resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
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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