resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
Eucommia Bark Helps Maintain Strong Bones
Eucommia bark is a major tonic herb used in Asia, and now throughout the world, that supports and helps mend the skeletal structure and its related tissues. Eucommia bark is collected from Eucommia ulmoides trees that are more than 10 years old.
Don't Believe It
One of our staff came into my office last week, very concerned about an article she had just read on a news media website. The article suggested researchers found "no health benefits" associated with taking multivitamins.
The Power of Words: DCs Share Drug-Free Approach
There's no doubt that words are powerful and important – especially in the chiropractic profession, where we have been struggling for years to find the right words to describe who we are and what we do.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
VA Names Sites for Pilot Chiropractic Residency Program
The Veterans Administration has announced the five VA medical facilities that will serve as initial sites for the administration's recently established pilot chiropractic residency program.
Diagnosing Flexion-Intolerant Lower Back Pain (Part 2): Exercise Rehab
One of the things that has puzzled us for years is the presentation of the flexion-intolerant patient. We have realized there is a large overlap with sacroiliac indicators. In acute lumbar pain, the SI often twists, subluxes, goes haywire.
The Urinary Bladder Official
The Bladder Official is known as the Official Who Controls the Storage of Water. In Western medical terms, this organ collects the urine excreted by the kidneys.
Asymmetrical Pronation: Effect on Adjustments
When your patients don't respond as well as expected to their chiropractic adjustments, oftentimes there is a source of interference in the pedal foundation – asymmetrical pronation.
News in Brief
Patriot Project: Serving Those Who Served; CTCA Chiropractor Receives Clinical Innovation Award.
Giving Testosterone Levels a Boost (Part 3)
Since testosterone and insulin status are inversely correlated, it's important to keep insulin low so testosterone will remain high.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
Ever Heard of the Lateral Raphé?
We have all had acute patients enter our offices listing laterally to the side at the level of the lumbar spine or expressing pain on lateral lumbar bending.
Managing Hallux Hypomobility Disorders (Part 2)
In part one of this series we discussed the unique properties and significance of the first toe in the propulsive phase of gait. In particular, we discussed the importance of the first metatarsophalangeal joint (MPJ).
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Grape Seed Extract: A Multifaceted Herb for Promoting Healthy Circulation
One of my favorite herbs is grape seed. Modern research has identified some intriguing health benefits attributable to the seed of this ancient fruit. I particularly use grape seed as an extract standardized for OPCs (oligomeric procyanidins).
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Weighing in on Weight Loss
If your practice trends anything like the U.S. population, you are probably noticing over two-thirds of your patients could benefit from weight reduction, particularly if their main complaints include chronic back or joint pain.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
March, 2009, Vol. 09, Issue 03
Prenatal Massage and Pre-Treatment Evaluations
By Elaine Stillerman, LMT
In addition to learning what to do to support your pregnant/postpartum clients and relieve their common discomforts, part of the prenatal professional training must include how to recognize when a massage should not be provided. And part of the dialogue that you have to establish with your clients is that when you feel a massage should be postponed until after they have been checked by their care providers, you mean it and stand behind your decision. It is not easy to tell a deserving client that her much-coveted massage is not going to happen, but if your pretreatment evaluations are positive, that is the only safe and responsible choice you can make.
But upon what standards or guidelines do you base your decision? The answer comes from understanding prenatal and postpartum anatomy and physiology. By the end of the pregnancy, most women have an increase of up to 40 percent more interstitial fluid. This excess fluid generally pools in her extremities, especially the legs and feet. In most cases, this "gravity" edema can be treated effectively with manual lymphatic drainage (MLD) and elevation of her legs. And although the swelling can be extensive due to poor posture, poor diet, excessive sodium in the foods she eats, standing a great deal during the day, weather conditions, and restrictive clothing to name a few contributing factors, it poses no health risk. Appropriate massage (MLD) will reduce the swelling by enhancing lymph absorption.
Assessing Serious Conditions
There are times, however, when the swelling is a symptom of a more serious condition - preeclampsia. This hypertensive condition is extremely dangerous for mother and her baby. Preeclampsia is a condition characterized by swelling of the face, hands, and feet, elevated blood pressure, excessive fluid retention, and protein in the urine. It is sometimes accompanied by severe headaches (or migranes) with or without optical "floaters." If preeclampsia is suspected or confirmed, all massage must be avoided until her blood pressure stabilizes and her care provider affirms that she and her baby are out of danger.
