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Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Syncretism: Acupuncture and Public Health in Cuba
"Syncretism" is defined as a union of diverse tenets or practices. On a recent trip to Cuba designed to demonstrate the integration of Traditional Medicine and biomedicine, our group witnessed this union firsthand.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
July, 2012, Vol. 12, Issue 07
An Introduction to TDR Massage: Focus on the Hand
By Linda LePelley, RN, NMT
Tissue Density Restoration (TDR) Massage is based on the theory that musculoskeletal pain and dysfunction increases in direct association with an elevation in tissue density (TD). As the density of affected tissue is reduced, pain is reduced and function improves.Through the processes of determining the locations and grades of elevated TD and then treating them with TDR Massage, or any other effective massage method, one is able to compile relevant data that is useful for assessment, planning of care, evaluating the effectiveness of the care given, as well as sharing and retaining that information through documentation.
After seeking treatment for severe hand, wrist and arm pain, and undergoing tortuous electro-diagnostic testing, my neurologist diagnosed me with Carpal Tunnel Syndrome. He predicted that failure to undergo bilateral hand surgeries would result in loss of the use of both my hands within a year. Because I was hesitant to risk surgery, I made the informed decision to put off scheduling the operations for a few weeks. I created a plan of care for myself, the result of which was the development of TDR Massage.
TDR Massage adheres to the same contraindications, follows the same distal to proximal pathways and uses many of the same basic movements of classic massage. It differentiates from other modalities in its meticulous nature and focus, and because of the protracted amount of time often required to facilitate change in the condition of the tissues. It is, however, time well spent. In my opinion, a good, relaxing, full-body massage takes about an hour. TDR Massage literally "zooms in" on the locus of discomfort and stays there until a change has been affected. It can take 30 to 45 minutes of focused work to attain the condition required in the tissues to be able to achieve that change. It is unreasonable to expect a significant or lasting improvement in dense tissue to occur, and get a full body massage within the same hour. It is for this reason that many people, even massage therapists themselves, are unaware of the profound transformation they are able to facilitate, and look upon therapeutic massage as a feel-good but temporary measure. Beneficial and measurable changes in the tissues take place, given enough time to do so. One would not expect to have an orthodontist remove braces after a month, or to have the cast of a broken limb removed after a couple of days. Elevated TD develops over time, and time is required to change it.
My reasons for introducing TDR Massage by focusing on the hands are three-fold. First, I want to show massage therapists that TDR Massage is an effective modality. The second reason is to demonstrate uniform documentation which clearly exposes outcomes and the third reason is so massage therapists have a great need for hand care and maintenance. A treatment that your client appreciates is good - a treatment that you know works well and you have experienced firsthand is great – and a treatment you can prove effective is, of course, priceless.
Mapping Your Progress
It is important to create a record of the condition of the tissues before administering TDR Massage. This documentation gives you, "before and after" information, which makes it possible to evaluate the outcomes of treatment and share the results. Also, it serves as a reminder of the initial severity of the condition, something people often forget once relief has been attained. Draw a TD map by using a simple diagram of the front and back of your hands and forearms up to the elbow. You are going to closely inspect each of them and record your findings on the diagram, making any additional notes you believe to be relevant.
There are guidelines for the procedure of TDR Massage, and sound reasons for them. In this introduction, I am limiting myself to discussing the basics of what you need to know to restore your hands. The most important principle of TDR is to stay at or below about a 3 on the 1-10 pain scale, whether you are examining the condition or providing the treatment. Never go over a 3, as pain is counter-productive and initiates or extends the inflammatory response which exacerbates the condition.
Using the fingers of one hand, begin your examination of the other. Applying what you consider to be moderate pressure, press into each millimeter of every spot from the tips of your fingers and work your way to the end of your elbows. I have found that normal, healthy tissue does not hurt when you press into it, even firmly. Use whatever symbols are meaningful to you and mark your TD map with all you find. Be sure to include the pain levels (I find the basic 1-10 scale very helpful). You may discover areas that have nodules, gristly sensations, skin on bone, lumpy areas or places where the tissue is hard and rubbery. Document these, and any other findings, even if they are not painful. You will want to roll your finger or thumb around over the tips of the fingers, press into the webbed area between your fingers, pinch the sides of the fingers and bend each joint as you check it. With your hand laid flat, press over each fingernail to search for hidden pain spots. Make note of any cracking or popping, restrictions or hesitations in movement. Work your way to the palms, press into and roll around on each bone in your hand. Don't forget the lateral aspect of the hand between the ulnar head and small finger. Be cautious on the backs of your hands to avoid bruising, and do not use excessive pressure over the carpal tunnel. In the same thorough manner, work your way to the elbow, leaving no spot unchecked. You now have a basic, "before" picture.
