Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Dorsiflexion Dysfunction: Evaluation & Manipulation Techniques
Almost every condition from the foot to the hip can be attributed to the inability to dorsiflex the ankle mortice and other joints that participate in dorsiflexion. Let's start by understanding normal versus abnormal dorsiflexion.
Change Lives by Supporting Chiropractic Research: Are You In?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fund-raising campaign to support chiropractic research.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
The Zen Art of "One Point"
We were always told in our Zen Shiatsu training (by Japanese and Japanese American instructors) that our ultimate aim was to to find that "One Point." To be so focused we could touch just one point to transform Qi throughout a client's body.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
More Chiropractors Required
An intriguing study published in the Journal of the American Board of Family Medicine examines how "chiropractic care affects use of primary care physician (PCP) services."
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Practice Policy (Gone Bad): The Sign
Every once in a while, you see something and think to yourself, That's a really bad idea. Case in point: I went to see my medical doctor the other day. Just after being "roomed," as they say, the nurse checked my vital signs. Then she left.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
News in Brief
Call for Abstracts Announced - Parker Las Vegas 2016; Logan Adds Doctorate Degree; New Role for Dr. James Edwards.
Fish Oil: A Key Component of Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
A Chiropractor's Guide to Yoga
"Doctor, can I continue to do yoga while undergoing your care?" "Is it OK for me to go back to yoga while I'm getting my back treated?" "It is safe to start my yoga classes again after my neck pain improves?"
Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Surprising Reasons for Orthotic Efficacy
Clinical outcome studies show orthotics are effective in the management of a wide range of injuries, including plantar fasciitis, Achilles tendinitis and patellofemoral pain syndrome.
What's Chiropractic Research Worth to You?
The Palmer Center for Chiropractic Research (PCCR), in celebration of its 20th anniversary, has announced it is spearheading a fundraising campaign to support chiropractic research.
Patient-Centered Care vs. Payer Restrictions: Your Ethical Obligation
Do you have an ethical obligation to evaluate your patients, make a diagnosis and provide evidence-based, patient-centered health care, irrelevant to the payer restrictions?
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Harvard Health References Flawed AHA Position Paper
In its special health report, "Stroke: Diagnosing, Treating, and Recovering From a 'Brain Attack,'" Harvard Health Publications includes information from the American Heart Association's 2014 position statement on cervical manipulation and cervical dissection – a statement the American Chiropractic Association emphasized in a letter to Harvard Health mixes "scientific facts with half-truths."
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
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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