resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
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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