resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
Leaving a Lasting Legacy: Donna Liewer
For the past 31 years, Donna Liewer has been on a personal mission "to comfort the afflicted and afflict the comfortable." In her role as executive director of the Federation of Chiropractic Licensing Boards, Liewer has accomplished that and much, much more.
One and Done: Keeping Patients From Vanishing After Just One Appointment
What happened to my 3:30 p.m. ROF? They may have rescheduled, but there are two common answers no one wants to hear: 1) "She called to cancel. I tried to get her to reschedule, but she refused." 2) "She no-showed.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
Creating Child-Friendly Clinics with ABT
The Zurich Dojo was scattered with toy ducks, dolls, trains, exercise balls and teddy bears during my recent pediatric workshop.
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Epigenetics: The Western Science Supporting Essence
Since the days of Darwin, western medicine has touted that our genes were set in stone, that our genetics were our destiny. We were told that the diseases that ran in our family were likely coming to us as well.
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
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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