resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
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.
Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
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."
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.
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.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
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.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
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.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
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.
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.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
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.
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: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
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."
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.
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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