New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
State by State: Chiropractic Leads Changes in Health Care
Monumental legislative bills in support of the chiropractic profession were passed recently in Washington, West Virginia and Oregon. Here is a review of this important legislation, state by state...
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
October, 2008, Vol. 08, Issue 10
Safety Protocols: The Carotid Artery
By David Kent, LMT, NCTMB
Regardless of your modality and whether you perform massage on an outcall basis, in a clinic or spa, or in another setting, it is always important to be aware of circumstances in which massage may not be beneficial for your client or when it might be necessary to take extra precautions during a session.
For example: A client enters with cervical pain and limited range of motion, complaining of pain along the length of the sternocleidomastoid muscle, as well as temporal, frontal and orbital headache symptoms consistent with trigger points in that muscle. In this situation, treatment will likely consist of working very close to the carotid artery; therefore, it is extra important to understand the anatomy and the body's physiological responses around this region so that you can ensure your massage produces positive outcomes.
In this article, I will discuss two conditions that require taking extra precaution when working around the carotid artery: plaque build-up in the carotid artery and a condition called carotid sinus hypersensitivity (CSH).
Plaque is made up of fat, cholesterol, calcium and other materials found in the blood. Over time, plaque hardens and subsequently clogs the arteries, which decreases blood flow through the arteries to the heart and the brain. This is called atherosclerosis.
In my full-body dissection seminars, I always remove a portion of the carotid artery; then I cut and peel away the arterial wall to reveal a "tube" of plaque lining the artery. This tube looks like a crudely formed plastic straw that is thicker in some areas than others. When squeezed, the tube makes snapping and cracking noises similar to a piece of plastic breaking. I demonstrate this for my students so that they understand why it's important to administer precise palpation and avoid making contact with the carotid artery during a massage. Palpating an artery that has substantial plaque build-up could pose serious risks to the client. In a worst-case scenario, a piece of plaque could break off inside the artery, travel to the brain and cause a stroke.
Using appropriate intake forms can help you identify clients who are at risk for plaque build-up. Intake forms should inquire about previous surgeries, health conditions and prescription medications. Some procedures to look out for include carotid endarterectomy: a surgical procedure for cleaning out the carotid artery and restoring blood flow to the brain. Other related procedures include coronary bypass, stinting or angioplasty. Blood clots are also related to plaque build-up, so look out for medications that include blood thinners and anticoagulants.
When red flags come up, heed the warnings - even if a client says they have previously received massage. In cases such as these, I will not proceed without a prescription for massage therapy from the physician currently treating the client's condition. This is a safeguard for everyone involved, and most patients will thank you for your concern and professionalism.
If you do not understand something a client wrote on an intake form, make sure to look it up before you proceed. For example, some clients use acronyms to describe their conditions; however, it is important not to assume you know what an acronym stands for. CSH is one such acronym that has multiple meanings.
Carotid Sinus Hypersensitivity (CSH)
The carotid sinus plays a key role in regulating blood flow to the brain. It contains baroreceptors that are sensitive to changes in blood pressure. It is part of the internal carotid artery just after it emerges from the common carotid artery, located just above the superior border of the thyroid cartilage (Adam's apple) at the level of C3. It is attached fascially to the sternocleidomastiod muscle (see image).
Carotid sinus hypersensitivity is an exaggerated response to carotid sinus baroreceptor stimulation. Massaging the carotid sinus stimulates nerve endings, which can cause the heart rate to slow. CSH is the most common reported cause of falls and syncope (fainting) in people over 65 years of age.
In a study of 1,000 people with no history of syncope, dizziness or falls, participants were given carotid massage for an average of 7.3 seconds in a supine and upright position with beat-to-beat heart monitoring. The study showed that 39 percent of the participants had some form of carotid sinus sensitivity; 24 percent had asystole (absence of cardiac heartbeat) for three seconds or longer; and 16 percent had symptoms, including syncope with carotid sinus hypersensitivity.1
In rare cases, only 1 percent of patients experiences spontaneous carotid sinus syndrome: a situation in which the symptoms can be clearly attributed to a history of accidental mechanical manipulation of the carotid sinuses, for example, by taking a pulse in the neck or by shaving.2 Therefore, it is necessary for massage therapists to be aware of the potential physiological effects when treating in this region.
Providing Safe, Effective Massage
There are several ways to ensure that you provide safe, effective massage therapy:
Treating in the sternocleidomastoid region can be a safe and satisfying experience for the client, as long as you take the necessary steps to ensure you are palpating properly and precisely. Always proceed with caution. To share your tips and experiences in the treatment room, please drop me a line at . And for more information about keeping it simple in your day-to-day practice, be sure to check out my other articles at www.massagetoday.com.
Click here for previous articles by David Kent, LMT, NCTMB.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.