resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
May, 2006, Vol. 06, Issue 05
By Garry Adkins, NCTMB
The idea of exploring palpation came from a doctor/client of mine I was working on years ago. As I worked on her, she told me I was using advanced palpatory techniques; at that time, I had no formal training in that regard, other than traditional massage or neuromuscular therapy.
When I attended bodywork classes in the past, the instructor would lecture on anatomy, and then tell the class to just feel the structures, without telling us how.Over years of doing bodywork, I have developed a certain confidence in my sense of touch; a form of teaching myself which way to stroke a muscle or tendon to receive the most benefit. After I read the book Palpation Skills: Assessment and Diagnosis Through Touch, by the experienced clinician Leon Chaitow, ND, DO, it all made more sense to me.
Chaitow writes that, according to Viola Frymann, "Palpation cannot be learned by reading or listening; it can only be learned by palpation." He goes on to say that an open mind also is vital to the task of learning palpatory literacy: Practitioners with the greatest degree of "rigidity," in terms of their training, often have the hardest time allowing themselves to feel new feelings and sense new sensations. Those with the most open, eclectic approaches (massage therapists are a prime example) usually find it easiest to "trust" their senses and feelings.
According to Karel Lewit, noted Czechoslovakian physician, "To begin to learn palpatory skill, one must possess a firm grasp of anatomy and the supporting soft-tissue structures. Palpation of tissue structures seeks to determine the texture, resilience, warmth, humidity and the possibility of moving, stretching or compressing these structures. Concentrating on the tissue palpated, and pushing aside one layer after another, we distinguish skin, subcutaneous tissue, muscle and bone; we recognize the transition to the tendon, and finally the insertion."
Regarding the learning process, Gerald Cooper states: "To begin to learn palpatory skill, one must learn to practice to palpate bone or muscle or viscera. Gradually, one learns to distinguish between a healthy muscle, a spastic muscle and a flaccid one, and gradually one learns there is a difference in feel between a hard malignant tumor and a firm benign tumor."
Chaitow also says, "Later on, critical judgment may be used in interpreting what was felt, but the process of 'feeling' needs to be carried out with that faculty silenced." No one has better expressed this need than John Upledger, DO, OMM, the developer of CranioSacral Therapy. He states: "Learning to trust your hands is not an easy task. You must learn to shut off your conscious, critical mind while you palpate for subtle changes in the body you are examining. You must adopt an attitude so that you may temporarily accept without question those perceptions which come into your brain from your hands. After you have developed your palpatory skill, you can criticize what you have felt with your hands. If you criticize before you learn to palpate, you will never learn to palpate."
This seems to work in a diagnostic sense, but to become proficient with your palpation skill while doing bodywork, we should look at what guides us. Intuition is an internal mechanism that aids in decision-making. It's what is called an instinct, a sense of something that tells a person to go in one direction or another. Combined with knowledge and training, it gives a person the tools to make solid decisions and get results they never thought possible.
Intuition has been defined by Shakti Gawain as an inner knowingness that we all have. It's knowingness that comes not from facts or life experiences; it's deep within us and gives us a connection to the intelligence of the universe. And if we learn to trust that and look within us for the source, we can find the awareness and actually find the answers to our questions. We also can find very specific and direct moment-by-moment guidance that will let us know what we are supposed to do and what we need to understand. If you think about it, anything we really need can come to us from that intuitive sense.
The Rational Mind
In our Western culture, we have been programmed to distrust our intuitive self. We have been taught to look toward and trust our rational, logical faculty. Our rational mind is like a computer. Any fact or information we have read or learned goes into our computer. The function of the rational mind is to pull out the appropriate pieces of information and combine them in ways to come up with the best answers based on that information.
The limitation is that the rational mind can only function on information it has received through learning and experience. The intuitive principle within us seems to have access to a much vaster storage of information. We seem, through our intuition, to be able to connect with infinite intelligence and awareness. So, we are not limited to just what we have learned in this life. We are able to tap into things we have no logical way of understanding, much in the same way a baby deer has the instinct to stand up just after birth.
To examine how our culture's attitude toward the rational mind has changed, imagine how the Native Americans lived long ago. They were taught from a very early age to smell the air, feel the wind and listen to the ground, just as animals can sense danger or tell just before it is going to rain. In our modern society, we have machines that can tell us if the atmospheric pressure indicates rain or snow is imminent.
Does everything you have seen, heard and felt about the person make sense? Let your rational mind come to a conclusion on how to proceed. Check your confidence level. Know you can help or satisfy this person. Let your rational mind go to the back and your intuitive self come up front. If you have to, say to yourself, "Intuitive self, I stick with you; whatever you say goes."
The Most Effective Direction
With your client prone, uncover the back to expose the trapezius. Apply little or no oil. While using only your fingertips, glide medial to lateral on the upper trapezius, and then lateral to medial. Did you notice any difference?
Now glide inferior to superior, and then reverse direction. Did you notice any difference? Try anterior to posterior, and then reverse. Maybe try diagonal? Of the four strokes, which one is easiest; which one has more resistance?
Next, try this with your client supine. Uncover one leg to expose the quadriceps. While using only your fingertips and no oil, glide medial to lateral, and then lateral to medial. Did you notice any difference?
Now glide inferior to superior, and then reverse direction. Did you notice any difference? Maybe try diagonal? Again, of the four strokes, which one is easiest; which one has more resistance?
With these two examples, the stroke with the most resistance is twice as effective as the other three or four. By going against the grain of a muscle, you will release the muscle faster, as well as help to relieve fasical restrictions.
Develop Your Intuitive Self
Finally, I feel that the last step to develop your intuitive self is to raise your self-esteem a notch. People come up to me all the time and say they wish they had my ability. What ability? Some of those people have had more training and experience than me. Life is a series of changes, yet many people cling to familiar things, disregarding their inner desire to grow as an individual. Openness to change can be risky. These people would say something to the effect of, "To be the kind of therapist I want to be, I have to have many years of training and experience. Maybe someday I will get there."
I say that you are there right now! Take the information you have. Be open to change and allow your instinct to guide you.
Garry Adkins is a senior faculty member and clinical event director at Irene's Myomassology Institute in Southfield, Mich. He is the former president of the Association of Michigan Myomassologists and has more than 15 years of experience as a massage and bodywork professional.
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