resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Latest Cassidy Study on Stroke Risk Published
The latest study to investigate whether a unique association between chiropractic manipulation and risk of cervical artery dissection / stroke exists has yielded similar encouraging findings, with the authors noting "no excess risk of carotid artery stroke after chiropractic care" and no significant risk difference between patients receiving care from a DC or a primary care medical provider.
Correcting Rib Dysfunction: Improve Patients' Pain, Posture and Breathing
As chiropractors, we tend to focus on the spine, and rightly so. Many problems our patients face can be corrected by manipulating the correct spinal level.
House Calls With Dad
My father was a chiropractor and he did house calls. On Wednesday nights, while my mother attended the weekly women's meeting at the Odd Fellows and Rebekahs hall in our small town, dad loaded up the portable adjusting table, fired up the Pontiac and drove off to treat a few patients in their homes. I went with him.
Chiropractic in Texas Is Under Attack
The profession of chiropractic faces an unprecedented challenge in Texas, an attack that is more aggressive, sustained and dangerous than anything previously seen. The medical lobby has launched a coordinated, multi-front assault.
Advancing the "Whole Organ" Spine Model
Historically, the human spine has been organized by body region utilizing specific anatomical landmarks and transition zones.
Gather & Grow
I recently attended a faculty seminar held by one of the acupuncture schools. There was a facilitator who led us through some very interesting experiences. The attendees were a diverse group with varying opinions.
Getting Unstuck: Healing From Trauma With TCM, Qigong & Movement
We all come into this world vulnerable, with seeds to grow into our strength. Some of us — through a combination of good fortune (i.e., family and culture we are born into, constitutional inheritance, or ability to learn) grow with minimal interruption from traumatic injuries and experiences.
The Acupuncture Channel System (Part 2)
The primary channels (main channels) are introduced in chapter 10 of the Ling Shu, these channels are referenced in many chapters throughout the Su Wen and the Ling Shu. The primary channels have become the main channel system used in TCM.
Helping Patients With Parkinson's Disease
Parkinson's disease (PD), a long-term degenerative disorder of the central nervous system that mainly affects motor function, has a slow onset over time.
TCM & the Caregiving Population: Treatment Considerations & Our Vital Role
Informal caregiving is increasingly a reality for many Americans who find themselves providing unpaid care for a loved one or a family member with a long-term, terminal, or chronic illness.
Treating the Lower Pelvis (Pt. 2): Midline Structures and Fascia
My previous article [October 2016 issue] outlined evaluation and treatment of pelvic issues involving the sacrotuberous ligament and the pubic symphysis. Now let's discuss two case studies that illustrate how to address additional problematic areas of the pelvis.
VF Works / DMX Works Epilogue: Almost Two Decades Later, the Lawsuits Continue
An article in the March 8, 1999 edition of Dynamic Chiropractic examined whether then-VF Works / Nu-Best Franchising was selling its franchises illegally to doctors of chiropractic.
Spiritual Initiation: Opening Your Higher Healing Abilities
People drawn to the field of acupuncture and Oriental Medicine tend to be those who march to the beat of a different drummer.
ICA Goes on the Vaccine Offensive
Have you watched the vaccination documentary, "Vaxxed: From Cover-Up to Catastrophe," by Andrew Wakefield MD, director, and Del Bigtree, producer? This is the documentary Robert DeNiro was pressured to remove from his Tribeca Film Festival.
Paperwork Done Wrong, Done Right
I was visiting a doctor's office recently and a member of his staff brought a stack of forms to his private office and laid them on the doctor's desk. She informed him he needed to complete the forms for patients and a few third parties.
A Brief History of Acupuncture and Oriental Medicine Doctoral Programs
A doctorate in acupuncture and Oriental medicine has been a goal of the profession since its beginnings in the late 1970s. At that time, however, the maturity of the educational institutions and the regulatory environment made it a goal with only a distant completion date.
Near-Infrared Therapy for Diabetic Neuropathy
The pain experienced by people with diabetes is a symptom of diabetic neuropathy. The impact on quality of life is significant. Pain makes walking difficult, sleep troublesome, and eventually contributes to a decrease in social interaction.
4 Things Every DC Should Know About Levels of Care & Prevention
As health practitioners, we help people with their health problems and assist them with health promotion and disease prevention.
AOM Residency at NUNM
Imagine you're a recent acupuncture graduate, worried about making enough income as you forge your new career and seek more in-depth training in a particular treatment style.
