than a simple preference for hands-on work; most say they did not get solid schooling in conducting an intake interview. The most acute gap for many of them is in interviewing for medical history. Fifteen years ago when I graduated from massage school, we could purchase commercially available, preprinted health history forms for massage therapy. I remember them on heavy paper, four pages, lists of medical questions, and questions about diet and nutrition, all very comprehensive. I suspect the form was borrowed from a medical setting, as many of the questions were way out of the scope of the average massage therapist. Still, seeing little else in the massage literature, I dutifully purchased a stack of them to begin my practice.
There was a small problem with this approach: I had not the slightest idea how to use them. I knew how to ask the battery of questions on the form, but I didn't know what to do with the answers. How would it change my massage to know that my client followed a certain diet, that he drank four to six alcoholic beverages per week, that she had had most of the common childhood diseases, that there was a family history of heart disease? In a nostalgic mood recently, I dug the form out of cold storage and marveled at its length. I can't believe I got through so many interviews without being asked, "Why are you asking me this?" before I switched to designing my own intake forms.
Mind you, I had graduated from a strong, two-year massage therapy program with many hours of training in hands-on work, communication skills and the sciences. The profession shared my interviewing uncertainty. In 1990, literature about massage contraindications was scarce. We had little shared understanding of what we had to know to massage safely, and a few alarmist stories about someone who had done something in a session somewhere and the client got sick afterward. We relied on this lore in the field, a very basic understanding of the body, and our wits to keep our clients safe and ourselves out of trouble.
Changes in the profession have made it much easier to identify client problems that we need to act on, avoid or treat with caution. Ruth Werner took our uncertainty in stride and produced A Massage Therapist's Guide to Pathology1 the first widely available text from which we could finally draw some links between health conditions and massage contraindications. Many other useful texts appeared as well, including books on medications and massage,2,3 other rich pathology texts, and even some texts for massage specialties, such as massage in the hospital setting.4 Articles are appearing on work with a wide range of clients. Together we're getting our feet under us about individualizing massage for clients in all states of health. Together we're figuring out the information we need to practice safely.
But we still need to work on how we gather that information without interviewing the client all afternoon. What is important to ask about a client's health? And, more importantly, how do we use their answers in massage design? How do we find out what we need to know in a brief interview format? How do we follow-up on clients' answers?
I have designed intake forms for my own practice, a massage school with a large clinic, and a training setting where we run one-time clinics for clients with cancer-with some medically complex individuals. I have seen countless intake forms in the literature and at the schools I visit. There are some basic, all-purpose questions that bear asking. In this series of articles I will focus on a few of them: "What is your activity level and the kinds of movement you do during the week," "Are you taking any medications," and "Are you currently in a physician's care?" I will also propose how to use our client's answers to these questions.
What is your activity level? What are the types of activities you engage in during the week?
This question often elicits a guilt response: "I should be going to the gym more"; "I'm afraid I'm something of a couch potato"; or "I'm at a desk all day." But it still can lead to valuable information for massage therapy. First, it can lead to tension patterns produced by a client's activities. This conversation can go a number of useful places. Chronic telephone use: which ear? Chronic neck and shoulder tension on that side. Massage with focus on the neck, attachments at the occiput, shoulders and lateral pecs. Massage therapists know where to find these tension patterns and ease them. Questions like this provide an early tip-off to where the session might go.
Questioning about activity and movement can be helpful in other ways, too. For an elderly client, one with a systemic illness or in strong medical treatment, the activity level can help a therapist assess how well the client can tolerate massage. For example, in general, it is important to work conservatively with people in cancer treatment, starting with gentler work. It may be advisable to introduce stronger massage in small increments over weeks of monitoring the client's response. The activity level of the client can help you assess where to start and when to add increments.
One client in her late forties has been in ongoing treatment for metastatic breast cancer for several years. She has been building a deck, clearing her land, cycling long distances. Another client has pancreatic cancer and is in strong chemotherapy. She is 83, and beginning to find the stairway to my office a challenge. Both require specific massage adjustments to their treatments for complications such as lymphedema risk, bone metastasis, and several other factors. But the first client, after taking those into account, may tolerate a reasonably vigorous massage and benefit from it.
The second, older client, clearly weakened by complications of her disease and in strong treatment, requires a gentler session. Tolerance of exercise can be used in assessing tolerance of massage therapy. Activity levels provide useful data for the massage therapist who can then change the length of the session, the pressure used, or even how gently or vigorously to stretch or range a joint in a session. A more customized session is then possible, rather than a single protocol for a client who checks "yes" in response to the question about cancer history.
The activity level and the types of activities are useful information for the massage therapist. Answers to these questions can provide key information quickly. This is especially important in high-volume massage settings with limited time for interviewing and documentation. Interviewing has its challenges, but we've come a long way from preprinted forms and our empty, uncertain use of them. As the profession continues to develop and we share more information with each other, the process of interviewing will become clearer and easier for us all.
Editor's note: Look for part two of Tracy's series in the July 2005 issue.
Click here for more information about Tracy Walton, LMT, MS.
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