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Is There a Neurological Basis and Correction for Macular Degeneration?
Macular degeneration, aka AMD (age-related macular degeneration), is a common eye disease and a leading cause of blindness in people age 50 years and older, according to the National Institutes of Health National Eye Institute.
Do Doctors Lie to Patients? (Do You Lie to Yours?)
In a previous column ["When Patients Lie (Bribe or Flatter)," Oct. 1, 2015], I discussed the issue of patients lying to doctors, and the many reasons why this can occur.
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.
The MRI: What to Do With the Results
As I wrote in my previous article on this topic, it is my goal for you, the doctor, to be an expert in interpreting MRI images yourself; and to be able to independently make decisions based upon a combination of clinical presentations and findings, followed by the MRI images.
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."
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.
Treating Pain: The Hypermobile Coccyx
When I write about the coccyx, I recognize that I am talking about a relatively small subset of patients. When I write for Dynamic Chiropractic, I am trying to reach 60,000 chiropractors.
RAND Study Recruiting DCs
Dr. Ian Coulter, RAND / Samueli chair for integrative medicine and senior health policy researcher for the RAND Corporation, has issued a call for participation, recruiting doctors of chiropractic for a practice-based research study that will examine "the impact of evidence, outcomes, costs and patient preferences on the choice of treatment for chronic low back pain and neck pain."
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.
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.
Taking Another Step Toward a Secure Future
In 2008, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) released a literature review on chiropractic care for low back disorders.
Enhancing Performance in Cross-Fit Athletes
Cross-fitness centers are expanding in number and increasing in popularity. To remain relevant to this growing portion of society, practitioners need to learn about the exercises and injuries common to this group.
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.
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.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
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.
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."
Diet, Nutrition and the Context of Risk (Part 1)
Food and supplement safety is a topic that often comes up when I speak to chiropractors for CE relicensing, even when it is not the advertised subject.
Chiropractic Around the World: WFC Country Reports December 2015
The following country updates are reprinted with permission from the December 2015 World Federation of Chiropractic (WFC) Quarterly World Report. Information is excepted for space and edited to DC-specific style guidelines.
The Clinical Versatility of Milk Thistle (Part 2)
Evidence is growing that the silymarin complex of flavonolignans from milk thistle can impact serum ferritin and iron overload in various clinical circumstances.
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.
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.
July, 2011, Vol. 11, Issue 07
Understanding Lumbar Disc Herniation
By Whitney Lowe, LMT
Practitioners are frequently concerned about whether or not it is appropriate to work on clients with herniated discs. Unfortunately, there is a great deal of misinformation about this condition.Disc herniations are sometimes blamed for back pain when they are not actually the cause. It is important to understand the anatomy and symptoms of disc herniation to make proper clinical decisions. Massage can be an effective adjunct treatment for clients with this condition.
When x-ray technology first emerged that could show herniations of the lumbar intervertebral discs, there was a rush to assign blame for low back pain on the bulging intervertebral disc, which clearly appeared to be protruding towards nerve roots. For decades it was assumed that if a person had back pain it was from a lumbar disc herniation. Sadly, this led to an excessive number of – and in many cases unnecessary - surgeries. Soft-tissue treatments are now proving to be quite effective at helping in pain relief for this condition.
In addition, it is now understood that many people with herniated discs function without any pain at all. With the advent of the MRI, disc herniations were proven to occur in a large percentage of the population. More interesting is that many people with disc herniations have no back pain whatsoever.1,2 Thus it is important to know that the presence of a disc herniation is not enough to assume that the disc herniation itself is the cause of the pain. Consequently, sound assessment (including referral if needed) is critical for determining what causes a person's pain.
The following is a more detailed look at the structure of the intervertebral disc and what occurs in pathological herniations in the lumbar region.