Waist Circumference: A Conversation Starter
New estimates suggest more than two-thirds of Americans are either overweight or obese. The medical significance of this statistic is astounding.
News in Brief
The American Association of Acupuncture and Oriental Medicine (AAAOM) board members recently met with the Korean Customs Service, which is similar to the FDA, to discuss herbal safety and importation issues.
The Large Intestine Official
The large intestine (AKA colon) is the great eliminator, or as J.R. Worsley called it, "The Drainer of the Dregs." Dregs are defined as the remnants of liquid with its sediment left in a container, or the basest, least valuable portion of anything.
February, 2013, Vol. 13, Issue 02
Fear Avoidance and the Issue of Chronic Pain
By Nicole Nelson
According to the American Pain Foundation, an estimated 50 million Americans suffer from chronic pain each year. Let's take a closer look at those suffering with chronic non-specific pain (CNSP) and explore how fear may be partly responsible.Specifically, this discussion will attempt to shed some light on how fear might perpetuate the pain experience without the presence of any musculoskeletal problem. Although the pain these clients feel is very real, it is distinct from those suffering from biophysical causes of pain, such as infections, tumors, osteoporosis, spondyloarthropathies and stepping on a nail.
Current understanding of pain neuroscience suggests that pain is a multi-dimensional experience that involves sensory, emotional and cognitive components.3,13,18,21,26-28,32 Likewise, the way the brain interprets and processes these components can vary pain intensity. It seems pain may involve more than structural problems, making our job as massage therapists a bit more intricate than addressing leg length discrepancies or elevated shoulders. A review of more than 900 studies involving back and neck pain concluded that psychological factors play a significant role, not only in chronic pain, but also in the etiology of acute pain — particularly in the process of transition to chronicity.13
The Fear Avoidance (FA) model, originally presented in the early 80's, is a psychological model that accounts for why certain clients may make the leap from acute to chronic pain. FA suggests that it is overly fearful individuals that wind up suffering with chronic pain, to the degree that they avoid seemingly benign movement patterns so as to protect themselves from further pain.23 The model theorizes that there are essentially two pathways an individual can take after suffering from an incident of acute pain. The first and more functional pathway suggests the individual perceives the pain as a non-threatening experience, daily activities are likely continued with a reasonable level of protection and a functional recovery ensues. The other path involves catastrophizing, where the individual perceives the injury as very threatening and develops a "worst case" outlook.4,7,21
According to the model, the nociceptive system becomes persistently active which leads to an extension of pain beyond the time frame of normal tissue healing. The worry associated with doing more harm leads to an avoidance of activity which can eventually cause further de-conditioning, and in severe cases, depression and isolation.30,32 In essence, these clients have lost confidence in their body's ability to withstand a physical challenge to the area they associate with their pain. Multiple studies have set out to examine the relationship between pain-related fear and it's potential to increase pain perception and delay recovery.2,3,12,32
The researchers have found some traits among those that exhibit fear avoidance:
So, how do we apply this knowledge to an actual client? By recognizing those with fear beliefs and behaviors, we can tailor our suggestions and therapy accordingly. Above all else you must help fearful clients understand that they are not helpless victims of pain, rather they are active managers of pain and do have a great amount of control.26,31 Generally speaking, this includes exposure to current biopsychosocial pain theory, getting them to move better, more often, as well as including positive lifestyle changes such as improving nutrition, reducing stress and optimizing posture. The list below includes a few specific ideas collected from the literature that will help shape your treatments to those exhibiting FA and experiencing CNSP. This list is hardly exhaustive, but should serve as a jump off point for you to study and explore treatment ideas which will complement traditional massage methods.
First, seek out the right practitioner. After bouncing around from practitioner to practitioner looking for answers, your FA/CNSP client is probably feeling extremely anxious about the source of their suffering and is starved for an explanation. If this is the case, help them seek out pain specialists that utilize a comprehensive treatment approach which incorporates cognitive behavioral therapy (CBT). This network of professionals will help your client realize that their pain is not necessarily a tissue problem, but one that is perpetuated by an interaction of physiological and psychosocial factors.
Cognitive behavioral therapy (CBT) attempts to alter FA behaviors, emotions and beliefs.22,31 This is commonly done through teaching the impact that thoughts and emotions have in maintaining pain as well as teaching stress management techniques, problem solving, goal setting and activity pacing. CBT can be performed in a group setting to reduce costs and allow the therapist to share successful cases of alternative thought and behavioral patterns from other group members.
