resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
March, 2009, Vol. 09, Issue 03
Clinical Reality for Pain and Injury Conditions
By Whitney Lowe, LMT
Take a look through any of the popular trade publications in our field and you will find a wealth of advertising for courses that are teaching you new techniques. The extravagant claims for methods that provide "permanent pain relief" or "immediate results in one or two treatments" can certainly pique your interest and make you think this is something you must have. Clearly, learning new techniques is a great way to retain enhanced skills and abilities as well as provide more ways to address client problems. However, the emphasis on techniques can be misleading when you are working with rehabilitative massage approaches because technique is only a small piece of the puzzle. Clinical success in treating pain and injury conditions requires a much more comprehensive approach and that is what orthopedic massage is all about.
Orthopedic massage is not a technique, although you use a wide variety of techniques as you apply this approach. Instead, it is a comprehensive system for alleviating pain and injury conditions with massage. A brief story helps illustrate why a systematic approach like this is so important. In the first year of my professional practice, I rented a small space in a medical office building; to build my business, I began networking with some of the physicians in that building. One day a physician sent a patient to me who was having severe back pain. I realized as I began talking to her that I had no idea what was wrong with her and I was genuinely puzzled as to whether massage would help her or hurt her. I had been taking all kinds of new technique workshops, but they hadn't really helped me learn how to make important clinical decisions such as: Should I try to treat her or not? If so, what techniques or approaches would be the most helpful?
I wanted the physician who referred this patient to me to respect massage as a beneficial treatment approach, so I felt uncomfortable just sending her back to the doctor who had sent her, telling him I didn't know if I could help or not. It was at that point I realized I needed to learn more about clinical management. What I hadn't realized is that what I was really looking for was not just a particular technique. Instead, it was a comprehensive approach for applying clinical reasoning skills.
Clinical reasoning is at the core of all successful clinical practice in the health care professions. Yet, you don't hear much about it in massage education because it's much easier to sell a sexy new technique. Simply put, clinical reasoning is "...the sum of the thinking and decision-making processes associated with clinical practice."1 The more effective you are at using your clinical reasoning, the more effective and successful you will be as a clinician. Developing effective clinical reasoning is not as simple as just taking a course in it. It is a more complex process that calls upon your skills abilities in a variety of different areas. Let's take a look at some of the most important aspects of clinical reasoning and how to improve those skills.
Researchers have looked into what separates experts from novices when it comes to clinical management skills in the medical field. One of the main factors they have found is that experts develop certain shortcuts by recognizing patterns of information that novices might tend to miss.2 For example, suppose a client comes in complaining of foot pain and reports a recent increase in running on hard pavement and plantar foot pain that is most pronounced first thing in the morning. These are just two clinical factors that have been shared, but someone familiar with plantar fasciitis will immediately recognize them as fitting into the pattern of that pathological problem. It does not mean that we have determined the client's condition with just those two elements. Yet, the ability to see that symptom pattern gives us a significant advantage over someone else who may only hear the client rattle off an accumulation of symptoms and not be able to make any sense of them.
The practitioner using effective clinical reasoning will then take these recognized information patterns and apply deductive thinking to analyze the clinical problem further. Deductive logic is what occurs with an "if, then..." statement. For example, IF this client reports sharp shooting pain in the upper extremity along with paresthesia on the ulnar aspect of the hand, THEN there is a good chance the pain complaint is originating from some neural pathology, in either the neck or upper extremity. This deductive analysis helps us determine if massage is appropriate and if so, how we should apply it.
Clinical reasoning is crucial not only in clinical assessment, but in the treatment process as well. Often you will hear treatment recipes and routines given that describe how to address a particular pathology; they will say perform this treatment X number of times and your client will get better in two treatments, etc. However, this approach is highly problematic and doesn't reflect clinical reality. Each client is an individual and each individual has a unique presentation of his or her soft-tissue disorder. One person's carpal tunnel syndrome should be treated differently than the next person's, even though they may have been diagnosed with the same disorder. It is your use of clinical reasoning and decision-making skills that help you determine how to modify your treatment approach for each client's unique needs.
As with many aspects of health care delivery, clinical reasoning relies on both art and science. You need a comprehensive understanding of science (anatomy, physiology, kinesiology, etc.) to help in symptom pattern recognition, construction of treatment strategies, and proper application of rehabilitative concepts in massage. Use of effective clinical reasoning is an art and skill that is developed with constant practice and study.
Treatment techniques will help you fill your tool bag, but if all you do is amass a series of techniques you only have a bag of tools and no knowledge about how to effectively use them. A wrench is a great tool, but you don't want to try using a wrench when a screwdriver is the proper tool. Similarly, you will be far more successful and your massage technique skills will have much more effect when you expand your use of effective clinical reasoning.
Click here for more information about Whitney Lowe, LMT.
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