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News in Brief
A Moment of Silence for Dr. Stephen Press; New ACA President Elected; F4CP Offers New MemBership Benefit.
Filling the Gap: The Role of Alternative Practitioners in a Broken Health Care System
I have been asked many times what got me into alternative medicine. My answer is simple: I want to truly help and make a difference in people's health.
Constructing Our Reality: The Primary Channels and Perception, Part 1
My favorite topic of discussion within Chinese medicine is the acupuncture channel systems. First of all, each of us have them. They are part of our bodies; not something external to us. To learn about the acupuncture channels is to learn about ourselves.
Energy: For Life and For Death
Energy is a deep topic in Traditional Chinese Medicine. Qi is understood to underlie all of existence, animated or not, and the qi of the living is studied with special attention.
Roots in the Community, Branches Far Beyond
The Jung Tao School of Classical Chinese Medicine (JTS) was founded in 1998 by Sean Christian Marshall in Sugar Grove, North Carolina, a small community near Boone in the state's westernmost mountains.
Health and Wellness Partnership
Yo San University of Traditional Chinese Medicine and The Wellness Center at the LAC + USC Historic General Hospital recently joined forces to extend care to the residents of Boyle Heights area of Los Angeles.
Transparency is Key at ASA First Annual Meeting
On March 4th and 5th the American Society of Acupuncturists (ASA) held a successful first annual meeting in Albuquerque, New Mexico.
Recording and Appropriate Billing of Timed Physical Medicine Services
There is a common misunderstanding about timed therapy services and although you do have some knowledge of timed service documentation, based on your comment on the 8-minute rule, your understanding is correct, but incomplete.
The Art of Listening
One of the most important clinical concepts for me was voiced by the legendary physician William Osler. "Listen to your patient, he/she is telling you the diagnosis." After treating literally thousands of patients, it can become almost second nature to quickly discover clues which reveal the underlying diagnosis.
The IME System: A Current Public Health Risk and Solutions That Are Working
I strongly believe in the independent medical examination (IME) system. There are far too many doctors in every profession who are not following E&M protocols and never claim MMI (maximum medical improvement) has occurred for their patients, which has caused financial stress for many private and public carriers.
How to Find and Fix TL Nerve Impingements
The thoracolumbar junction (TLJ) and the peripheral sensory nerves that exit from it are frequent, important and rarely recognized sources of lower back, pelvic and hip pain. Let's outline a clear exam protocol for diagnosing the problem.
Asking Patients the Right Questions
When was the last time you asked a patient a question? Maybe 30 seconds ago? But, are you asking the right questions to elicit valuable and useful information? As a healthcare provider, you've likely spent hundreds of hours learning to ask the right questions to gather critical health information from your patients.
Musculoskeletal Disorders Take Center Stage
Looking for the latest on the musculoskeletal pain epidemic and the increasing premium placed on preventive strategies including chiropractic? Check out The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action.
The Power of Eccentric Exercise: Hamstring Injury Prevention and Rehab
For almost 20 years, I've worked with professional athletes who make a living by running really fast. It goes without saying that hamstring injury (HSI) prevention and rehabilitation is a big part of what they expect from a sports chiropractor.
An Interview with Amanda Shayle
JW: Can you share with us some of your history and how you became an acupuncturist? What did you do prior to becoming an acupuncturist? Where did you go to school?
Vitamin D Fails to Help Knee OA? The Proper Perspective
The March 8, 2016 issue of JAMA includes a study about vitamin D supplementation for osteoarthritis of the knee. This is a really weird study.
NCCAOM Launches New Membership Organization
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) recently launched a new national membership organization, the NCCAOM Academy of Diplomates.
The Rest of the Patient Story
I've written previously about allowing a patient to tell you their story – about taking the time to listen and engage all the aspects of their case history, the injury in question, and the related issues.
Building Relationships and Referral Networks with Allopathic Practitioners
Dr. Doug, an orthopedist of 20 years, had heard stories from patients who tried acupuncture. While he was able to address many of their complaints effectively, some appeared to gain additional benefit when their care included TCM.
Business Lesson #1: Adapt or Else
My wife and I recently enjoyed an excellent meal at a restaurant recommended by some friends. We often have concerns about restaurant recommendations, as many have been disappointing.
Essentials of Assessment: The Squat
The squat is a simple, fast and functional tool to evaluate patient symmetry and function. As simple and easy as it is to implement, it can yield considerable amounts of valuable, clinically relevant information.
