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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."
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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?
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.
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.
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.
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.
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.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
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.
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.
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 previous articles by James Waslaski.
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