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A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
A Chinese Medicine Story: An Interview with Mazin Al-Khafaji
Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
February, 2012, Vol. 12, Issue 02
Seeing Your Massage Clients Through a New Lens
By Ann Catlin, LMT, NCTMB, OTR
I've worked with people young and old with complex medical conditions since 1979 when I began my career as an occupational therapist. From rehabilitation centers, home health agencies, psychiatric hospitals, hospices and long-term care facilities, I've been around the block a time or two.But my work the past decade as a massage therapist has helped me see things through a new lens.
One such thing is the importance of distinguishing between a primary diagnosis and the secondary conditions resulting from the primary illness or injury. It's important to realize that secondary conditions can impact our clinical reasoning, leading to modifications in our approach or techniques, as well as our own feelings and emotional reaction to our client.
There are many diagnosis commonly found in older adults who require skilled nursing or home care. However, I'm focusing on only one — Parkinson's disease, a progressive neurological disorder. Nerve cells located in the area of the brain that controls movement degenerate causing symptoms associated with this disease. In spite of aggressive research, the exact cause is unknown; however there is speculation that genes and environmental toxins might play a role.
So, let me ask, is it necessary to be an expert about Parkinson's disease to have a safe and beneficial massage session for a person with the disease? I don't think so. It's not the diagnosis itself that drives our approach, but rather our observations of the secondary conditions or symptoms. Secondary conditions are those things we can see, feel, hear and sense during a session. They impact our decisions about how to carry out a session; how we position our client; how we communicate; what techniques to use.
What follows are three secondary conditions (symptoms) of Parkinson's disease and corresponding questions that influenced my own clinical reasoning when a woman was referred for massage therapy sessions to improve physical comfort and sleep. Mrs. P. was a woman with advanced Parkinson's disease being cared for in her home by family and a team of home care professionals.
Symptoms included tremor while at rest, involuntary shaking of an extremity, often the hands when the muscles are relaxed. For example, the hands shake when they are lying in the lap. But when the person reaches for something or performs other purposeful movement, the tremor is lessened. Clinical questions: Will her hands shake while I'm trying to massage them? If so, is it okay to massage them anyway? How much pressure should I use? Would compression be a good technique to use? Will massage help quiet the tremor?
When I started seeing Mrs. P., I noticed her right hand had a mild tremor that continued as we talked about how she wanted to receive her massage. I determined that gentle compression techniques to the arm and shoulder attachment sites would be a good technique to use since compression has an inhibitory effect on the nervous system. If compression did not ease the tremor, I understood there was still benefit to offering unconditional touch to sooth her.
Bradykinesia is when people have difficulty initiating movement and appear to move in slow-motion and walk with small, shuffling steps. Speech becomes slurred because the muscles of the mouth and tongue are affected and some people have a mask-like facial expression. It was clear that Mrs. P. was not able to get onto a massage table. Should I use a table-top massage device or have her get up on the bed? Is the area free of clutter or anything that might be a fall risk should she need to move from the chair? Should I have her remove clothing knowing that it takes her a long time to do so? She had a mask-like look on her face making it difficult to read her non-verbal expressions. How else might I determine her reactions and watch for signs of pain?
Mrs. P's speech was very hard to understand because she had difficulty forming the words and her voice was very soft. It took my full attention to understand. But she made it clear that she preferred to get onto her bed for our sessions. Her daughter helped her transfer from the chair to the bed. Mrs. P's movements were excruciatingly slow making the process difficult. It took several minutes for Mrs. P. to get settled in a supine position on the bed. She was dressed in loose fitting clothes and I decided it best to not ask her to remove anything. We would work around and through the clothing.
There was muscle rigidity and atrophy causing stiffness and sometimes painful contractures in the arms, legs and trunk. Is there pain? Does it hurt to move? How much range of motion is present? Should I try stretching it? Are there any positioning techniques I could use to increase her comfort and support during the massage?
As the disease progressed, Mrs. P's muscles became very tight and stiff especially in her arms, legs and neck. She now found it extremely difficult to speak and was now mostly silent. But she was alert and her eyes were bright. Now, when I arrived for our evening sessions she was already in bed. Her arms were usually bent at the elbow and held tightly to her chest. Muscle spasticity in her legs caused them to be clasped together and crossed at the ankles. Her daughter reported that Mrs. P. had difficulty sleeping because of pain. I discovered that effleurage strokes, gentle compression and focused touch, eased the spasticity that caused the stiff posture and she was able to relax her arms enough to be placed comfortably on pillows at her side. Her legs relaxed allowing them to uncross at the ankles. Within minutes of starting our session Mrs. P's eyes would close as she drifted into sleep. Her family reported that on nights she had massage she slept through the night, giving all of them much needed rest.
As our sessions continued, the fact that Mrs. P. had Parkinson's disease became less relevant in my mind. More important were my keen observation skills; meeting her in present time, responding to each moment of every session and allowing her to receive the gift of touch in any way that served her. Sometimes that meant having her cat sit on her stomach watching my every move. I'm not sure if that's a secondary condition or not, but I know I sure enjoyed it!
According to the Mayo Clinic, "Massage therapy can reduce muscle tension and promote relaxation, which may be especially helpful to people experiencing muscle rigidity associated with Parkinson's disease."
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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