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The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
First Do No Harm?
There's no questioning the frightening nature of breast cancer, which strikes one in eight women in the U.S. – eclipsed only by skin cancer in terms of prevalence.
Spieth Thanks His Chiropractor After Historic Masters Win
Jordan Spieth didn't just capture the hearts of golf enthusiasts worldwide with his record-setting, wire-to-wire victory at the 79th Masters Tournament.
Professional Credentialing and Board Certification: An Ethical Faux Pas
Because of the Affordable Care Act, health care systems are coordinating care through accountable care organizations (ACOs) in order to reduce the cost of care and improve quality of care.
We Get Letters & Email
A House Divided? (May 1 issue) provoked significant response from readers. Here are several of the surprisingly similar comments we received.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Rethinking Musculoskeletal Pain – A Public Health Perspective
The American Public Health Association (APHA) is the world's oldest and largest association of its kind, founded more than 140 years ago and boasting over 25,000 members.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
ACA or ICA: Which Best Represents You?
Last June, I was honored to represent Texas ICA members as their representative assemblyman at the ICA Annual Meeting in Kansas City.
Green Tea Improves Cognitive Function in Elderly Subjects
Publishing their results in the journal Nutrients in May 2014, researchers showed that drinking the equivalent of 2-4 cups of brewed green tea (or bottled tea) daily improved cognitive function or reduced the progression of cognitive dysfunction in elderly subjects.
Our Biggest Challenges to Compete in Wellness Care
In the first article in this four-article series [May 1 DC], I made the case that chiropractors should either embrace offering lifestyle wellness in their practices or face the possibility of losing their place in the wellness care marketplace.
Giving Vets the Care They Deserve
The Department of Veterans Affairs (VA) administers the largest integrated health care system in the United States.
Reducing the Autogenic Inhibition Reflex: Making Weak Muscles Strong
The autogenic inhibition (AI) reflex is a sudden relaxation of a muscle in response to excess tension.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 2)
As we noted in our previous article, with a positive Derifield (+D), the doctor observes the reactive (shorter) leg in the prone position that becomes longer or "crosses over" in the flexed position.
April, 2011, Vol. 11, Issue 04
Trends and Modalities: Are You Still Practicing Old School Techniques?
By James Waslaski
As an educator, it's critical to keep abreast of current research and to constantly challenge your belief systems. You may have read the popular article "Don't Get Married" (MT February 2008) written by a close friend and colleague Erik Dalton.1 In that piece, he cautioned manual therapists about getting too attached to trends and techniques for fear that new research findings may prove them totally wrong.Regardless of whether you are an educator, practicing therapist or both, keeping up-to-date with the latest information is essential to our profession; and in some cases, it will also keep old school techniques in the past where they belong.
I have spent six years writing a textbook (available this year) called Clinical Massage Therapy: A Structural Approach to Pain Management (Pearson Publishing). During that time, I've edited the information in that text hundreds of times based on the reviews of other manual therapists and the fact that many of my earlier thoughts on bodywork techniques have been proven, by recent clinical studies, to be flawed. Let me share some of the things I have taught in the past that, in light of new research, now seem embarrassingly inaccurate.
Old School Rule #1
Deep cross-fiber friction aligns scar tissue.
About 18 years ago, I wrote and taught that in the presence of a muscle-tendon strain, the appropriate therapy was to apply deep cross-fiber friction in one direction only for up to 6 minutes and then apply ice. The person I studied with made the claim that the act of deep cross-fiber friction had the ability to re-align the disorganized scar tissue. However, if you look at the disorganized fibers, several mistakes are apparent in this thought process.
Old School Rule #2
Clients presenting with chronic tendon pain due to overuse of the elbow, shoulder, knee, or Achilles tendon have tendonitis.
