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How to Bill Evaluation and Management Codes
Q: I am in need for guidance on how to bill evaluation and management (E&M) codes in addition to acupuncture the same date of service, I have never been paid for an exam when done with acupuncture and I believe I am doing it wrong.
Introducing the Dynamic Chiropractic Digital Edition
In response to the changing habits of our readers, Dynamic Chiropractic is proud to introduce a digital edition of the publication beginning with the July 2016 issue.
Time for World-Wide Growth
Acupuncture is the organically growing around the world. The legislative body in Quatar has said acupuncture is "okay." The United States has five states to go to have every state recognized and regulated.
Immunotherapy: Where Molecular Medicine Crosses Into Holistic Thinking
Immunotherapy, and its promise as a cancer treatment, has been in the news a lot in the last few years, and for good reason. Real shifts are happening in oncology and exciting researchers, clinicians, and patients.
Does Anyone Know You're a Good Chiropractor?
If you had a chance to read the recent article in Time magazine (April 6), you know it provided some good information about the efficacy of chiropractic to the magazine's substantial consumer audience.
What Should You Call Your Patients (and What Should They Call You)?
When I walked into the exam room, the new patient looked uneasy, fumbling with his cellphone. He was a huge Polynesian man, probably in his 40s, with unrecognizable island tattoos.
Acupuncture at a Pain Clinic
Introduction: Pain is the most comprehensive human experience. The experience of pain is associated with the somatic, emotional and social impact. Pain has not only somatic symptoms, but also psycho-social dimension, especially in case of chronic pain.
The Good, the Bad and the Successful in Social Marketing
You might be thinking, "social marketing, don't you mean social media?" No, I mean social marketing. Every day, I keep reading, hearing and learning more and more about the changes happening in social media.
Chiropractic Needs a Lesson in Education
The American Chiropractic Association has launched a campaign, The National Medicare Equality Petition, to enact federal legislation that would achieve full physician status for DCs in Medicare.
We Get Letters & Email
Another Slap in the Face for DCs; I Know Where to Find the Missing Chiropractic Patients; Clarification on Vitamin D Study.
The Effectiveness of Chinese Medicine in Treating Infertility in the Philippines
Infertility is defined as the inability to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse.
Are Herbs Useful for Chronic Pain?
The human nervous system is what makes us special, but our greatest strength also makes us vulnerable: witness the growing incidence of chronic addictions, anxiety, depression, sleep disorders and chronic pain syndromes.
Herbal Medicine Continues to Evolve
Product manufacturers, industry partners, distributors and practitioners work as a collective Traditional Chinese Herbal Medicine (TCHM) community to produce high quality TCHM prescriptions that bring low-risk healthcare to thousands of patients everyday.
Day in the Life of an Advanced- Practice DC (Pt. 2)
Let's continue our Q&A with Stephen Perlstein, DC, APC, chair of the New Mexico Chiropractic Association PAC and president of the American Academy of Chiropractic Physicians. Part 1 of this interview appeared in the May 1 issue.
Treatment of Type 1 Diabetes Mellitus: The Latest Breakthroughs
There are now more than 29 million diabetics in the U.S. and 10% of them have Type 1. The incidence has been increasing in recent years at an epidemic rate.
Case Studies and Answer Analysis for NCCAOM Exam in Foundation of Oriental Medicine
Case studies are very common for acupuncture school students, either in class exams or during taking the national board exam. Most test takers feel they have no idea where they should start and how they should start to analyze those complicated cases.
Bring on the Bitters
Out of all the possible flavor choices with foods, such as sweet, sour, salty, and umami (deliciousness), which would you choose first? Bitter, though not as enjoyable, is also a flavor.
F4CP Campaign Addresses Public Misperceptions of Chiropractic
In late 2015, results of the Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic were published. The report found that 33.6 million U.S. adults (14 percent) had utilized chiropractic care within the previous 12 months.
