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Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
November, 2012, Vol. 12, Issue 11
Practice Building with Self-Care Tips
By David Kent, LMT, NCTMB
Our patient's lives are affected, on many levels, by their pain. They spend a lot of time and money receiving treatment and are looking for the best return on their investment. Building a successful practice that stands out from your competition includes providing self-care tips.Patients need to know how to care for themselves between treatments. They appreciate, respect and recommend your practice when you deliver useful information that is easy to understand and implement into their daily lives. Here are some suggestions for delivering self-care tips. I have also included links to video clips that discuss these concepts in more detail.
After a cleaning procedure at a dental clinic, the hygienist provides a new toothbrush with samples of toothpaste and floss with patient self-care tips. They explain and demonstrate proper techniques for brushing and flossing (See image 1). The hygienist also stresses that implementing these simple recommendations will prevent costly oral disease, pain and medical procedures. They finish by giving you the samples, collecting payment and scheduling the next appointment. This is a time proven practice-building model in the healthcare profession. (Read "Practice Building: Getting Inside Your Patient's Head," MT, January 2011).
Patients often ask their massage therapist for advice or guidance pertaining to self-care. Just like a dentist or other healthcare provider, you can easily provide cost effective self-care tips. However, you can only make recommendations within your legal scope of practice, so stay current with the laws.
Treatment can be more specific when patients are assessed and educated about their postural patterns, restricted joint range of motion, myofascial trigger points and how they cause pain (see image 2.) Poor posture and improper biomechanics while walking, running or performing any repetitive movement can perpetuate or reestablish a patient's pain. These patterns develop over hours, days, and years from holding in positions that caused some myofascial tissues to habitually stay shortened and others lengthened. Other activities that contributes to poor posture in today's modern world include a lack of physical exercise, being overweight, sleeping on one side or supine with a pillow under the head and knees, sitting the majority of the day while eating, driving, at a desk or computer, watching TV, etc.
With the digital camera built into an iPhone, smart phone, tablet or iPad, you can instantly take postural analysis photos and gait videos. No special software is needed, just the camera built into the device. Zoom-in on photos and show patients their forward head and high shoulder posture (see image 3). Play the gait video, assessing the positions and movements of the lower and upper extremities. This level of education leaves a lasting impression of your ability to quickly identify the musculoskeletal cause of a patient's pain while instantly providing visual evidence of your objective findings and how it supports their subjective complaints. A picture is worth a thousand words so show each patient the myofascial causes of their pain, then explain how your treatments and self-care tips can help. (Read "Practice Building with Postural Analysis," MT, January 2012).
Patients are more likely to implement self-care tips that are simple and easy to make a part of their daily lives at home, work or when traveling. Every patient has unique challenges and they must individualize their own self-care routine. Explain what muscles and joints are being stretched, where they are located and why restoring proper movement helps their symptoms improve. To establish and maintain proper posture, gait and other movements the muscles throughout the body must be able to completely contract, relax and lengthen. The cervical, thoracic and lumbar spine must flex, extend and rotate. The ribs should move with breath and each scapula fully retract, protract, elevate, depress and rotate on the rib cage. All of the joints in the body need to properly move as they are designed.
As a visual aid, I use videos, anatomical models and even a slinky, to help patients understand the movements that take place throughout their vertebral column and rib cage. Next, I show them the movements I perform daily to maintain good postural and normal range of motion in the joints throughout my body. I am able to communicate to my patients with first hand knowledge and experience. I show my patients how I stretch, depending on the environment, sitting on a chair or standing holding onto a desk, table or counter top.
I demonstrate how I use an exercise ball throughout the day to stretch and maintain good range of motion (see images 4a and 4b). I also mention how to select the correct size, safety tips and major differences between the various types on the market.
My schedule is busy and changes frequently. I downloaded a yoga application onto my iPhone and now I have a variety of 20-minute routines with me anytime, anyplace, at home, between treatments or when traveling. I integrate yoga into my self-care routine and share how it helps both physically and mentally.
Patients often do not know how or when to use ice. This is a perfect opportunity to provide self-care tips that are simple, cost effective and set your practice apart from the competition. Review the importance of a towel between the ice pack and skin, indications and contraindications. Create a fact sheet about the use of ice to give to your patients.
For patients with acute soft tissue injures, I show them helpful tips for applying ice. I freeze water in 9-ounce cups to create large ice cubes. I keep them handy in the freezer at the clinic or in a cooler when on out calls. This size allows for application on large or multiple areas.
So the patient can conveniently start ice applications, I send them home with a few 9-ounce ice cubes by placing the ice in a freezer strength (Zip Lock) plastic bag.
Ice is extremely beneficial, but not always a practical option. Many people find topical analgesics helpful for providing relief of their symptoms.
Medical doctors give patients samples of drugs. You can provide samples of topical analgesics. One company will supply you, free of charge, patient education brochures with your name and phone number printed on them with a sample packet of the topical analgesic attached. This is a free way to promote your business. Topical analgesics sell for a fifty percent profit and are great way to increase your income. Place a counter top display case of the product in your treatment room and checkout counter. Also take a counter top display when preforming chair massage or at public events like health fairs.
The economy today does not allow people to miss work or lose income. They need treatment that is cost effective and provides long-term solutions. I hope this article showed you how to take the best from the dental model and redesign it for your practice. Give every patient the gift of knowledge and standout from your competition. Teach them how to care and maintain their bodies to avoid pain and unnecessary emergency treatments. Educate them on posture, gait and self-care tips. Give them a gift bag, just like the dentist, with sample packs of the topical analgesic, ice cups, recommendation sheets and your business card with the date and time of their next treatment. Good luck and I wish you success.
Editor's Note: Check out this exclusive practice building video from David Kent: www.youtube.com/playlist?list=PLVpoWkt4aQvK9mUJNL_OMZ9zEIZqutwC9
Click here for more information about David Kent, LMT, NCTMB.
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