resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
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.
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.
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?
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.
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.
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.
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."
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.
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.
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.
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.
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'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.
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.
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.
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.
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.
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.
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
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 more information about David Kent, LMT, NCTMB.
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