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Is the EHR Ship Setting Sail Without Us?
The numbers are in: As of July 2014, 10,253 doctors of chiropractic have received $123,059,868 in EHR stimulus funds – and yet that represents less than 15 percent of our profession.
News in Brief
Major Organizations Announce Joint Conference; Fighting for Section 2706; New Vice President of Chiro. Program at Parker; Two Families, One Chiropractic Dynasty.
Overcoming Barriers to Exercise Compliance
One of the most common questions other practitioners ask me is, "How do I get patients to do their exercises?" I am not frustrated by my patient compliance, as many doctors are; in fact, I am actually happy with my patients' involvement and commitment.
We Get Letters & E-Mail
Not All Evidence Is Equal; An Abundance of Misinformation; A Well-Researched Decision; Far Too Dangerous.
Defending With Vitamin D: Helps Prevent Progression to Diabetes
A 2014 clinical trial published in the American Journal of Clinical Nutrition provides additional evidence that optimal vitamin D nutritional status may be important in preventing the progression of prediabetes to diabetes in prediabetic adults.
Love a Nurse – and They'll Love You Back
According to various sources, there are about 3 million registered nurses in the U.S., and according to the American Nurses Association, they are under serious pressure in today's health care reality.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Billing for Same-Visit Extraspinal and Spinal Manipulation
Q: I have always been under the premise that when billing 98943, extraspinal chiropractic manipulation, on the same visit as spinal manipulation, 98940-98942, that the extraspinal manipulation requires modifier 51.
Women's Health: Herbal Formulas to Help Patients With Dysmenorrhea
Chiropractors have long treated women for menstrual pain (dysmenorrhea). Since roughly 60 percent of all chiropractic patients are women and 30-50 percent of women have a history of menstrual cramps, the vast majority of doctors of chiropractic will inevitably see patients with dysmenorrhea.
The Art of Day-to-Day Assessment and Treatment: Clinical Pearls
Let's focus on the day-to-day process of assessing and treating the patient. I am proposing a particular attitude; a way of looking at the patient. This often evolves over a few treatments and then changes as you figure out what is significant.
The Wisdom of the Second Office Location (SOL)
There are some things I never want to do again, like riding a motorcycle 100 mph. I call these things my "negative bucket list." Other things I have on that list include water skiing, riding a roller coaster and eating habanero peppers.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Image Is Everything: The Power of Branding
Successful businesses use color and design to attract people to their service. They understand how important image is and hire experts to create an attractive package. Starbucks works hard to create an atmosphere that is warm and inviting.
State by State: Comparing Chiropractic Scope of Practice
"The issue of 'scope of practice' has been a bugaboo ever since our early quests for legal recognition for chiropractic," according to Dr. Claire Johnson, editor in chief of JMPT and National's other two chiropractic journals.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
A Dream Come True for Chiropractic: Funding Prevention and Public Health
Back in 2005, Sen. Tom Harkin (D-Iowa) said: "Let's face it, in America today we don't have a health care system, we have a sick care system.
Are Your Work Orders in Order?
There are times when a patient's occupational duties will delay or prevent them from recovering. These circumstances create the need for the doctor to recommend modified duty or remove the patient from work.
December, 2005, Vol. 05, Issue 12
By Keith Eric Grant, PhD, NCTMB
In a previous column, I touched on medical applications of massage that appeared in the indexed medical literature from 1997 to the present. Of 213 instances of medical goals addressed by massage, 155 (73%) were systemic rather than tissue-specific (clinical/orthopedic) interventions. Systemic treatment goals included increased well-being, stress and pain management, and improvements in self-image. These "systemic" effects of massage also are well-represented in the research reported by Tiffany Fields and the Touch Research Institutes (TRI).5 The TRI home page highlights observations that massage therapy: facilitates weight gain in preterm infants, reduces stress hormones, alleviates depressive symptoms, reduces pain, improves immune function and alters EEG in the direction of heightened awareness.5 With the above observations in hand, it seems time to consider mechanisms for the effectiveness of massage.
Tissue specific interventions (TSIs), while requiring understanding in anatomy and movement to implement effectively, are simpler conceptually. TSIs largely can be understood by reduction to specifics. The practitioner needs to be able to listen to client history, assess active and passive range of motion limitations, look-up and implement special orthopedic tests as needed, and thus gain a working hypothesis of the location, extent and nature of injured tissue i.e. the "lesion" resulting in pain or limitation. I differentiate active and passive range of motion limitations because they differentiate between pain felt in a musculotendinous unit when it's actively contracting and pain produced in ligaments, joint capsules and antagonist muscles when they are passively stretched. I note "looking up" special tests because I am a believer in having and knowing how to use information resources rather than in memorizing everything in sight (or reach). Procedures frequently used will be memorized. I define the result of assessment as a "working hypothesis" to clarify that it's not a medical diagnosis.
With TSIs, the techniques follow from assessment and isolation of the lesion(s). Tendinosis on tendinous attachments benefits from the stimulation of inflammation by local friction.1,2 Adhesions between fascial layers release under slow separating pressure. Trigger points succumb to ischemic pressure combined with various methods to lengthen the affected tissue. Muscle hypertension can be lowered by methods of positional release and post-isometric relaxation. The assessments and treatment might be intricate, but they are not inherently complex in the sense that we can conceptually connect the treatment goals and the intervention.
Understanding how non-tissue-specific touch affects the state of our human systems has not been so easy. We are able to record the effects, as has the Touch Research Institutes, but we haven't had a sound mechanism to explain them. My opening quote from Ashley Montagu motivates why touch would be expected to have profound effects on us, but it, too, stops short of mechanism. The answer, however, is starting to take shape in diverse venues of science and mathematics.
Over the last two decades or so, a new area of research has evolved. There are systems in which important properties lie, not in the individual parts alone, but in the interaction and communication between the parts. These properties have become known as "emergent properties," be cause they literally emerge from the complexity of interactions.6 In 1984, the Santa Fe Institute was founded specifically to study such complex systems.4 The April 2, 1999 issue of the journal Science was devoted to interdisciplinary viewpoints on research in complexity. These included papers on "Complexity and the Nervous System," and "Complexity in Biological Signaling Systems." Numerous papers and books have come out of studies of things describable as "information networks," including studies on organization spontaneously emerging in the structure of the Internet. We slowly are gaining the tools and the understanding that seemingly simple appearances can arise out of the complexity of interactions. We also are finding understanding that such systems can have multiple stable states and flip between them depending on input from outside.
Thus, we come to the human body as a system of systems a system with neurological, chemical, immune, emotional and sensory interactions all communicating. Sensory input includes touch in a big way. We come back to the observations of TRI and Ashley Montagu, with the understanding of massage and touch as a major input to a complex system. We don't understand the details, but we understand the basis for touch to create profound changes in the homeostasis of the human system. There are important structures of the human body that are not physical; they exist only in the fluid interchange of information within the living system.
In the end, it's not the complexity of the touch being done, but the complexity of the human system being touched that is most profound. Someday, we might be able to model the complexity of neurological-chemical-emotional-sensory interactions to determine patterns of sensory input that are most effective at inducing positive change. We still are far away in the infancy of such concepts. The best tool we have to bring to bear today is the equal complexity of the observational instrument known as the human practitioner. The human ability to learn from practice and observation and then to react in real-time to sensory input remains unmatched. We are slow at consciously processing input, but rapid at "unconsciously" matching patterns. There is great value in being able to initiate a simple touch, judge the response and adjust our input toward assisting the client's system toward a better place. We've known this intuitively for a good while. We are just beginning to develop the scientific finesse to explain it.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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