resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Putting Public Health Into Action: Thinking Globally, Acting Locally
The Chiropractic Health Care section of the American Public Health Association (APHA) met at the 141st APHA Annual Meeting and Exposition in Boston late last year, and it was another triumph for chiropractic and its public health advocates.
Common Disorders of the Temporomandibular Joint
The evaluation and management of craniofacial pain is a complex endeavor, which often encompasses the presence of temporomandibular joint disorders.
Acupuncture Ambassadors: A Chat with Leader Anthony M. Giovanniello, MSAc,LAc
When you first meet Anthony Giovanniello, you realize he's a humble practitioner, yet is bursting with a type of dedication that you can't help but be overwhelmingly inspired by.
The Deficiency Myth
If you went to the same kind of medical school I did and took the same kind of licensing exam I took, you were trained to seek out and expect to find primary deficiencies here in the U.S.
The Many Faces of Cervical Compression
When evaluating the neck, there are any number of orthopedic tests to be considered.
Using Facial and Scalp Acupuncture To Treat Neuromuscular Facial Conditions
As a practitioner and instructor of facial rejuvenation acupuncture I have gotten many calls over the past 10 years from individuals seeking help for various conditions affecting the facial muscles, nerves, and overall function of the face.
Gallop Confidently Into The New Year
Happy New Year! As you may know, this is the year of the Wooden Horse. I received a wonderful gift for Christmas. It is a beautiful glass sculpture of a horse, by Luili Gong Fong, a Chinese artist.
Peer Points: Spreading The Word
Pedram Shojai describes his venture into Traditional Chinese Medicine as a journey led by various "mystical experiences." Shojai decided to change the course of his career when he looked deeper into the basics of TCM.
Betraying Patients and the Profession
Imagine flying from New York to Paris on a jumbo 747. Your thoughts are on your vacation and experiencing the City of Lights. Midway over the Atlantic Ocean, you overhear the flight attendants talking in muffled voices.
Why Stretching Doesn't Work
Like most chiropractors, a good part of my day is spent working with sedentary office workers who spend eight to 12 hours a day glued to a desk chair in front of a computer.
The Importance of Staying Focused
Our world is so full of over stimulation and constant information. We live in a fast paced, ever-changing society. If you seek you will receive.
News in Brief
Parker Announces Executive Director of Parker Professional; Athletic TIPS Program Getting Financial Support; ANJC Award Recipients Named.
Look, Listen and Learn to Code
Study of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) coding system can leave a doctor of chiropractic a bit confused. The description of the five new-patient and five established-patient examination codes takes up several pages in most coding books. The degree of detail and charts used to describe the codes can be overwhelming.
Embracing the Light
Four years, ago I was diagnosed with a labral tear in my hip that was excruciating and "required surgery" according to an orthopedic surgeon. I tried everything and although the symptoms had mostly abated, I had to give up Yoga practice and everything that could exacerbate the tear.
Qigong to Empower Our Youth
Qigong is an ancient form of exercise and meditation used to promote longevity and health. This practice has traditionally been used by adults to balance the body through mindfulness, focused breathing and gentle movements.
New Knee, New Pain (Part 2)
The patient presented to the chiropractic clinic with symptoms of genu varum and pain on the medial aspect of the tibiofemoral joint.
Climbing the Ladder of Opportunity (Part 1)
President Obama spoke of building "ladders of opportunity" in his State of the Union and Inauguration addresses.
We Get Letters & E-Mail
Let's Restore Integrity to Health Care – Starting With Us; MDs Offer More – So Can We.
Gaining an Independent Occupational Code with the U.S. Bureau of Labor Statistics
One of the most important national activities currently taking place in relation to the development of the field of AOM profession is the Department of Labor's Bureau of Labor Statistics' (BLS) revision of the 2010 Standard Occupational Classification (SOC) system.
An Introduction to Evidence-Based Clinical Practice - Again
One of your patients is in for treatment and catches you off guard by asking you a question about a news article she recently read. It seems that a new intervention for back pain was found to reduce the rate of serious side effects by 50 percent.
An Alternate Method For Choosing The Right Formula For Your Patients
A constant question for us in the clinic is when to make adjustments and when to stay the course. A patient comes in and says, "Things are the same as last week."
Ask and You May Receive
A friend of my mother has had a problem with her ears for almost 20 years. Whenever the wind blows, it sends shooting pain through her jaw. She has seen any number of medical specialists over that time, but with no relief.
Preserving the Natural Resources and Culture of Chinese Herbal Medicine
As the world experiences unprecedented population growth and ever-increasing ecological pressures, the topic of preserving Chinese medicine's natural resources has attracted steadily increasing attention from practitioners.
Increased Breast Cancer Risk: Another Implication of High Cholesterol
In addition to being a known risk factor for heart and cardiovascular disease, recent studies have highlighted the link between high cholesterol and increased risk of breast cancer. Breast cancer is the second most common malignancy in women after skin cancer.
October, 2011, Vol. 11, Issue 10
Massage and Diabetic Peripheral Neuropathy
By Rita Woods, LMT
You can use your massage skills and talents to work on clients with diabetic and chemotherapy induced peripheral neuropathies. The degree of success is dependent upon the stage/severity of the neuropathy, client compliance with their own medical care and the "homework" you give them, and your understanding and use of the correct massage therapy protocol.
