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Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Chiropractic Research in Review
Occupational LBP in Primary- and High-School Teachers; Treating MVA Complications With Chiropractic Care; Neck Pain: Immediate Effects of Active Scapular Correction; Taping Benefits Stride, Step Length in Fatigued Runners.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
June, 2011, Vol. 11, Issue 06
Models and Evidence-Bases
By Keith Eric Grant, PhD, NCTMB
The techniques we use as massage therapists are increasingly coming under scrutiny and review. To an extent, this is part of a general movement in health care to review both the effectiveness of interventions and to compare what is actually done in practice with what accumulated evidence suggests would be the "best course".Two reports from the Institute of Medicine out this year underline this review: "Clinical Practice Guidelines We Can Trust" and "Finding What Works in Health Care: Standards for Systematic Reviews". The motivation from this introspection was noted by Joseph Padula in his blog "Managed Care Matters" — even many medical guidelines have had little or no solid evidence behind them, often resulting in less than optimal treatment.
In part also, the scrutiny of massage techniques and conceptual models behind the techniques stems from a cohort of massage educators looking to frame a more sound basis for massage therapy as a component of health care and to bring what's being taught into agreement with modern knowledge of anatomy and physiology. This has turned into an ongoing, international discussion across multiple social media: Facebook, Twitter, and ABMP's "Massage Professionals" forums, in particular.
Looking at evidence requires asking two types of questions; questions that I believe are separable. First, are there specific conditions for which we have evidence that massage techniques provide an effective treatment or co-treatment? If so, what can we say about the reliability of the evidence? Is it supported by research in addition to anecdotal (narrative) observations? In the best of possible worlds, we would like research and anecdote to reinforce each other and add to our insights. Enkin and Jadad provide a context for this delicate process of integrating experience and research.
Those who really follow the principles of evidence-based health care, "the conscientious and judicious use of current best evidence from clinical care research to guide health care decisions," understand that conscientious and judicious use does not mean blind adherence. They are making efforts to integrate research evidence with other types of information, values, preferences, resources and circumstances. Enkin and Jadad also caution about the interplay of belief with anecdotal "evidence," especially when anecdotes and research disagree, leaving the clinical practitioner to face a paradox.
Despite its low ranking in the evidence hierarchy, anecdotal information exerts a disproportionately powerful influence on clinical thinking and behavior. The paradox was well described by William Asher: "If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too... It is an almost insoluble problem, and the majority of worth-while doctors are driven to a compromise in which they muster enough genuine belief in their treatment to keep their patients happy and maintain their own respect, while preserving enough doubt to admit their inadequacy during transient bouts of uncomfortable honesty."
It's in trying to resolve the interplay between research and clinical anecdotes that we find the second kind of question. Do we have an explanation for the effectiveness of our techniques that doesn't violate laws of physics and is in accord with modern knowledge of anatomy, physiology and neurology? I explicitly add neurology because our body is not just physical. Our brain does an amazing computational feat in taking the myriad of sensory signals as input and providing us with a body sense as output. This second type of question brings us into the realm of conceptual models or maps for the actions of our techniques. Any such model is an approximation of reality. We can further subdivide questions about such a map into: "Is it useful?" and "Is it a correct approximation?"
Gregory Bateson, in "Form, Substance and Difference," from Steps to an Ecology of Mind (1972), elucidates the essential impossibility of knowing what the territory is, as any understanding of it is based on some representation: "We say the map is different from the territory. But what is the territory? Operationally, somebody went out with a retina or a measuring stick and made representations which were then put on paper. What is on the paper map is a representation of what was in the retinal representation of the man who made the map; and as you push the question back, what you find is an infinite regress, an infinite series of maps. The territory never gets in at all. [...] Always, the process of representation will filter it out so that the mental world is only maps of maps, ad infinitum."
Elsewhere in that same volume, Bateson points out that the usefulness of a map (a representation of reality) is not necessarily a matter of its literal truthfulness, but its having a structure analogous, for the purpose at hand, to the territory. Bateson argues this case at some length in the essay "The Theology of Alcoholics Anonymous."
To paraphrase Bateson's argument, a culture that believes that common colds are transmitted by evil spirits, that those spirits fly out of you when you sneeze, can pass from one person to another when they are inhaled or when both handle the same objects, etc., could have just as effective a "map" for public health as one that substituted microbes for spirits. While treatments of the individual would differ between the two models, actions such as isolation and quarantining would not.
Our challenge as a health care profession in the modern world comes in the way we address these questions, identifying areas needing research, filtering out disproved myths and ensuring the transfer of knowledge into practice.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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