Second, try to encourage meditation and mindfulness. It is believed that catastrophizing accounts for 7% to 31% of the variance in pain severity.26 Improving the client's mindfulness has been shown to be an effective approach to pain management, likely by interrupting the thoughts of a doomed outcome.6,16,17,27 Mindfulness has been defined as, "awareness that emerges by way of paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment." Proponents of practicing mindfulness exercises, such as mediation, theorize that a mindful state is mutually exclusive of one that is busy catastrophizing, which involves interpretation, conceptual processing and judgment.27,28 Simply put, when one is mindful, one cannot have a doom and gloom outlook.
The third concept to keep in mind is that hurt does not mean harm so encourage them to move. One must consider that well intended medical professionals that are unfamiliar with psycho-social and behavioral perpetrators of pain, may have actually exacerbated your client's fears about movement and exercise (i.e. "let your husband carry your purse, it's too heavy for you" or "be extremely careful when getting up.") Naturally, flare ups as a result of too much activity is a legitimate concern for many with chronic pain; however, exercise has repeatedly been shown to be an effective pain management strategy.1,5,10,14,25,29,33 It is worth mentioning that these clients will feel discomfort when increasing their levels of activity, particularly when they have been leading sedentary lives. That said, a graded exercise plan is indicated and should be encouraged as the client will eventually adapt to increased levels of activity. I generally advocate clients begin this process by consulting with an individual with clinical exercise experience. If they are apprehensive about this idea, suggest they perform something they enjoy doing, perhaps walking (de-conditioned clients might do best by walking in a pool.) Recommend they walk 3 to 4 days per week for a length of time and speed that is challenging but not exhausting. Propose they add five additional minutes to their walk each week.
It is widely accepted that chronic pain sufferers exhibit deficits in proprioception.19 It has been observed that chronic back pain patients no longer consider their back as being a part of them and do not feel that the back can be controlled automatically.18 Lorimar Moseley's research has shown that sufferers of chronic low back pain have been found to have difficulty delineating the outline of their back when asked to complete a drawing of "how it feels."12 It is also possible that the varied alterations in trunk muscle recruitment patterns evident in CNSP patients may be a manifestation of a disturbance in body perception.8 Moseley and the NOI group have also shown that people in pain often lose the ability to identify left or right images of their painful body part(s).
This research suggests that the brain has an altered image of itself. One way to help your client gain a more accurate picture of their own body is by performing right/left rolling patterns, similar to how a baby begins the movement experience. Rolling, is not only a movement strategy that is believed to improve proprioception, mobility and core function, but it is a great assessment tool to see where you should direct your soft tissue work.9 As your clients perform these movements, keep an eye out for any lack of symmetry between rolling from right to left and left to right.
There are four basic rolling patterns.
It is well documented that those suffering with chronic pain also have poor breathing patterns.11,19,24 It stands to reason that better breathing habits will yield a more functional core by improving diaphragmatic motor control and will also help in relaxing the client, thereby making it a very useful strategy in FA/CNSP cases. Learning to evaluate and correct poor breathing habits is an extremely important skill. I highly suggest Leon Chaitow's book, Multidisciplinary Approaches to Breathing Patterns Disorders, for further information.
Progressive muscle relaxation
PMR is an excellent way to reveal to the client that they are holding unnecessary tension within their muscles. Have your client either seated or lying on the massage table. After beginning with several deep breaths, instruct your client to alternately tense, hold, and then relax groups of muscles in his or her body. Direct your client's attention to the sensations of tightness felt while contracting and tensing the muscles. Your client's awareness should be dialed into the sensations of warmth, heaviness and relaxation in their body, as they review each muscle group individually, spending some additional time on problem areas. Instruct your client to perform this technique at home two to three times per day or at moments when they are feeling stressed or are about to perform an activity that they associate with pain.
The pain experience can be more complicated than just a physical problem. FA can perpetuate pain, limit activity, lead to further de-conditioning and ultimately lead to depression and isolation. Although great bodywork will be hugely beneficial to your FA/CNSP clients, a comprehensive treatment approach involving CBT might be necessary. Likewise, this specific set of clients must realize that they are not passive in this process. Meditation, better breathing habits and exercise are all terrific ways your clients can regain a sense of control over their pain.
Nicole Nelson a licensed massage therapist in Jacksonville, Fla. She has a masters degree in Health Science from the University of North Florida and is a certified Advanced Health and Fitness Specialist through ACE.
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