July, 2012, Vol. 12, Issue 07
Do You Ever Wonder: What Technique Should I Use?
By Whitney Lowe, LMT
Open up any trade publication or listing of continuing education courses and you will see a vast array of different techniques you can learn. Many of these technique approaches claim to be new "inventions" and completely revolutionary.While there are clearly novel approaches to bodywork treatment, many of these techniques are simply variations on traditional massage techniques that have been around for a long time. With so many different techniques, it can be really difficult for the practitioner to know which techniques would be best in each unique client treatment. While the lure of advertising claims like "instant results" and "permanent pain relief" may seem attractive, can we really make those kinds of claims and be taken seriously as a health care field at the same time?
Like the carpenter or artist that uses tools to ply their trade, various techniques are at the root of our success in treating our clients. But what's the best technique to get the job done? The answer is clearly that it depends. Many years ago I grappled with this issue and recognized that other massage therapists do as well. To help understand and address this issue, I developed a four-part orthopedic massage system that could act as a framework for the clinical decision-making process of what techniques would be appropriate for different clients in each unique clinical situation. Two of these four component parts are directly related to helping the practitioner make an appropriate treatment decision about which techniques will be best for each unique client presentation.
As the saying goes, "If all you have is a hammer, then everything looks like a nail." This is quite applicable to what we do in massage as well. If you have narrowed your focus to one or two particular treatment techniques, then you may end up taking an ineffective approach and using them on a wide variety of conditions with only limited success. That saying could easily be changed to something like, "If all you have is neuromuscular therapy, everything looks like a trigger point." Very few people practice with that level of exclusivity on just one technique, but you can end up really narrowing your focus if it is not varied enough. Clients present with many types of soft-tissue disorders. In addition, one person's carpal tunnel syndrome can be very different from the next and the treatment approach for one person could be quite wrong for what is needed by someone else.
Another challenge for us if we focus too narrowly on just one or two techniques, is an over-emphasis on our lens of bias; and we all have one. The lens of bias is the way we look at client issues and the most effective way to address them. One of the best illustrations of the lens of bias concept came from an article written by Dan Cherkin and his colleagues in 1994. The article was titled, "Physician Variation in Diagnostic Testing for Low Back Pain. Who You See is What You Get."1 They found variation in the diagnosis of low back disorders depending on the practice and theoretical focus of the physicians; the lens of bias. We look at various pain complaints and treatment strategies differently depending on this lens of bias that is structured by what we have studied and practiced.
Match the Physiology
The second key component of this system is matching the physiology of the tissue injury with the physiological effects of the treatment technique. In order to choose the most appropriate treatment technique, we must understand the specific physiology of the pain or injury complaint. We must understand WHY we do the things we do. That means we also have to understand the physiological effects of our massage techniques. Over the years, I have heard some very interesting (and inaccurate) descriptions and explanations of what certain massage techniques were supposed to be doing (physiologically) to the client. If we base our treatment choices on inaccurate physiology, we may be far less effective. But we could also end up doing something that is detrimental and contraindicated, or even end up hurting the client as a result.
Take a look at how this might play out in a clinical situation. Suppose you have a client that comes in with lateral forearm pain and weakness. After going through an interview with the client, you decide to treat the client with deep friction massage to the proximal wrist extensor tendon attachments at the lateral epicondyle. After several weeks of treatment, the client reports that the condition appears to be getting worse.
You might wonder why the deep friction massage was not working in what seemed to be a classic case of lateral epicondylitis (tennis elbow). Further consideration of the physiology of the injury condition and the physiological effects of the treatment technique suggest what might be wrong. Suppose in your initial evaluation you didn't identify weakness in the wrist extensor muscles and note that the pain at the elbow was mild compared to the way it usually presents with lateral epicondylitis.
The client might actually be experiencing radial nerve entrapment in this region, which is a condition also known as "resistant tennis elbow" because of the way its symptoms mimic tennis elbow. You might be applying deep friction to a nerve entrapment disorder and making it worse. Instead, it would have been more appropriate to have identified the source of the client's disorder as a nerve entrapment problem and consequently your treatment choices would have changed and emphasized methods that would help reduce compression on the radial nerve.
Effective clinical massage is a comprehensive practice and having a systematic method for addressing assessment and treatment is at the root of clinical success. If you begin to pay much more attention to WHY you do the things you do and make sure there is a good physiological rationale for each treatment strategy, you are likely to see much greater success in your client treatments.
Click here for more information about Whitney Lowe, LMT.
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