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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.
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.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
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.
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.
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.
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."
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."
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.
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.
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.
Lab Rats (Roaming the Streets)
The title of this article is an accurate description of American consumers (regardless of age) in the modern era.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
August, 2011, Vol. 11, Issue 08
Investigating the Physiology of Massage
By Massage Therapy Foundation Contributor
In this month's Massage Therapy Foundation Research Column, we are exploring how massage works on a physiological level. While massage has been shown to be effective in various settings - little is known about the mechanism of how massage produces its benefits.It is commonly thought that at least some of the effects of massage come from alleviating muscle tension. However, it has yet to be conclusively shown to reduce the underlying neural activity (tone) in the muscle. Who hasn't asked or been asked, "Where are you experiencing tension today?" as Langdon Roberts asks in his article published in the March 2011 issue of the open access International Journal of Therapeutic Massage and Bodywork.
Langdon Roberts, MA, CMT, of the Center for Transformational Neurophysiology in Soquel, Calif., investigated this issue in a study entitled "Pressure Application and Resting EMG." Using surface electromyography (EMG) to measure muscle activity, Roberts hoped to quantify the exact change in muscle activity during two types of massage - light, medium and deep massage applied in the order of increasing pressure (IP) or decreasing pressure (DP). In this study, the electrical activity generated was measured in the m. rectus femoris of the left legs of twenty-five individuals. Roberts hypothesized that muscle activity would be lower after either massage, with IP resulting in significantly lower EMG activity than DP.
Roberts writes, "[When] Goldberg et al. compared light and deep petrissage to the triceps surae [...] deep massage produced a greater reduction in the H-reflex, an electrical analog of the stretch reflex." The H-reflex (Hoffman reflex) is a measure of spinal cord excitability. Roberts cites other research that appears to link a reduction in H-reflex and massage, although he notes H-reflex hasn't been linked to pain reduction or any other known benefits of massage.
Roberts used a clinical crossover design in this study, meaning all 25 individuals received both IP and DP massage, with at least four weeks in between. The ethics of Roberts' study protocol were approved by an internal review board at the Muscular Therapy Institute in Cambridge, Mass. The massage setup was simple, with electromyography electrodes placed proximally and distally to the left rectus femoris, at its musculotendinous junctions. Each massage session was composed of three strokes for each level of pressure to each leg's rectus femoris, beginning with the left leg.
Roberts solicited the three levels of pressure as: "light, but not insubstantial," "moderate" and "as deep as possible without causing pain or a sensation of increased muscle tension." Each slow stroke was performed in a toward-proximal direction and lasted for 15 seconds. Two minutes elapsed between each pressure level. The massage therapist wore thumbtip pressure sensors and applied the strokes using adjacent thumbs. These gloved sensors showed that people in the IP and DP group preferred different objective vs. subjective pressure levels as indicated in a repeated-measures ANOVA [p<0.02]. Further study may show that subjects who receive deep pressure first require a deeper objective pressure to get to a pressure subjectively on the border of pain. In other words, clients may be able to withstand deeper pressure when it is used first. Unfortunately, equipment malfunctions prevented a test of this hypothesis in this study; only 14 subjects had "reliable" data available for statistical analysis.
The EMG results, while surprising, confirm many massage therapists' intuition. Using repeated-measures ANOVA on a group with all DP data, Roberts found, "EMG varied significantly across the four time points [p < 0.03]." In the DP data the application of deep pressure without previous massage caused a sudden increase in muscle activity, which diminished when lighter pressure was later used. This was not the case with the IP group, where "IP data indicates that EMG did not vary significantly across the four times points [p = 0.71]." These results did not differ between the IP-first and DP-first groups [p = 0.30 & p = 0.38].
Although the individuals studied were mostly (>80%) women, this is typically true about the population that seeks massage therapy as well. Another limitation of the study is that different muscles may show different EMG results, since Roberts cites studies that show "a reduction of EMG activity after massage [...] consistently found only in the frontalis muscle." Notably, the massage in this study was applied only to the rectus femoris muscles that were already relaxed, not in pain or otherwise uncomfortable.
This study validates the use of EMG as a tool for investigating the physiological basis of massage. One potential subject for further study includes a comparison of the EMG methods used here - a MEDAC Sys/3 physiological monitor. Roberts recommends a system of "counting repeated minima during each collection period," which he suggests as superior to "counting mean values" because of the commonplace nature of EMG artifacts or false readings.
How can you apply the results of this study to your own practice? If your treatment goal is to reduce or minimize EMG activity, then you should begin with light pressure and gradually increase your pressure during effleurage strokes, especially on the large muscles of the quadriceps. Unfortunately, these results are limited to asymptomatic rectus femoris muscles studied in a small group of people by a single therapist. Further research may show that a DP style of massage consistently causes a sudden spike in EMG activity, and could relate that to patient outcomes. Research has not shown a link between EMG activity and subjective tension. According to Roberts, "Carlson et al. [found] no relationship between perceived tension and EMG activity in clients with muscle pain or in pain-free subjects." Roberts suggests it is likely that "multiple modulating factors" could be at play in the EMG results seen here.
The research reported here was funded by the Massage Therapy Foundation, the same foundation that supports this column. We hope Roberts' and others' research will elucidate to what extent endorphins, reflex pathways, and/or the "freeing of nociceptive or mechanoreceptive nerve endings" contribute to the physiological benefits of massage. For more information on the MTF, visit our website at www.massagetherapyfoundation.org/.
Source: Roberts, L. (2011). Effects of Patterns of Pressure Application on Resting Electromyography During Massage. International Journal Of Therapeutic Massage & Bodywork: Research, Education, & Practice, 4(1). Retrieved from www.ijtmb.org/index.php/ijtmb/article/view/25/154
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