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Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
December, 2008, Vol. 08, Issue 12
Body Art: Tattoos and Piercings
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
A couple of years ago, I was teaching a class about massage and the parasympathetic effect. To make my point, I stood behind a student, put my hands on her trapezius and then began to do some gentle petrissage through her sweater.Chatting blithely away about blood vessel dilation, changes in breathing, and dropping blood pressure, I failed to notice that this poor, polite student was not enjoying her massage. She was wincing, tightening up and leaning away. When I finally noticed and asked her what was going on, she said she had just had a big tattoo put on her shoulders. The whole class gasped in sympathy.
On a related topic, a reader named Tamra sent me this note: "I was standing behind a person in the grocery store with surgical steel ball implants in her cervical area (bilaterally) from about C3 to C7, in what would be considered the lamina groove. I wondered as I was standing there: If she were my client and she had neck pain, what would I do? How would I treat her? I had no answers, only avocados."
I know that I am a good deal older than many of my peers in the massage profession, and I freely confess to being a bit of a fogey about body art. I was so grateful that the threat, "Whatever you have pierced, I'll have pierced. And then I'll show all your friends," worked on my children and I never had to shop for a navel ring. That said, for many people tattoos, piercings and other physical modifications are a mode of self-expression that is important and deeply meaningful. While, like anything, body art can be abused, it can also be very creative and empowering. In the words of Andy Barnett, a professional piercer and tattoo artist, "I want to adorn the body, not mutilate it."
Many of us have clients with various forms of body art. Under some circumstances this can require some adjustments in our work. This article offers a brief primer on tattoos and piercings, the challenges that they may pose for massage, and strategies that can help us be safe and effective practitioners in this context.
Tattoos are pictures drawn on the skin through shallow injections of colored ink. Tattoo artists use tiny needles and a rapidly pulsating machine to deposit the ink just under the skin. Standards for hygiene in licensed tattoo studios are high, so the risk of infection from contaminated equipment is minimal. With "garage artists," this is not always the case, meaning blood-borne infections like HIV, or hepatitis B or C can be spread this way.
The dyes in tattoo ink can be a problem for some people. While inks are safer than they used to be, a lack of regular oversight means that not all inks are hypoallergenic. Allergic reactions are rare, but not unheard of. Because they most often occur in reaction to any color in the red family, new tattoo clients may be counseled to begin using red in small amounts until they know how they'll react. Reactions can cause itching, blisters and bumps (called granulomas) around the edges of a tattoo.
A person with a new tattoo is usually counseled to cover it for a day, avoid submerging it in water for up to two weeks, and rub it frequently with ointment and then with unscented lotion to promote speedy healing. New tattoos involve compromised skin - an obvious contraindication for massage. After the initial tenderness subsides, many people experience intense itching for a few days. This is another caution for massage, which can make itching worse by drawing blood to an area. The safest course in this situation is to wait for any pain and itching to resolve before doing massage in an area with a new tattoo.
Piercings are self-evident, and the variety of body parts that are pierced continues to expand. I remember being both shocked and vastly curious the first time we had a massage student with a nipple ring. (In my own defense, I will point out that these were the days when it was daring to have more than one hole in an earlobe.)
Piercings involve using a special needle to penetrate the skin. Various types of instruments are then inserted into the opening and secured from both sides. The piercing heals when scar tissue forms a tunnel around the instrument. The young woman Tamra described had several long instruments that were inserted to reach horizontally under her skin across the back of her neck.
Depending on the site, piercings can take anywhere from a few weeks to several months to heal completely. At that time, jewelry can be removed and replaced easily. (There's the answer to Tamra's question, by the way: She can take the studs out of her neck to receive massage, if necessary.) Most piercing jewelry is made of surgical steel. Surface piercings, like those on the young woman with the nape studs, have a relatively high rejection rate, but they tend to be most successful when the jewelry is made of surgical-grade Teflon or acrylic, which can conform to the body's curvature. While piercings are healing, the person is advised to keep the area clean and avoid letting anything like hair or clothing catch on the jewelry.
The size of the jewelry is an important safety factor. If it is too short, it can be drawn into the skin, and if it is too long, it can create unnecessary friction as it rubs on nearby structures. Tongue studs that are the wrong size are notorious, for instance, for causing damage to teeth and gums. Other risks with piercings include the possibility of excessive scar tissue or keloids, or trauma if the jewelry is torn out.
Guidelines for massage in the context of piercings are clear: New piercings involve injured skin and must be locally avoided until the lesion has scarred over. On the other hand, older piercings pose no contraindications, and the jewelry can be removed to make massage more effective whenever necessary.
Many thanks to Tamra, who posed this interesting question, and to Andy Barnett of Frankie's Tattoo in Clearfield, Utah, who generously allowed himself to be interviewed for this article. For next time, the floor is once again open. We can continue in this vein with additional information about body art (implants, braiding, scarification, etc.), or we can pick up something entirely different. It's up to you: What's on your table?
Until then, many thanks and many blessings.
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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