In order to test for the presence of this potentially life-threatening illness, we assess the swelling by pressing on the lowest part of each leg, just above the ankle. Press for a count of 5. If the indentation does not fill, or remains pitting, and the ischemic region does not appear red again within 10-30 seconds, massage is contraindicated and the client must see her care provider immediately. Some women develop preeclampsia during postpartum recovery, so the test for pitting edema must continue for the first six weeks, or during the puerperium recovery.
In order to protect against hemorrhaging during childbirth, pregnant women produce more blood clots. During the second trimester, there is an increase in the synthesis of plasma fibrinogen (coagulating factors VII, VIII, IX, X, and fibrinogen) that continues throughout the first few months (8-10 weeks) of postpartum. The potential in blood clot formation (thromboembolism) is five to sixfold during pregnancy and up to three months postpartum. These clots primarily appear in the deeper veins of the legs: the femoral, iliac, and saphenous veins. In order to prevent dislodging these clots, the safest and most effective modality to employ is, once again, MLD.
The risk factors for clots during pregnancy include a sedentary lifestyle, being confined to bed rest, a maternal age of 30 or older, being over-weight, having an autoimmune disease like lupus, and being pregnant with the fourth (or more) child. In addition, clots may develop because of the weight of the gravid uterus slowing iliac and femoral circulation, sluggish blood flow, venous stasis, increased blood volume, and higher levels of progesterone relaxing the smooth muscle fibers. (Although many of these changes reverse soon after childbirth, fibrinogenic activity doesn't normalize until 8-10 weeks postpartum.)
Illness and death from venous thromboembolism occur 1 in 1,000 to 1 in 2,000 pregnant and postpartum women. These figures do not reflect deaths which occur after the traditional 6-week recovery period.
Deep venous thrombosis (DVT), which occurs mostly in the left leg and its resultant pulmonary embolism are the leading causes of preventable in-hospital mortality in the United States. In general (not necessarily related to pregnancy and postpartum), the signs of DVT are commensurate with the degree of blockage in the vein and inflammation of the vessel wall. Many people, including those who are pregnant, are asymptomatic, but it is important to evaluate both legs before massaging your pregnant or postpartum mother for the signs that we can assess.
Surgeries, like Cesarean sections, increase the risk of thromboemboli and the sequelae of a pulmonary embolism. After surgery, most clots occur in the left leg, although both legs must be evaluated.
While lightly placing your hand(s) down the back of her leg (you can perform this before she gets on the treatment table or through the sheet with your client lying on her side), palpate for localized unilateral swelling, heat, pain (which occurs only 50 percent of the time), tenderness on the over-lying dermatome (50 percent of the time), muscle contraction, and possible redness. Keep in mind that the edematous leg will feel hot all over; remember that you are feeling for localized symptoms. In addition, her legs will feel hotter around the joints where the fluid tends to aggregate and in areas where the veins are superficial like the backs of her knees or her ankles.
The second test is specifically for the calf muscles and evaluates the presence of clots in the saphenous vein. However, this Homan sign or Homan check is present in less than one-third of patients with confirmed DVT and is positive in more than 50 percent of patients without DVT, so it is nonspecific. Still, it is a relatively fair barometer to use. With her leg extended, flex her knee to about 5 degrees. Dorsiflect (bend or flex backward) her foot. Any sharp pain in her calf may indicate a positive result. If you suspect that a blood clot is present, do not massage and refer her to her care provider immediately.
To effectively use these pretreatment evaluations, let your pregnant (postpartum) clients know that you will be doing them before each treatment. Once you become proficient, they will take less than one minute to do collectively. If you suspect pitting edema or the presence of a blood clot, explain this to your client in a calm manner and suggest that she seek immediate medical confirmation. I usually suggest that these evaluations are not absolute medical diagnoses but rather indicate that caution should be exercised, and massage should not take place. Instead, I offer my clients an opportunity to book another appointment, once the situation has been addressed, "on the house." However, it never fails that my clients return and pay, regardless of my offer.
Make these pretreatment evaluations a part of your prenatal/postpartum practice. You will feel more confident about giving the massage and your clients will be grateful that you are taking appropriate care of them and their babies.
Click here for previous articles by Elaine Stillerman, LMT.
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