Shoulder Rehab: The Gait Connection
Shoulder problems can be difficult to rehab completely for several reasons. The shoulder is made up of several joints that must function together smoothly to provide the extreme mobility that is possible and necessary for many activities.
2016 Trudy McAlister Foundation AOM Scholars
This year, the Trudy McAlister Foundation (TMF) received a record number of excellent applications for the 2016 scholarship awards and has awarded five scholarships for $2000 each. More information is available on our website: AOMScholarship.org
Diet, Nutrition and the Context of Risk (Part 2): Food Poisoning
Other than the morbidity and mortality linked to eating too much food, "all-natural" organisms that contaminate our food cause more illness, more hospitalizations and more death than food contaminated by heavy metals, plastics, preservatives, artificial colors, emulsifiers, artificial sweeteners and pesticides combined.
The Eight Extraordinary Confluent Points
The eight extraordinary confluent points are a very popular set of acupuncture points in the modern practice of acupuncture. They are also called the intersection, meeting, command, opening, master, and the flowing and pooling points of the eight extraordinary vessels.
Who is Your Ideal Patient?
Being in a healthcare practice requires you to think critically about many things including your equipment, techniques, documentation, financial goals, and the retention of clients and staff.
The Liver: The Official of Planning
The Liver, with its paired Official, the Gall Bladder, belongs to the Element Wood within us. Wood grants us the power of birth – new beginnings, growth, breaking through boundaries and surging forward. It is the vigorous, exuberant energy of the spring season.
Five-Element Reaches Out to Serve the Community
In 2006, a student at the Institute of Taoist Education and Acupuncture (ITEA) approached the administration about an idea for his senior project.
March, 2012, Vol. 12, Issue 03
A New Method for Dealing with Hip Rotators
By Shari Auth, MA, Lac., LMT, NCBTMB
Remember "Piece Goods Often Go On Quilts" or as my anatomy teacher taught us, "Pirformis and the Go-Go Queens?" Both are memorization tools for recalling the names of the six deep lateral rotators of the hip.The first letter of both phrases corresponds to the first letter of one of the rotators (i.e. piriformis, gemellus superior, obtuator internus, etc.) Left-brain knowledge crammed in during massage school all to be forgotten later, with the exception of the fashionable piriformis. We may have forgotten the names, but in clinical practice, hip rotators are hard to forget. Tight hip rotators contribute to lumbago, sciatica, turn-out in the legs and feet, and just plain old hip pain in people who travel, sit or clench too much.
Clients hip rotators can be contracted and short for a long time before prompting them to see a massage therapist. For the average person, yogis and dancers aside, this is one of those hard-to-reach, hard-to-stretch and overall unconscious places.
The Auth Method is a system of massage that makes the health and well-being of the practitioner's body the priority, without sacrificing results. The method was developed with the belief that with the right tools, technique and body mechanics, performing massage can be effortless. In the Auth Method, the forearms are the preferred massage tool for the majority of massage work for a few reasons. The forearms are more durable massage tools than the hands, fingers or thumbs, so you can work longer on your clients with less wear and tear on your body. When it comes to hip rotators, this durability provides a strong tool for getting into the deep muscles of the pelvis. Let's face it, the hands, fingers and thumbs are no match for the large muscles of the hips.
Massaging the hip rotators with the fingers or thumbs can be pokey and uncomfortable for the client. When using the forearms, you have a broad surface area of contact, so the sensation is smooth and not pokey. This broad contact is ideal for working larger muscles groups because you can massage more of your clients in less time. Finally, the forearms are perfect for leaning into. I recommend using body weight instead of muscular force when massaging. Using muscular force is exhausting and runs the risk of working too deep. By using body weight, you'll naturally sink to the first layer of tight tissue; as that layer releases, you'll sink to the next layer of tight tissue. Work patiently, layer by layer, to create a deep tissue massage experience that is painless for your client and effortless for you.