In 2000, Khan et al found no signs of inflammation in tissue biopsies from patients diagnosed with overuse syndromes such as tendonitis of the elbow, shoulder, patellar ligament and Achilles tendon - no lymphocytes, neutrophils or macrophages at a cellular level. Additionally, they observed no swelling, redness or inflammation on the surface level.4
In the absence of an inflammatory process, the more appropriate term to describe a muscle tendon strain is tendinosis. Khan and associates concluded that a majority of tendon pain could be resolved simply by reducing the load on the tendon or by restoring normal muscle resting length to opposing muscle groups. Once muscle balance is restored and the tendon is unloaded, the therapist must reevaluate the area via muscle resistance tests to isolate the strain. (Fig 3)
To more effectively soften and reorganize the cross-linked collagen matrix, I believe therapists need to gently apply multidirectional frictioning to the damaged area. (Fig. 4) Then, to eliminate the pain and restore pain-free movement from most overuse tendon injuries, techniques then include eccentric muscle contraction are helpful. (Fig. 5) Unfortunately, too many manual therapists are still applying aggressive and prolonged deep cross fiber frictioning to muscle-tendon strains and possibly turning tendinosis into tendonitis.
Old School Rule #3
Should we perform deep tissue or trigger point work to weak, inhibited muscles?
This particular old school teaching really concerns me. To make my point, I'd like to relate this to manual therapists doing trigger point or deep tissue work to weak, neurologically inhibited (overstretched) muscle groups, prior to treating the short tight muscle groups. For simplicity, let's first look at the short, contracted muscle groups doing the pulling and then we'll address the stretch-weakened antagonist muscles. In the majority of the people on the planet, the pectoralis major, pectoralis minor, and subscapularis are short and tight, causing the rhomboids, middle trapezius, and posterior rotator cuff muscles to become neurologically weak and inhibited due to eccentric loading.
When you start a client face up and lengthen the short, tight anterior muscle groups, you aid in relaxing the weak inhibited posterior shoulder stabilizers. Once the therapist manages to restore normal muscle resting lengths to the tight agonist muscle groups, it reciprocally turns down the noxious afferent stimuli and relieves many of the myofascial and neuromuscular pain patterns. However, the jury is still out on the trigger point part of this, but I have always gotten better results treating short, tight contracted muscle groups prior to treating weak, inhibited antagonists. (Figs 6-8)
In most of the population, I believe it's difficult to resolve trigger points (myofascial tender points) in the weak, inhibited rhomboids by starting a client face down and doing trigger point work. Since much of our pain comes from living in forward head flexed postures with medially rotated shoulders, starting a client face up often makes more sense. This assures that the majority of short flexor muscles groups are lengthened prior to working on weak, inhibited extensor muscle groups. This commonly seen distorted neuromyofascial postural pattern is illustrated in greater detail when you view Tom Myers' Anatomy Trains and in the upper and lower cross syndrome taught by Erik Dalton.
Medical Vs. Clinical Massage
In my own career, I started in the field of sports massage, and went on to learn more advanced work from some of the greatest pioneers and structural body workers in our industry. Orthopedic or clinical massage is now a total system rather than a single modality. That total system of assessments, special orthopedic testing, clinical reasoning, multidisciplinary and multimodality treatments, along with precise client self-care protocols will facilitate myoskeletal alignment and eliminate pain and injuries. It will also optimize athletic performance, aligning us with all other manual therapists for the best interest of each client. Having said that, the question arises: Is this sports massage, clinical massage, medical massage or are we simply talking about massage with intent to bring the body back into balance, facilitate healing, and eliminate pain?
I'll be writing an in-depth article on the subject of medical massage in an upcoming issue, but, for now, let's loosely define this commonly used name. I believe "medical massage" should be considered an umbrella term to include most forms of specific restorative and enhancement manual therapy techniques, particularly those directed at resolving a client's/patient's particular pain complaints. I chose to use the term "clinical massage" in the title of my book in order to honor and respect the many other modalities that have an amazing effect in changing medical outcomes i.e., cranial and visceral manipulation, myofascial release, lymphatic drainage, posturology, myoskeletal alignment, anatomy trains, structural integration, oriental bodywork and the list goes on. Even a good relaxing massage to reduce the stress that leads to many diseases and illnesses plays a critical role under the umbrella of medical massage.
The fact is, positive things begin to accelerate exponentially when therapists learn to blend multiple touch-therapy assessment and treatment modalities with functional retraining to better address our client's/patient's pain and injury conditions. Much more information will be shared in future articles about the scope and practice of medical and clinical massage and the positive attributes gleaned by combining various modalities in an evidence-based clinical practice.
Author Note: The material presented at the World Fascia Congresses is a good example of how quickly information about the "stuff we touch" changes. www.fasciacongress.org/2012
Click here for more information about James Waslaski.
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