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Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
December, 2011, Vol. 11, Issue 12
Learning from Harm
By Keith Eric Grant, PhD, NCTMB
In 2003, Ernst and Grant separately reviewed the medical literature for reports of harm from massage therapy. Both papers were consistent with Ernst's conclusion that, "Massage is not entirely risk free.However, serious adverse events are probably true rarities." I want to briefly point out and review four case reports added to the literature since those two reviews. First, let me add some motivating comments.
As noted by Cohen and Nelson (2011), the legal basis for the regulation of health care practices by the states is protection of the public from harms of incompetence and malfeasance. The latter is primarily a function of oversight and discipline. The first, ensuring competence within scope of practice, has elements both of training and of monitoring for capacity to practice. Here, I'm focusing on the aspect of training.
The importance of a scope of practice is to define what tasks a practitioner is expected to competently perform, in what contexts, and the presence of what co-morbidities. Looking at case reports of injuries might provide a window on flaws in the expected competencies. However, It isn't enough just to know that an injury occurred. We need to identify the nature of the risk and determine if specific changes in training and practice protocols can eliminate or reduce it.
Aksoy et al. report the case of a 38-year-old woman with complaints of persistent right shoulder pain and limited range of motion (ROM) after a single session of deep tissue massage. There were no predisposing factors or specific muscle pains prior to massage. During a deep tissue massage for purposes of relaxation, she felt pain on the left side of her neck and at the top of her left shoulder radiating toward her arm while work was being done along her neck and shoulders. The pain continued afterward, and the patient noted that her left arm felt "long and heavy" while standing. She also had difficulty lifting her arm up and reaching back. There was no numbness or tingling during or after the deep tissue massage. Subsequent diagnosis indicated injury to the spinal accessory nerve, resulting in weakness of the trapezius muscle and scapular winging. While pain resolved, two years after injury recovery of strength was only partial. While a cautionary note for deep work at the neck and shoulder, no details are given that allow technique evaluation. Any sudden pain during massage treatment follow by subsequent indications of motor impairment should be taken as a clear indication for referral.
Crump and Paluska report a case of venous thromboembolism (VTE) following vigorous deep tissue massage in a previously healthy 67-year-old man with no identifiable risk factors other than his age. The authors note that physicians are often either unaware of or fail to follow evidence-based guidelines for the prevention and treatment of VTE. In this case, there was a five-day delay between initial medical examination at an emergency room and initiation of treatment subsequent to a second exam by his primary care physician. The patient reported a history of right calf pain and swelling, which had preceded the onset of his back pain by five days. The right calf symptoms had begun the day after receiving a vigorous deep tissue massage (for nonmedical reasons), which had included the lower extremities. His calf symptoms had gradually improved over the next five days, at which time he developed the right upper thoracic pain that had prompted his initial visit to the emergency department. The reporting physicians' conclusions are simply cautionary.
This case report suggests that nonpenetrating trauma to the legs, such as vigorous massage, is a potential risk factor that might be unrecognized and underreported. This report should not necessarily deter individuals without any known risk factors for VTE from receiving massage therapy. Additional research is needed to clarify the risks associated with nonpenetrating trauma to the legs, especially in older adults and other susceptible groups.
Wu and Wang report on a 40 year-old woman with injury to the posterior interosseous nerve (PIN) following a local friction massage for tennis elbow (lateral tendinosis). A detailed review of history and physical examination did not reveal any other possible etiology other than the friction massage. The technique anomaly in this case appears to be extension of the friction massage to more than 4 cm below the epicondyle. The authors note that such extension exposes the PIN to risk of damage via compression in its path through the supinator muscle. They recommend that friction massage not extend more than 4 cm below the epicondyle.
Lee et al. report on a cervical cord injury after massage in a 47 year-old male. In this case, the massage was for relaxation. He lied supine without a pillow under his neck, and passive range-of-motion exercise was applied as warm-up movements for his arms. The operator then applied oil on his body, followed by gliding and compression over his anterior thorax and bilateral neck. Suddenly, he felt acute weakness of all four limbs. The weakness remained even though the massage was stopped immediately. He needed moderate to maximal assistance to stand and walk.
There is nothing particularly striking in the description of the techniques themselves. The authors note that the mechanism of injury is not clear. However, the client had a history of cervical spine degenerative disease and had also experienced far more limited muscle weakness following a previous massage. The report underscores the need for taking a history and in obtaining medical clearance for massage where there are factors predisposing toward serious injury.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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