Stretch and Release
Placing a muscle in a stretched position while performing massage is a wonderful tool for a massage therapist, because it intensifies the massage without further taxing the massage therapist. Extra effort by the therapist isn't needed for the recipient to receive deeper work. This comes in handy when you're working on a large or muscular client. Taking a muscle off the stretch softens the muscle and allows the practitioner to sink deeper into the muscle. Alternating between putting a muscle on and off the stretch while massaging is an effective technique for releasing a muscle. It incorporates all the benefits of stretching with massage, coupled with the benefits of taking a muscle off the stretch.
First Things First: Warming Up the Hip
Because the hip rotators are deep to the gluteus maximus, it is necessary to first massage the gluteus maximus. After the gluteus maximus has released, it is easier to contact and work with the deep rotators. With your client in prone position, undrape their hip. Tuck the drape securely under either leg. The drape should cover the client's midline. Effleurage the hip and leg, sufficiently spreading oil throughout. Stand alongside the table at the level of your client's anterior superior iliac spine facing down the table toward their feet. Spread your legs a legs-length apart with either leg in front. If the leg closest to the table is in front, try leaning your hip against the table for comfort. Rest your forearm closest to your client just below the iliac crest with your elbow skimming the lateral border of the sacrum. Be mindful to use your upper forearm versus your middle of lower forearm. Using the upper forearm provides you with more leverage.
Rest your other hand on your client's leg. (Image 1) Gradually lean your body weight onto your forearm and sink into your client's hip muscles. The massage table should be low enough that you can comfortably drop your body weight onto your client and high enough that your back is straight. Glide down your client's hips, tracing the border of the sacrum with the edge of your forearm and ending the stroke at the ischial tuberosity. Keep your forearm parallel with the massage table so you have a broad base of contact, this will ensure that your massage stroke isn't too pokey. (Image 2) Repeat the stroke as needed to warm up the hip and release the gluteus maximus.
Deep Hip Rotators
To massage the hip rotators with a stretch, pick up your client's ankle and bend their knee to 90 degrees. (Image 3) Repeat the same hip stroke with the knee bent; when you reach the vicinity of the rotators, about halfway down the sacrum, move their ankle and lower leg laterally. (Image 4) This will put the hip rotators on a stretch. You will feel the rotators become taut as they are being stretched. This taut quality will increase the intensity of the massage for your client, so be mindful not to overstretch or apply too much body weight onto the area. You may only have to move the ankle a couple of inches until the rotators have an adequate stretch — proceed slowly. By massaging the hip rotators in the stretched position, you are able to release tight hip rotators as well as lengthen short hip rotators.
Slowly bring the ankle back so it's hovering over the knee, releasing the stretch in the rotators, softening the tissue and allowing you to sink in deeper on the rotators. Repeat this stretch and release over the entire region of the rotators, increasing the stretch as necessary, moving slow and steady. This is a deep and often tight area for our clients. Encourage your clients to breath into their hips during this work. This will relax them and promote circulation in the area.
Releasing tight rotators can reduce turn-out in the legs, changing the alignment through your client's lower body. I have noticed that my clients are more grounded, centered and relaxed after receiving deep bodywork in the hips. Check in with your own body when massaging. Be conscious of keeping your shoulders relaxed, back straight and legs active. Remember, this is your time, too. At the end of the massage, if our clients are more relaxed but we are more tense, we have only succeeded in transferring tension rather than reducing it. Massage, even in deep areas of the body, can and should be easy on your body.
Shari Auth, MA, Lac., LMT, NCBTMB, is a licensed massage therapist and acupuncturist, and is certified in the Rolf method of structural integra-tion. She is the creator of the Auth Method and has a full-time practice in New York City. Auth teaches continuing education workshops and has a DVD, Auth Method of Therapeutic Massage: A Guide to Using the Forearms. For more information, visit www.authmethod.com or www.shariauth.com.
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