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The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
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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