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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
July, 2007, Vol. 07, Issue 07
Successfully Treating Cervical Trauma Using Deep-Tissue Techniques
By Don McCann, MA, LMT, LMHC, CSETT
Jim, a 35-year-old accountant, suffered a cervical flexion/extension injury in an auto accident. After chiropractic treatment had exhausted his personal injury protection (PIP) coverage, his chiropractor released him saying he had reached maximum medical improvement.However, he still was having severe neck and shoulder pain with headaches. He sought treatment from several massage therapists whose ads stated that they did deep tissue, therapeutic massage. He was totally unimpressed both by the amount of pain he endured during his sessions and the lack of improvement. A friend referred him to our clinic with the reassurance that not all deep-tissue therapy had to be a painful experience and he would see results.
During Jim's initial session, structural evaluation revealed a forward head posture with a reversed curvature of his neck. On his intake form he marked the back of the neck and top of the shoulders as primary pain areas. The therapist explained to him that his treatment would address the pectoralis region and anterior neck first, and then the painful areas in the back of his neck and the top of his shoulders. Jim was amazed because previous therapists had only concentrated on the areas of pain. As the treatment proceeded, he was pleasantly surprised that this therapy was very tolerable even though some of the strokes were deeper than previous work, and he was feeling better.
The important thing to learn from this is that it is crucial to have a structurally-based strategy for applying therapeutic massage techniques. Deep tissue therapy, whether it is myofascial release, myofascial unwinding, myofascial stretching, or deep trigger-point release, will result in significant long-term structural changes. If these releases and changes do not contribute to structural balance and normalization of structural function, then they are likely to contribute to structural distortion patterns and structural dysfunction, which tend to create worsening conditions and increased client pain.
In Jim's case, the tension was released from the musculature of the anterior shoulder and neck first, allowing the shoulders and neck to move back facilitating the initial structural improvement. As the shoulders and neck released, the spasms in the back of the neck and top of the shoulders began releasing even before treatment was ever applied to those areas. If therapy had been applied to the primary areas of pain in the back of the neck and top of the shoulders first, the tightened musculature in the anterior neck and pectoralis muscles would have pulled the head and shoulders forward even further as the posterior musculature was released. The structure would have worsened by the increased misalignment resulting in increased pain. Thus, it is very important for therapists doing therapeutic massage to always be aware of the structural consequences and ramifications of releasing fascia, adhesions and shortened muscles. To address Jim's complaint regarding the pain he experienced with other deep-tissue work, a three-step approach to working deep tissue was used.
The first step is the application of milking strokes to release the fluids, toxins and ischemia, which reduces the inflammation and clears some trigger points. Tissues swollen with toxins, fluid and inflammation are extremely sensitive and painful to touch, so light, slow, gentle strokes are used. This results in a decreased sensitivity of the tissues, which allows palpation of the tissues without major discomfort and prepares the tissues for deeper work.
The second step is the application of directed myofascial unwinding strokes to release the holding pattern of fascia in the structural dysfunction and to further clear trigger points. These strokes are very slow. You sink in until you feel the resistance in the tissue and then hold constant, steady pressure until the resistance starts to melt. Follow the tissue as it melts, keeping the pressure slow, steady and constant. You will feel many layers softening and releasing at a deeper level than where the actual pressure is. The deeper you go, the slower you go. These strokes released most of the myofascial holding pattern that held the structural distortion within Jim's neck and shoulders preparing this area for more specific deep work to release scars, adhesions and tightened individual fibers.
The third step is the application of individual fiber strokes to release deep fascia, adhesions, scar tissue and atrophied tissues locked in the soft tissue. Many of these deep adhesions, along with scar tissue, entrap nerves and lock the structure into distortion. These are deep, specific strokes, moving very slowly, staying within pain tolerance levels.
This three step approach can be used in any area of the body and will allow you to apply effective, deep therapeutic massage while staying within your clients' pain tolerance. Jim stated that, even though these strokes appeared to release tissues more deeply than previous deep-tissue treatments, he did not have the discomfort that he experienced in those treatments and his pain disappeared after just a few sessions.
Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.
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