resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
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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