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End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
A Q & A About Updated Codes
Yes, indeed there was an update to ICD-10 on Oct.1, 2016. This is a regular update to the diagnosis coding system and this type of update will occur every Oct. 1, just as it did when the ICD-9 system was in place.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
January, 2011, Vol. 11, Issue 01
Practice Building: Getting Inside Your Patient's Head
By David Kent, LMT, NCTMB
What makes your outcall, chair, spa or clinical practice different from the others in your area? Implementing systems that make your practice standout from your competition are fundamental to insuring success.When a client experiences an appointment, there are many things that leave unique lasting impressions. However, what triggers a client to reschedule, return and refer? Let's look at a few subconscious triggers our culture and society has taught our clients to expect when visiting a health care provider. Then we will outline ways to integrate these systems into your massage therapy practice so your clients reschedule and refer new business.
Throughout life when we have pain or other symptoms we go to the appropriate health care provider. For example, we go to a dentist for a toothache, a family-care physician for the flu, and a chiropractor for a vertebral subluxation.
Patterns: Over the years, various doctor visits have taught us recognizable patterns that we now expect when we go to a health care provider. Typically, we arrive at their office and check-in, payment is confirmed, and then complete intake forms that include: health history, current symptoms, height, weight, blood pressure and so on.
Physiology: If the function or physiology of an organ system is in question, the health care provider will test and measure levels in the blood and urine. These levels are compared against established normal ranges for variations sending up "red flags".
Anatomy: Likewise when the form or anatomy of the body is suspect, they evaluate the structures utilizing an array of techniques from a palpation exam, orthopedic and neurological assessments, range-of-motion and muscle testing, to name a few.
Imaging: Some imaging such as X-ray, MRI, and ultrasound provides an internal view of the anatomy allowing us to see: a broken bone, a tumor and other abnormalities in the body. (Image 1) "Before" and "after" photos are commonly used by many medical specialties, from reconstructive to cosmetic surgery, because they document measurable change from start to finish.
Findings: The health care provider proceeds to explain the origin of your symptoms while referencing the tests, imaging and photos as supporting evidence. They often highlight or circle the high and low markers on the reports that indicate abnormalities. They often point out specific areas on the X-rays, MRIs or photos of the structures involved. (Image 2) Finally, they present the solution in the form of a treatment plan. Read "The Initial Treatment: Generating Thousands to Your Practice" (MT, July 2010).
Integrating Patient Expectations
Besides experiencing the above scenarios themselves, how many times have our clients also watched it repeatedly on TV and in the movies? The bottom line, our clients expect their health care provider to gather information with intake forms, listen to their history and evaluate their current condition (subjective component), followed by palpation, assessments, tests and imaging (objective component). All findings and tests are reviewed (assessment). Finally, we are told the treatment options (plan). Being aware of these patterns allows you to implement similar systems into your massage therapy practice. Let's look at each component and understand how it applies to you.
Subjective Component: Regardless of where you work, the acronym, OPQRST is a helpful system to efficiently guide the documentation of our client's subjective complaints. The following is a breakdown of that system:
Onset: When did the symptoms (pain, tension, restricted range-of-motion) start? What were they doing immediately before or leading up to the time the symptoms began?
Provokes: What activities or movements cause the pain and/or symptoms to start or get worse? What makes it better?
Quality: Describe (using the patient's words) the phenomena they are experiencing. Terms might include but are not limited to: pain, aching, burning, stabbing, numbing, pressure and tingling.
Radiates: Where is the pain? Does the pain radiate? If yes, where?
Severity: Have the client rate their current level of pain on a scale of 0-10, with 0 = no pain and 10 = severe pain.
Time: When did the current pain start? How long has the condition existed?
Completion of an intake form, questionnaire and pain scale is followed by the therapist reviewing OPQRST, providing a professional initial impression that is effective, thorough and customary to the client.
Objective Component: Now that we understand the client's symptoms, we can start the investigative process of determining other contributing factors. The first step is to identify what parts of the body are functioning abnormally. Orthopedic assessments are quick, easy and effective ways to test for musculoskeletal abnormalities or impairments. (Image 3)
Postural analysis photos are excellent for documenting posture, educating clients and customizing treatment plans. Keep the process simple, the camera and screen built into many cell phones can be both a powerful assessment and education tool. (Image 4) They allow you to instantly take, review and zoom-in on a picture. Showing a client their posture adds a whole new meaning to the saying "a picture is worth a thousand words". The visual impact for the client to see their high shoulder, forward head or collapsed abdominal posture is a powerful educational tool that makes a lasting impression of your ability to identify, understand and address their problems.
Assessment: Looking at the anatomical facts allows you to establish a clinical impression or assessment, so you can create a logical treatment plan.
Plan: Just like other health care providers, you must proceed to explain the origin of your client's symptoms and a solution while referencing the tests (orthopedic, range-of-motion) and postural analysis photos as supporting evidence. Read "Tools to Succeed for Massage Therapists" (MT, May 2009). It is important to "connect the dots" on a level the client can easily understand. The client must feel you understand the origin of their pain and can implement a successful, goal oriented, treatment plan. Here are a few tips:
Highlight: Highlight or circle items on the intake forms, questionnaires and pain scale of significance. Review each item with the client and take notes as appropriate.
Focus: Like doctors and other health care providers utilize X-rays, MRIs or CAT scans to educate patients, draw conclusions and design treatment plans. Make it easy for your clients to understand the stresses their musculoskeletal system is enduring by zooming-in on different postural analysis views and explain how your treatments can help. (Image 5)
Explain that muscles help to determine the location and position of bones in space, so by looking at the client's posture along with various assessments, we know which structures (muscles, ligaments, joints, nerves, etc.) are being stressed or compromised.
A lateral view photo makes it easy to show a forward head, rounded (protracted) shoulders or a collapsed abdominal posture. An anterior view photo will quickly identify the presents of a fallen arch, high shoulder, and much more. Use the photos to create measurable treatment goals. Read "Getting Comfortable With Postural Analysis" (MT, July 2008).
Correlate: Myofascial Trigger Points (TrPs) can form and be perpetuated for numerous reasons. Poor posture is one contributing factor. The formation of trigger points in the trapezius muscle is easy to understand when we cross-reference the posture photos.
Use visual aids like trigger point wall or flip charts to educate clients of referral patterns. Reviewing trigger point patterns with the client builds trust and confidence. Clients find it comforting to see their pain pattern on your charts. (Image 6) Explain how your treatments can help to address trigger points.
Reinforce: When a client asks during or after a treatment why a muscle is tight or tender, take this opportunity to briefly reinforce the connection between their posture, limited range-of-motion, trigger points and pain. Teach clients stretches, movements and offer tips that support their therapy.
Sample: A dental hygienist gives you a new toothbrush and floss at the end of a cleaning. Similarly, a medical doctor often gives patients drug samples. In similar fashion you can provide samples of topical analgesics. One company will supply to you, free of charge, brochures with a sample packet attached with you name and phone number printed on it. This is an easy and inexpensive way to promote you business. Selling topical analgesics can provide addition income.
Thank: It only takes a moment to say "thank you" or a few minutes to send a note. It is always nice to be acknowledged and feel appreciated. Read "Building Raving Fans" (MT, April 2008).
Society has taught your clients what to expect when visiting a doctor or health care provider. With this knowledge you can integrate the above systems into your practice to standout from the competition while triggering your clients to reschedule, return and refer. Ultimately, you must present the solution in the form of a treatment plan.
Click here for more information about David Kent, LMT, NCTMB.
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