You will want to prepare your work area, which should be comfortable and warm with no drafts, and you may want to heat any cream or oil you plan to use as well. Start by soaking your hand and forearm up to the elbow in very warm water for a few minutes, dry thoroughly with a warm towel, moving all the tissues around the bones. While you may not progress far from the fingers and palm in the course of the initial treatment, you still want the lymphatic pathways open to facilitate the clearing of debris and to encourage circulation.
Place your finger or thumb on the tip of the digit you are starting with; press into it, move the tissue around and search for any tightness, tingle, twinge or pain and using your TDR map as a guide. When you find a "bad" spot (tender or painful), massage it gently but firmly, as if you are trying to reach and move the periosteum of the bone underneath it. Take whatever time is required to work until the pain is gone. Remember the rule, keep any pain level around 3, and then just keep doing it until the pain melts away. You will find that there can be extreme differences in the level of pain from one spot to the next, often a barely measurable distance away. You will need to adjust the pressure and force you use to account for those different levels. Use the finger or hand that is being treated to assist by flexing, extending and resisting; helping hunt down and clear out the smallest pain points. Once that first spot is restored, move over a millimeter, find the next spot and repeat until you are done. Every now and then, shake your hand. Use a warm towel to grasp the area you are working on and gently move the tissue all around in wide, generalized, circular motionsas this helps reveal tender or painful spots. Be sure to work the cartilage of every joint. Our thumb joints and the base of our index fingers are, of course, usually the most affected. I chose to treat them each session for a short while, but then moved on to areas that were not difficult. My thumb pad took the longest to clear, and while the rest of the hand stays good for months, it is this area that requires the greatest maintenance. I've found it to generally be the case for others as well. You will find that every spot that hurts is denser than those that do not hurt, and every dense spot that is restored stops hurting. This is not to say that every dense spot hurts, however, given enough time, they likely will.
You may find areas that seem to be skin over bone, with little or no flesh involved. Press gently into them and massage over the bone, particularly at the margins where there is palpable muscle or connective tissue below the skin. Assuring that the muscles of the forearm are plump and easily mobilized can have a dramatic improvement of hand strength. Excessively tight musculature needs the same close attention. People say, "Well, at least I'm firm," when in actuality, the tissues are condensed and often have experienced a loss of strength and flexibility. You may be surprised to find that hard, knotted, ropy muscles will plump back up with warmth and massage. By doing so, not only are the muscles improved, but drainage pathways are restored as well.
The amount of time required to complete the TDR varies from person to person and seems to be determined in large part by the length of time the TD has been elevated. I found the treatment made my hands feel better in just a couple of days. Within a week I knew it was going to work so I cancelled my appointment to schedule the surgeries. After about six weeks of daily treatment my hands were not just better, they were as good as they had ever been. By this time, I'd learned that every pain or discomfort has a relative degree of elevated density associated with. I've gone on to treat several different hand problems, such as trigger finger, tendonitis, and arthritis with the same good results. I make it a policy to teach my clients how to maintain their improved hands or feet.
While I have not gone into advanced assessment and treatment methods at this time, there is enough information provided here to make a positive, lasting change in the condition of hurting hands. You will want to map and document your progress and the final results.
So often we've heard arthritis described as, "Degenerative Joint Disease," but I believe that rather than a disease of degeneration, it is actually an affliction of accumulation. I look at the x-rays of hands, crippled by arthritis and see that while the involved cartilage and soft tissue has become overgrown and gnarled, the individual bones retain their shape and appearance within the ghostly white, cloudy images. I am convinced that when these bones become dislodged and dislocated, with catastrophic deformation and loss of function, it is due to the tension exerted upon them by the buildup of mineralized plaque, coupled with contracting fascia. That which appears to be "bone-on-bone" degeneration of cartilage is actually a hypo-hydrated crust, the restoration of which can result in the return of normal joint articulation, relief of pain and return of mobility. I believe the crust of arthritis, considered to be an overgrowth of bone, is in actuality a sort of plaque which, over time, accumulates an aggregation of minerals and eventually becoming hard and bone-like. However, this formation is based on a plaque-like matrix and plaque is about 60% fat, which melts. Using warmth and focused, persistent massage, the plaques melt away and the minerals dissolve and are flushed away with the tissues re-hydrated and restored to normal function.
While most operations are necessary and indispensable, it seems inappropriate to risk surgery or take a surgeon's valuable time for a condition that is manually treatable. Massage should be the first line of treatment for carpal tunnel syndrome, trigger finger and Dupuytren's Disease, rather than a last ditch, "I'll try this because I've tried everything else and it didn't work," approach for these and other non-trauma related hand disorders.
Linda LePelley, RN, NMT is a registered nurse and licensed massage therapist with 19 years of clinical massage experience. She developed Tissue Density Restoration (TDR) Massage, an effective treatment for the pain found in hyper-dense tissues. For more information, visit www.MyHealingHands.com.
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