Neuropathies are characterized by a progressive loss of nerve fiber function. Diabetic peripheral neuropathy or (DPN) can be defined as "the presence of symptoms and or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes." This is by far the most common form of neuropathy and one that you are likely to see in your massage practice. Symptoms include pain, tingling, a burning sensation, numbness or loss of feeling, pins and needles feeling and even muscle weakness. This neuropathy usually starts in the toes (in the most distal peripheral nerves) then progresses to the foot, then up the ankle and so on. The hands can be affected in the same way. This condition is almost always bilateral, involving both feet and or both hands. While DPN can involve organs and other body systems, our goal here, staying within our scope of practice, is to normalize function in the feet and hands using appropriate massage therapy techniques. It's important to understand some processes to help hone your skills and to help educate your clients about why it is important to follow their doctors orders. Understanding the why of something often encourages participation and compliance.
First, let's look at the condition itself. The feet of a person with long-term or poorly treated diabetes will often look discolored in a mottled pattern, bluish, shiny/tight or swollen. The client may or may not have been diagnosed with diabetes. Often, it's the neuropathy that causes them to go see their doctor. Early stages usually show no outward physical signs but more advanced stages may show blue toes. This can (and usually does) eventually turn to gangrene where the tissue dies and turns black. The first sign of gangrene can look like a small poppy seed sized black spot. This tissue cannot be regenerated and amputation is the end result of this progression. Naturally, the goal is to begin working on these feet before the condition gets to that point. Following is a case study provided by Charlotte Versagi, LMT, using the massage protocol. This was her first and most dramatic case that eventually led to the saving of hundreds of toes and feet.
The client was a 55-year-old male construction worker with severe diabetes and bilateral cold/blue feet with numbness and tingling. He could barely stand to have his feet touched and his feet were so painful from neuropathy that he could barely get his feet into his work boots in the morning and almost cried when he pried his boots off at night. When he went to the doctor, he was told, "you should plan on an amputation sometime in the near future." There was no mention of any treatment option, no additional medication proposed, just "plan on amputation."
He came to Charlotte asking what she could do. She started the protocol, very slowly, very lightly and called in his wife to teach her. After a few weeks, they were going in "to the bone" as the protocol suggests. He came once per week. His wife was performing the protocol twice a day. He rubbed his own feet whenever he could. In four months, he had almost no pain, had full function and his feet were warm to the touch and normally colored. The doctor retracted his statement about amputation. It should be noted that the client was following a strict diet and taking his medication as directed and was compliant with all aspects of his diabetes care.
Glucose in the body undergoes a series of chemical reactions. If you consume normal amounts of sugars (fructose, sucrose, any form of "sugar" including honey) the early stages of the chemical reactions form an equilibrium reaction. This is called a reversible reaction and allows the body to function optimally. On the other hand, if too much sugar is consumed, these reactions are not reversible and a cascade of events take place by joining the glucose molecule with a protein or fat in an abnormal process which is pathological in nature. This process is called glycation and involves every fundamental process of cellular metabolism. Eventually, through a series of reactions, you wind up with advanced glycation end products or AGEs. These are bad things and cause nothing but harm and damage.
Glycation has been implicated in many diseases and inflammatory processes. It affects the cardiovascular system in a very big way. Tissues that have a slow turnover (more permanent) in the body are most affected by glycation. So the cardiovascular system, connective tissue and skin, nerve tissue and renal tissue are major targets. Inside a blood vessel are elastin fibers to which AGE molecules will attach, thus decreasing the diameter (or caliber) of the blood vessel. There is also a lot of collagen in the arterial walls that can cross-link with the AGE molecules further compromising the blood vessels ability to function properly. Each time there is a glucose spike and AGE molecules are formed, distal circulation is compromised and the blood vessels themselves become occluded beginning with the small capillaries. Unable to supply the surrounding tissue and nerves with nutrients and oxygen the resulting oxidative debt turns toes blue and causes nerves to malfunction sending signals to the brain of pain, tingling, burning and numbness. In addition to the mechanical damage, it is believed these toxic AGE molecules (and other toxins) also trigger the release of substances that further damage the adjacent nerves.
The most important factor to getting DPN under control is to first stop the sugar spikes. Clients must maintain their glucose at a balanced level. No great highs or lows. (They know what level their doctor wants them to maintain.) With diet and medication under control, the massage therapy protocol (coming next article) can truly help save toes and feet from amputation and relieve some or all of the pain and misery of the neuropathy. The next article will discuss chemotherapy induced peripheral neuropathy and give the detailed step-by-step massage therapy protocol for peripheral neuropathy as developed by Charlotte Michael Versagi who has graciously allowed me to share it, in its entirety, with Massage Today readers.
Editor's Note: For additional information, see Step-By-Step Massage Therapy Protocols for Common Conditions by Charlotte Michael Versagi with contributions by Rita D. Woods. Published by Lippincott Williams & Wilkins, 2011. To find this book and more on medical protocols, visit www.charlottemichaelversagi.com or www.darienlourde.com.
Click here for more information about Rita Woods, LMT.
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