Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
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.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
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.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
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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