resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
We Get Letters & Email
Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
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.
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.