resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
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.
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.
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.
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."
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.
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.
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.
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.
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.
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.
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.
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.
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.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
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.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
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.
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.
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.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
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.
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."
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.
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."
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.
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.