resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
August, 2005, Vol. 05, Issue 08
Medical Conditions in Massage Practice, Part III: Interviewing for Medications
By Tracy Walton, LMT, MS
Thanks to better training and texts, massage therapists tell me their knowledge of contraindications is growing. But many still report gaps in knowing how to interview for contraindications and how to apply the answers in the session.This series of articles has offered some suggestions for closing those gaps. In Part I, I wrote about my own intake attempts early in my career and how my interview changed over time. I also offered one important interview question regarding client activity level and types of activities with examples of the information it can bring to light for the massage session. In Part II, we added the question "Are you in a physician's care?" with follow-up questions. This question alerts the therapist to medical conditions that might pose contraindications.
Now let's turn to a third all-purpose intake question, which follows the second question nicely: "Are you taking any medications?" Along with a few follow-up questions, this question yields useful information during an intake. Unfortunately, the information in this territory can seem cryptic: drug names are notoriously foreign-sounding and long (amoxicillin, amitryptiline), sound similar (celexa, celebrex, cialis), and many of us misspell them. The good news is that massage therapists can use information about meds without having to go to pharmacy school. By asking a few follow-up questions for each medication and doing a little investigation, we can determine which massage contraindications or modifications to use. Below are some follow-up questions with some examples of how the MT might use the answers.
How do you spell that?
Correct spelling may come from the client or a little more investigation. Correct spelling is key to looking up a medication - perhaps not in the moment, but at some point for your learning. If the client can't provide the correct spelling ("It's those little yellow pills" or "The ones I use for thyroid"), it's still possible to get the needed information. But at some point determine the closest spelling possible. Search engines on the Internet can be quite forgiving with less than perfect spelling. For example, suppose you have a client with Crohn's disease on a medication that neither of you can spell correctly. If you type in "methatrexate" or even "methatrexate Crohn's disease," Google will return a kind message to you: "Did you mean methotrexate?" There are numerous sites about medications. One I use is www.drugs.com, which lists consumer information alphabetically by drug. Many drugs also have their own Web sites, including coumadin.com or prednisone.com. These sites have general information about the drug, including why it's prescribed and side effects.
What is the medication for? What is it designed to do?
This may unearth a medical condition to ask more about, especially if the condition affects tissue or organ function. Bringing it to light, the MT may need to follow contraindications for the condition itself. Suppose a client lists medications for hypertension and heart disease. The medication may not resolve the problem entirely but may just control it, and the disease is still present. Hypertension or heart disease could require modifications in client position, pressure used on the legs in case of a risk of blood clots (DVT), and other modifications. If the condition itself puts someone at risk for stroke, the massage therapist should not use pressure near the carotid artery or on any pulse points. If the client is taking ibuprofen or aspirin for the pain of an unstable injury, treat the area as unstable and avoid stretching or other strong passive movement in that area, and refer the client to his/her physician. Stronger pain medications, such as narcotics, interfere with perception and the ability to give the MT feedback about pressure. The practitioner should only use gentle pressure and joint movements to avoid causing injury.
Self-medication is vital information that comes from asking this question. Upon finding out that a client self-medicates for musculoskeletal pain, sleeplessness, headaches, etc., the massage therapist should suggest (sometimes strongly) for the client to see a physician or other health care provider for diagnosis and additional help.
Is the medication effective?
This question gets at over- or under-treatment, and there is some overlap with the question above. If a medication is not effective in reducing blood pressure, for example, treat the client as if he/she has high blood pressure and investigate massage contraindications accordingly.1 If a medication is good at preventing blood clots it will probably cause easy bruising, so lighten the massage pressure. Coumadin, a blood-thinner (anticoagulant), is one such medication. It is commonly presented as a massage therapy contraindication, but only one element of massage - pressure - is contraindicated. Use follow-up questions to determine how much pressure is too much. Some people experience mild bruising as the medication carries out its task; others have more severe problems as the right dose is determined over time. Other elements of massage therapy, including stroking, kneading, joint movement, etc., may be perfectly acceptable as long as they are carried out with gentle pressure.
Are there any side-effects or complications of the medication?
If so, other massage adaptations may be necessary for each side-effect or complication. This question has some overlap with the question above. If pain medication is so strong that it causes drowsiness in a client, he/she should not receive a vigorous massage. If it makes the client urinate frequently, he/she may need to get up during the session. If a drug (such as prednisone or other steroid medication) causes a change in fluid balance and produces swelling, massage should not attempt to shift fluids dramatically from tissue to vessels, or along vessels. A gentle session is in order. Some practitioners have advanced training and specialization in stronger work with pathologies, injuries, swelling, and scars, but most basic therapists should follow an important rule of thumb: a body adapting to strong medicine does not need the additional burden of adapting to a strong massage. More information on massage and medications is available from trainings and textbooks.2
Looking back at the questions above, note that some overlap can occur in the information gleaned. This is as it should be. The best interviews give the client several ways to respond to the most vital information. If the client doesn't mention "easy bruising" after the third question, perhaps he or she will recall it after the fourth question. Avoid too many redundant questions that prolong an interview, but give clients more than one chance to recall and mention key information.
This series has provided three all-purpose questions for the interview:
Each question can spark longer conversation, and it takes skill to move the interview along in the right direction - toward the massage table for a safe, effective, thoughtful massage. Interviews are longer for some clients, shorter for others. In most cases, ideal intake interviews are brief but also allow for a thorough, efficient transfer of information. At times these goals seem at cross-purposes, but with experience interviewing becomes easier. Thorough interviews lead to safe treatment for the increasing number of people seeking massage therapy. In addition, a good interview enriches each massage session and the therapeutic relationship with each client.
Click here for more information about Tracy Walton, LMT, MS.
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