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Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
January, 2011, Vol. 11, Issue 01
Rehabilitation: The Protocol Defined
By Whitney Lowe, LMT
Orthopedic massage is a highly effective system for addressing soft-tissue pain and injury complaints. What makes this approach so effective with a wide variety of movement system disorders is the fact that it is a comprehensive treatment approach and not just a massage technique.In the mid-1990s, I proposed a model for an orthopedic massage system that included four primary components. These four components are: 1) orthopedic assessment, 2) matching the physiology of the tissue injury with the physiological effects of treatment, 3) using a variety of treatment approaches, and 4) appropriate use of the rehabilitation protocol. It is this fourth and final component of the system (the rehabilitation protocol) that requires some additional explanation, as it is a comprehensive topic on its own.
In the late 1980s through the 1990s, I spent a number of years working in orthopedic, chiropractic, and physical therapy clinics. These experiences were invaluable in helping to shape and mold my understanding of how to evaluate and treat all kinds of soft-tissue injuries. It was during this time that I began to observe an interesting pattern occurring with many of the patients who were being seen in treatment.
As part of the treatment process, patients were often given rehabilitative exercises to perform. Many of the patients performed the exercises, but then reported that their condition actually worsened instead of improving. While it is natural to assume that some people might not benefit from a particular treatment approach, there was a disproportionate number of people who were having adverse effects to this treatment regimen. Many people were being given strengthening and conditioning exercises when there was still a serious tissue dysfunction present. The strengthening exercises then aggravated the existing complaint. This situation started me investigating what could be different in the treatment approach to prevent this large number of adverse outcomes. It was out of this exploration that I developed the rehabilitation protocol concept as a fundamental component of the orthopedic massage system.
Soft-tissue pain and injury conditions may involve fiber damage like that occurring in muscle strains or ligament sprains. In other situations the dysfunction may simply result from impaired function, like that seen in myofascial trigger point pathologies or nerve impingement syndromes. However, despite the wide array of tissue pathologies there is a progression of tissue healing that is similar in all these conditions. As clinicians our treatments must maximize and take advantage of this healing response. Appropriate use of the rehabilitation protocol helps you accomplish this crucial treatment goal.
The rehabilitation protocol has four separate stages: normalize the soft tissue dysfunction, improve flexibility, reestablish appropriate movement patterns, and strength conditioning. Let's take a look at each one of these stages in greater detail to understand how they work with your massage treatments.
The first stage is to normalize soft tissue dysfunction. Regardless of what type of tissue injury or dysfunction has occurred the first thing that must happen is to bring that tissue dysfunction back to its normal state or at least as close to its normal state as possible. For example, if there is a muscle strain with torn fibers, normalizing the soft tissue dysfunction means addressing the torn muscle fibers and resultant scar tissue with deep transverse friction massage. If the primary dysfunction is a myofascial trigger point, normalizing the soft tissue dysfunction involves neutralizing that trigger point so the muscle spindle cells are not overly activated and the muscle tissue can return to its normal state.
The second stage is to improve flexibility. Soft tissues require adequate flexibility and pliability to work at their optimal state. If they are bound and restricted by scar tissue, movement and function are impaired. In the event that muscles are chronically tight from excessive trigger point activity, there are likely to be biomechanical distortions or problems in the regions acted upon by those muscles. Full restoration of functional movement cannot return if adequate flexibility is not restored. Once the soft-tissue dysfunction has been normalized and tissue flexibility has been restored, it is now appropriate to move on to the next stage.
The third stage is to re-establish appropriate movement patterns. Proper movement patterns need to be introduced to the soft tissues in the healing process to encourage optimal function. There are many ways to restore proper movement patterns after a soft-tissue injury. Sometimes movement restoration includes specific exercises such as those performed in physical therapy or a movement-oriented discipline like Feldenkrais or Aston Patterning. In other situations restoring proper movement might simply be making ergonomic changes in a person's workstation or the way in which they engage with tools in their daily activities. The initial tissue dysfunction must be addressed and flexibility restored before these correct movement patterns can be reinforced. If the first two stages have not been accomplished it will not be easy, or in some cases even possible, to restore proper movement patterns.
The final stage is strengthening and conditioning. It is this stage which is often performed too early in the rehabilitative environment. Strengthening or conditioning activities do not require you to be lifting weights in a gym or working out in a formal exercise facility. Sometimes it is as simple as training your body for the demands it faces. For example, massage therapists benefit from hand and finger strengthening exercises which could be performed with simple rubber bands. These conditioning methods prepare the practitioner for the physical demands of daily work activities.
In most cases, a massage therapist is not directly involved with strengthening or conditioning activities for the individual if those activities are being performed for the purpose of injury rehabilitation, as it is outside our scope of practice. However, knowledge of the process of strengthening and conditioning is exceptionally valuable and will help guide appropriate treatment decisions throughout the course of treatment.
The rehabilitation protocol should be considered a set of guidelines, not strict rules. There is a progression through the rehabilitation protocol from the first stage through the fourth. However, it should not be viewed as a strict process where all of the first stage must be accomplished before moving to the second stage and all of the second stage accomplished before moving to the third, etc. There can be overlap between the different stages, but you should see your client's soft-tissue injury or pain complaint move through these stages and not jump to the end of the protocol before the earlier stages have been mostly accomplished.
It is our job to recognize what stage our clients are at in the rehabilitation protocol and adjust our treatment approaches accordingly. It is through accurate orthopedic assessment processes that we make the determination of where they are in the recovery process. Once you understand and appropriately apply the rehabilitation protocol you will find much greater success in your treatment outcomes with a wide variety of pain and injury complaints.
Click here for more information about Whitney Lowe, LMT.
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