resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
What's New in the NCCIH Strategic Plan
The NIH National Center for Complementary and Integrative Health (NCCIH) released its draft strategic plan 2016-2021 for public comment in early spring of 2016.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
February, 2012, Vol. 12, Issue 02
Dealing with Fibromyalgia
By Stuart Taws
It is estimated that between two to four percent of the population are now suffering from fibromyalgia, including Irritable Bowel Syndrome and TMJ. Perhaps our massage school education did not include how to successfully deal with fibromyalgia.Massage therapists often express a lack of confidence, some fear and anxiety along with the lack of a clear program for how to go forward and help their clients diagnosed with fibromyalgia.
In 1990, the American College of Rheumatology (ACR) established the definition of chronic widespread pain and the 11 of 18 tender point test to diagnose this "mystery illness." Interestingly, for most people, these points are naturally a little tender. This protocol has proved to be somewhat of a tragedy. A male MD "prodding" a female in pain looking for tender points then announcing that she has fibromyalgia has a negative downside. Once a medical practitioner determines that you have a certain condition and names it, then you get to keep it. You become like Alice in Wonderland going down the "Rabbit Hole" of a series of elaborate and sophisticated medical tests. The results confirm your symptoms and perhaps your worst fears, but along with the diagnosis there is no forward looking answer to your pain free recovery. Please note: the ACR 11-18 tender point protocol was for study criteria only and was never meant to be used as a diagnostic tool.
After decades of research, there is still no satisfactory answer by the medical profession for chronic pain syndromes. You receive prescriptions for painkillers, sleeping medication and anti-depressants. These deal with symptoms, not the cause of the condition.
When you're in pain for many years, you change physiologically. In one study by the University of California, they found that persistent stress shortened the length of the telomeres in the DNA. If stress can affect your very DNA, imagine what it can do to your sensitive molecules. Stress changes you at a molecular level. When you are in pain, life changes and you change. All the happiness of life has been put into the mortar and pestle of life, crushed like chaff and blown into the wind of despair. Sleep is continually disturbed so the REM phase, where all emotional stresses of the day are processed keeping mental health and stability, is rarely achieved.
In 1997, F. Wolf (University of Minnesota) published an article looking at some of the data collected in population-based studies. He found "that the number of tender points an individual has is highly correlated with the number of measures of distress. High threshold tender points are a sedimentation rate for distress."
In the mechanism of pain, it is observed that after injury the nervous system can delay it's response to that injury by a day, week or a month. When a person is diagnosed with cancer, the oncologist often asks what happened in their lives two years previously. When you ask a similar question of your fibromyagia clients, surprisingly I have found there was a serious illness or a vehicle accident, death in the family or a bitter divorce and custody battle over the children, all within the last two years. As the manifestation of pain is delayed, the connection is not made and falls into the mystery illness category.
"Information regarding pain is immediately transmitted from the injured tissue to the cerebral cortex," according to Dr. Linda Sorkin. Notice that pain quickly becomes a matter of the higher centers. She continues, "The peptides and injury products activate the pain fibers, sensitize and excite the nociceptors. There 'silent nociceptors' that signal well after tissue damage and that inhibition of this activity diminishes the perception of pain. There are spinal cord sensory cells, that when activated by injury refers pain to portions of the body that share these neurons, or cell cross talk. These fibers release glutamate and peptides from their central terminals and this biochemical cascade magnifies and enhances the response, becomes triggered into a long lasting spinal sensitization and the resulting hyper sensitization to pain even spills over into un-injured tissue."
This biomechanical cascade throughout the body over a period of developing hyper-sensitivity means you can have sites of pain all over where there is no injury. This understanding is vital. Similar to many MD's, some massage therapists fall into the trap of being judgmental, supposing their clients are somewhat neurotic and using an imaginary pain as a secondary benefit in life. You must always believe everything they tell you. "When they tell you the pain is real, it is real," said Dr. Daniel Clauw, Professor of Rheumatology and the director of the University of Michigan Chronic Pain and Fatigue Research Center, is the country's leading expert on Fibromyalgia and the author of many studies. "In people without pain, these structures encode pain sensations normally. In people with fibromyalgia, the neural activity is increased."
"It is time for us to move past the rhetoric about whether these conditions are real, and take these patients seriously as we endeavor to learn more about the causes and most effective treatments for these disorders," said Richard Harris, a Research Investigator.
These studies indicate that fibromyalgia patients have abnormalities within their central brain structures. Clauw states, "this is a diffuse, central problem with pain processing, a problem with the way people are processing pain or sensory information." Pain, he says, "is a miscommunication between the brain and the spine. It's as though someone has increased their volume control center, turning the volume up."
How do we use this information? The brain, spinal cord and the CNS are described as listening systems. The new neuro-sciences when referring to the brain and CNS use the expression plasticity. They are not fixed but are plastic; the input from the extremities can be changed. We do this by giving the listening systems new information and changing the direction of the input back into the higher centers. This remodels how the brain and CNS modify how they process pain.
The handmaidens of chronic pain syndromes are fear, anxiety and underlying anger. Pain in itself is harmless.
It is how the brain and CNS process and respond to perceived injury insult that cause the alarm. There is not the software to do an MRI, CAT scan, PET scan and X-Ray of the sensitive nervous system. The sensitive nervous system has gone off like a fire alarm, every fire department in the region has been mobilized, lights flashing, loud sirens piercing the night, and guess what, there is no fire! I tell the client that rightly or wrongly their "silent alarm has been tripped" and their brain and CNS believes they are under attack. They only response the body has to protect them is the inflammation response with the end result of pain.
Now here comes the tricky part, especially for a male therapist talking to women in pain. I compliment them on being so sensitive, as the truly caring and compassionate souls of this world often end up in pain. I try to change the context of the pain from not being some sort of divine punishment, but rather an unfortunate random reaction to a very stressful world. If your intention is good and kind, that shines through. When you carefully and gently suggest there is nothing physically wrong with them, rather they have a lovely kind friend deep inside trying so hard to help them, maybe too hard, they seem to accept that. Not only are you the only one that has patiently listened to them, but you also are the only one that is actually going to gently touch them for an hour, a rarity in the medical profession.
Listen to your client; but you must have a specific program in mind. If this is done seamlessly, moving back to the original site of pain briefly, there is not the time for the client to work out what you are doing, so there is a certain amount of distraction. I really like a side lying position with the client at the very end of the table. This is not working on soft tissue only; my intention is to dramatically change the input into the CNS. If you get the nervous system on your side first, then any therapy you use will be infinitely more successful.
Remember, during all this time you are talking to the sensitive nervous systems, re-assuring these delicate systems they are safe and secure and to desist in their protective mode. That is what getting the nervous system on your side first means. This is the most important part of any treatment.
Stuart Taws is a Sports Rehabilitation Therapist originally from England, now living in California. Stuart is the developer of Soft Tissue Release - the Taws Technique. For 20 years he has been teaching through Massage Schools and Weekend Workshops. For more information, visit www.softtissuerelease.com or
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