Anatomy Of The Disc
Intervertebral discs are made of a dense fibrocartilage. There are two component parts to the disc: the inner gel-like substance called the nucleus pulposus and the denser layered fibrocartilage on the outer rim called the annulus fibrosis (Figure 1). Compressive loads applied to the intervertebral disc cause the inner nucleus to push against the annulus fibrosis. With continued pressure over time, the annulus loses its structural integrity and breaks down causing the disc to change shape.
As the disc changes shape, it will push out in the direction with the least restraint. The most common direction with least restraint is in a posterior and lateral direction. The intervertebral foramen is located close to this region and this is also where nerve roots exit the spine (Figure 2).
There is various terminology used to describe the change in the disc's shape as it is impacted with chronic compressive loads such as protruding, herniated, prolapsed, bulging, or ruptured disc. Also frequently heard is the misnomer, slipped disc, which is technically misleading because the disc has not slipped anywhere, it has just changed shape. An effort has been made to update the terminology so it is consistent with the differing levels of severity of the disc herniation. The terms shown in Figure 3 reflect the types and severity of disc herniation and are preferable for describing disc herniation.
Signs And Symptoms
The most common signs and symptoms of disc herniation involve sensory or motor impairments. Sensory symptoms include sharp, shooting, electrical-type pain sensations, as well as paresthesia (pins and needles) or numbness. Motor impairments are evident with either muscle weakness or atrophy. Lumbar nerve roots feed the nerves of the lower extremities, so symptoms from lumbar disc herniation are generally felt in the lower extremity, although pain may be felt in the back as well.
The region of the lower extremity where the impairments are present helps indicate the corresponding affected nerve root. For example, in the upper lumbar region the nerve roots primarily feed into the femoral nerve and therefore symptoms are generally felt in the anterior thigh region. If the disc herniation is in the lower lumbar region, symptoms will generally be felt down the posterior side of the leg because these nerve roots feed the sciatic nerve. Other nerve compression pathologies can produce symptoms similar to disc pressure on a nerve root. Assessment will help determine crucial information about where the nerve compression is originating.
A key question for massage therapists is whether or not it is appropriate to work on somebody with a herniated disc. Massage therapy can be a valuable means of helping to reduce the aggravating factors that perpetuate lumbar disc herniation and the subsequent pain and dysfunction that result. As with other potentially serious medical conditions, it is a good idea to obtain a doctor's clearance before treating the client.
Many of the muscles in the lumbar region, and especially those attaching directly to the lumbar vertebra, increase compressive loads on the intervertebral disc when they are tight. Consequently, reducing tightness in the lumbar muscles helps decrease compressive stress on the intervertebral disc, thus relieving symptoms. Massage will not reverse the process of disc herniation that has already occurred, but it can help reduce compressive forces that can further deform the disc.
A common concern expressed by massage therapists is whether or not working in the lumbar region will press the protruding disc against the adjacent nerve roots. Note that in Figure 4 we see the relationship between the lumbar muscular structures, the transverse processes of lumbar vertebra and the nerve roots. The transverse processes prevent direct pressure on the nerve root. While the specific massage techniques will not directly compress the disc against the nerve roots, it is possible to aggravate pain from a disc herniation with massage in the lumbar region indirectly by moving the vertebral bodies.
Because the disc does not always protrude in the same direction in relation to the nerve root there is no way to know for sure which motions or positions will aggravate nerve root compression. A good general rule of thumb is that if any motion or position or technique further aggravates the client's symptoms, it should be immediately stopped. However, relieving muscular tension in the lumbar region is an important step to reducing disc compression.
Because herniated discs are more common than once thought, it is likely you have had clients with this condition. In general you should consider it relatively safe to work on clients who have disc herniation. A standard rule of caution should be that anything that further aggravates the client's neurological symptoms should be immediately stopped. As usual, if it is at all possible to get further clarification of the exact nature of the problem from a physician you should definitely try to do that. Massage therapy can be a valuable adjunct treatment for clients with disc herniations, so the more you know about this condition the more effective relief you can provide your clients.
Click here for more information about Whitney Lowe, LMT.
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