resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
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.
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.
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.
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.
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.
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.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
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.
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.
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.
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."
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.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
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.
July, 2005, Vol. 05, Issue 07
Medical Conditions in Massage Practice, Part II: The Client in a Physician's Care
By Tracy Walton, LMT, MS
Thanks to better training and texts in the field, massage therapists tell me their knowledge of contraindications is growing. But many report gaps in knowing how to interview for contraindications and how to apply the answers in the session.In part one of this series, I wrote about my early attempts at interviewing and how that changed over time. I also offered an interview question - about client activity level and types of activities - with examples of the kinds of important information it can bring to light for the massage session (June 2005, www.massagetoday.com/archives/2005/06/04.html).
These articles offer all-purpose questions for the massage interview and examples of using the client's answers in massage design.
The task of interviewing clients for contraindications feels easy for some therapists, harder for others. Some tell me they rush through it to get to the hands-on session; others like to take their time. The massage setting can also influence the interview. In private practice, we have as long as we are comfortable scheduling with the each client. Many therapists allow an extra 15 to 30 minutes for a first-time session. In contrast, most spa and other high-volume settings (on-site, sports events, fundraising walks, etc.) allow for very little information gathering. Years ago I worked in a spa where we were taught to limit our intake to one question on the way from the greeting area to the treatment room: "Is there anything I should know about your health?" Many spa practitioners tell me this is still the limit of their questioning.
The problem with this question is that clients don't usually know what we're looking for or which health conditions are important to massage therapists. Indeed, some frustrated massage therapists tell me that they don't always know what they're looking for either. Our pathology and clinic training doesn't always prepare us for gathering information quickly, easily and thoroughly in a range of massage settings. From massage therapists I meet around the country, I am learning that given lists of contraindications, massage therapists don't always know how to interview for them. Given lists of interview questions, we are not necessarily taught how to use the answers.
As the profession develops, we will grow to understand our interviewing tasks more fully and be able to adapt them to the special challenges of different massage settings. I am confident that we will standardize brief, efficient interviews and protocols for higher-volume settings and more extensive intake practices for other settings. For now, here are some "umbrella" questions to ask every client, which should be added to any interview regardless of the setting in order to get a good health picture and design an appropriate massage for each person.
Are you currently (or have you recently been) in a physician's care?
For those in high-volume settings without forms or record keeping, this is a question to ask on the way to the table. Even if your setting allows forms and ample interviewing time, ask this of everyone. If your intake form includes a list of specific conditions, this is a good all-purpose question to catch any that are not listed. It might prompt a client to remember something he/she forgot to mention elsewhere on the form. Then you can apply appropriate massage contraindications.
This question leads to the first, most obvious follow-up question: "For what condition or complaint have you been seeing them?" Here you are looking for the diagnosed condition to determine massage contraindications and for the complaint that may have brought the client to the physician in the first place. For example, suppose a client has chronic acid reflux or constipation for which she is seeing a physician. If there are no specific questions on your form about digestion and elimination, the physician question may capture this. Reflux might dictate a change in the massage position - a surface slightly inclined toward the head - or bolstering in the side-lying position. Constipation, depending on the cause, may indicate reflexology or acupressure techniques, or even gentle abdominal strokes or contact.
Another, broader follow-up question might be, "Are you seeing any health practitioner regularly?" to spot conditions the client may be bringing to a chiropractor, acupuncturist or movement practitioner, for example. Here you might find out about his/her acupuncture treatment for headaches, dental treatment for TMJ, or chiropractic treatment for a chronic low-back injury. Answers can lead to collegial conversations with these professionals and to proper timing and coordination of treatments.
I know acupuncturists who ask their clients to let acupuncture "sit" for a day or two before following with other treatments such as massage. Massage therapy can be a useful adjunctive therapy for TMJ. The chiropractor would benefit from knowing the massage therapist's approach to the client's low-back issue. And in each of these cases, there might be contraindications or indications to massage therapy depending on the cause of each condition. If a number of diagnoses are possible, massage should be tailored to the most conservative of these: If doctors are looking at either arthritic changes or bone metastasis as a cause of pain in the low back, treat the area as though bone metastasis were the cause and avoid pressure and joint movement in the area until proven otherwise.
"What kind of diagnostic procedures are you undergoing (have you recently undergone)?" is another direction to go. The diagnostics question is useful for several reasons. It tells us what the client's other health care providers are concerned about: tumor as a cause of headache; fibroids as a cause of low back pain; stress aggravating stomach ache. This information is useful without memorizing lists of diagnostic tests. Instead, ask the client what is being investigated, and why. While some clients are more knowledgeable about their care than others, this question may yield clear contraindications or indications to massage. Massage therapists don't necessarily need to go to nursing school or medical school to understand their clients' medical status - they just need to figure out what other care providers are concerned about, then investigate their own field for any adaptations for massage.
Finally, a compelling reason to ask about a client's diagnostic procedures is simple interest in the client's life. Put simply, diagnostics are stressful. Sometimes painful, often requiring awkward positioning or holding still, some procedures aggravate muscle tension that we may be well equipped to relieve once we've followed suitable precautions. The long wait between test and result can be difficult, depending on the nature of the test and possible diagnosis. Our clients' experiences of their medical care can tell us not only where to avoid massage but also where to focus it and how to listen. I once worked with someone who had an MRI for a knee injury the day before. She was awaiting word on whether to have surgery. The MRI was hurried and the technician neglected to tell her when the test was starting. It began before she was comfortably positioned, and she had to hold perfectly still for 20 minutes. Already frazzled, this experience left her more worn out with tension in her hips and low back. The wait for the doctor's call was an anxious time. Careful massage of tense muscles and a listening ear helped her cope as she waited for word on her immediate future.
We handle the human body with care and attention, but we also interview with care and attention, which is as therapeutic as our hands-on services. We ask about another's experience of their body. Questions about their health care tell us something about the texture of our clients' days. These small questions ask, "What is it like to be you?" which can, in and of itself, be healing. A client's answers are as useful to our massage design as our own palpatory cues. At the same time, they can deepen our understanding and the compassion we bring to our work.
Editor's note: Look for part three of Tracy's series in the August 2005 issue.
Click here for more information about Tracy Walton, LMT, MS.
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