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Looking Back: Abstracts From Chiropractic History (Summer 2015 Issue)
The following abstracts are reprinted with permission from Chiropractic History, the official journal of the Association for the History of Chiropractic. Chiropractic History is the leading scholarly journal of the chiropractic profession dedicated to the preservation and dissemination of the profession's credible history.
Medicine as Metaphor
The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others.
The Roots of TCM in Depression Treatment
In traditional Chinese medicine, there is historical precedent for the treatment of so-called "Shen" (Heart-Mind) disorder, or disorder/dysregulation of the spirit, which is also considered as distinct but not separate from the cognitive function of the brain.
Adding Microneedling to Your Clinic for Results and Profit
Microneedling has taken the beauty world by storm over the last 10 years. Under the names dermaroller, microneedling or skin needling you will see these treatments listed in the services of nearly every fashionable beauty salon and day spa in the country.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Chiropractic Care and Risk of Stroke: The Shoe Moves to the Other Foot
For decades, numerous papers have linked upper cervical chiropractic care to the incidence of vertebral artery dissections and stroke.
7 Reasons You Want a Beacon in Your Office
Have you heard about how "beacons" are transforming the way businesses interact with their customers? Beacons are low-energy Bluetooth devices that have the ability to send information to a smartphone app.
Online Marketing Basics: Google Ranking, Part 1
We all know there is so much opportunity with online marketing. And, let's face it, if you don't have a presence online with a website and social media, you are probably not where you want to be.
The Source-Luo Point Combination, Part 3
Dr. Nguyen Nghi (NVN) was born in Vietnam and is one of the most important scholars, writers, teachers and practitioners of modern time. Many of his theories and applications are the source of modern teachers from Europe and the United States.
Research: Know What You're Talking About
Have you ever seen a patient in your office with multiple serious health problems you weren't sure exactly how to address?
Reverse Digit Span: A Useful Assessment Tool for Patients With and Without Concussion
Reverse digit span is an easily administered test of attention span. It is a component of the SCAT3 test, which is frequently used to assess concussion. It has been part of the armamentarium of cognitive assessment for many years.
The Winter of Life: A Personal and Chiropractic Practice Perspective
Last November, my wife and I invited an elderly relative, Uncle Josh, to spend the winter with us. He was 82 years old at the time and turned 83 during his stay. As soon as he accepted our invitation, we began preparing.
The Art of Creating a Healing Space
I always advise my graduates to examine their group practice or treatment rooms with fresh eyes after they leave my CE workshops. I tell them, "Ask yourselves - is your space qi filled, welcoming and healing? Or is it cold and clinical?"
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
Can Acupuncture Treat Knee Pain?
Recently, an article in the Journal of the American Medical Association concluded that, "neither laser nor needle acupuncture conferred benefit over sham for pain or function" among older chronic knee pain patients.
Merger Creates New Model of Care
Two San Francisco powerhouses of holistic healing, the American College of Traditional Chinese Medicine (ACTCM) and California Institute of Integral Studies (CIIS), are merging. Together they are building a visionary approach to applied integral health.
Are You Making the Wrong Impression?
Taking a page from Stacy and Clinton of The Learning Channel's hit television program, "What Not to Wear," we recently published an article in the summer issue of Chiropractic History: The Archives and Journal of the Association for the History of Chiropractic, that explores the evolution of physician attire from prehistoric times to the present.
The Integrative Medicine Puzzle: Putting the Pieces Together
The conversation is changing in the broader healthcare community with patients actually moving the discussion toward more integrative topics. Patients today want to know their options.
Abdominal Acupuncture for Eye Healing: The Sacred Turtle and Ba Gua Map
Our ideas about western medicine have shifted in recent decades, while the public is asking more from health care providers.
Colon Health and TCM
I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor."
Exploring and Learning from the Gift of Life
I'm grateful to have had the opportunity to teach cadaver dissection classes and workshops with Stephen Cina at the New England School of Acupuncture over the past seven years, first through the Sports Medicine Acupuncture Program and later as a NESA elective course.
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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