resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
How We Can Help the Injured Brain
The majority of patients with mild traumatic brain injuries recover within seven to 10 days. If concussion signs and symptoms continue beyond seven days, the diagnosis changes from acute concussion to post-concussion syndrome.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
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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